Dry eyes can be painful and unrelenting and is a very common chronic condition in most adults throughout Colorado. Over-the-counter treatments are adequate for many, but some will find improved comfort and sometimes vision with specialized treatments done around the eyes. Springs Aesthetics offers novel treatments to help with this frustrating condition in Colorado Springs, Denver, Castle Rock and other areas of Colorado.

What is Dry Eye & Why Is It Important?

As we age, our eyes become more susceptible to dry eye issues. The healthy, youthful tear film has 3 key components: aqueous; mucous; and a lipid layer. They are all important for differing reasons. The aqueous (watery) component is essential to ensure adequate tear volume to disperse and cover the ocular surface, and to keep the balance of other component ratios. Colorado Springs is a high altitude, arid environment. This exacerbates discomfort from dry eyes. Most adults in Colorado have some degree of dry eye even if they don’t know it.

Dry eye symptoms can range from: intense sharp pains; irritation; blurred vision; ocular redness; mucous-like discharge; morning crusting; and even excessively watery eyes.  Excessive tearing of the eyes can be from an underlying unhealthy tear film or deficient tear film state.  The tearing is reflexive because of these deficiencies.  This can be confusing to some patients, but the analogy that quantity doesn’t supersede quality is helpful.  An easy example of this is that you can a car gas tank with water, but it will not make the engine run even though the tank is full.

There are various forms of dry eye treatment to include: standard over-the-counter lubricating artificial tears; tear-film targeted artificial tears (e.g., oil deficient states); more recently lubricating artificial tears with small amounts of brimonidine (Lumify) that reduces red eye much more safely than the eye drop vasoconstrictors (Visine); anti-inflammatory prescribed drops to improve tear production (Restasis, Xiidra); closure of the outgoing (off the eye) tear drain openings (punctal plugs or cautery); as well as ocular lubricating ointments.

Helping dry eye patients is very rewarding for Dr. Burroughs as he has had clinically significant dry eyes for over 16 years that he became aware of upon moving from humid Florida to the drier climate of Utah.  Most all eye doctors (Ophthalmologists or Optometrists) are knowledgeable and prepared to make specific suggestions to patients with dry eye.

What Are Some Helpful Non-Standard Dry Eye Treatments?

Intense pulse light treatments have been gaining momentum for several years.  Dr. Burroughs was amongst the first to offer IPL treatments for his patients suffering from oil deficiency dry eye states.  The IPL treatments can loosen and help mobilize the “constipated” oil that come from vertically oriented upper and lower eyelid oil glands.  Warm compresses simply aren’t sufficiently helpful in many patients to reliever their symptoms or are hard time-wise to comply with.  Newer lid-forming goggles are now available to help with this approach, but they still must be used daily and oftentimes several times a day.

Some oral antibiotics (e.g., doxycycline) prescribed at “anti-inflammatory” as compared to anti-infective doses have been helpful to loosen these oils out into the tear film, but they typically require long-term use, and many patients don’t want to be on long-term antibiotics.

Radiofrequency Forma treatments offered at Springs Aesthetics can help thoroughly loosen the thickened eyelid oil glands to better be secreted into the tear film.  These are done on a weekly basis, and take about 15 minutes.  They are not painful, and can be very helpful for some patients.

Dr. Burroughs, as an ophthalmic subspecialist, offers IPL (intense pulse light treatments) that when appropriate protocols are followed be safely performed to yield amazing results. Touch ups may be needed as necessary. These treatments must be carefully performed to avoid an eye burn and long-term injury.  Safety shields (laser shields) are directly applied to the ocular surface to cover and protect the eye.  The treatments are performed in under a few minutes once the shields are in place.  There is no downtime, but the vision may be blurry for a few minutes to an hour because of the ointment used to protect the eye during placement and removal of the laser eye shields.  Best results are obtained with a 3 treatment series performed every 3-4 weeks.  Most patients with oil-deficient dry eyes will start experiencing improvement after the 2nd treatment in the series.  Results can last months, but are best obtained with periodic re-treatments every 2 to 6 months.  The IPL treatments won’t replace artificial tears, but they are very helpful for severe cases or for those that have trouble remembering or applying artificial tears.

Springs Aesthetics also offers medical-strength lid hygiene solution (Hypochlor) for at home use.  The Hypochlor solution is sprayed onto a cotton makeup pad.  This can help dry eye patients because a healthier and cleaner eyelid margin helps the eyelids properly blink, not get foreign material onto the eye surface, and keeps the surfaces of the oil gland openings clear.  Some patients get a build up of bacteria or even mites (Demodex) on the lid margin and eyelashes that can exacerbate dry eye and irritate the eye in and of itself.

BlephEx is a medical device that thoroughly cleans the eyelids and eyelashes from built up discharge, bacteria, presence of mites, old makeup, and dead cells.  It is like a professional teeth cleaning but for your eyelids.  It uses a special foam tip and solution that is applied with a rapid rotary movement to thoroughly cleaned the eyelids and eyelashes.  Treatments typically take about 10 minutes, and there is no downtime.  Many patients feel immediately better after a treatment.  Blepharitis is inflammation of the tear film and has several causes, but at least 50% of individuals with blepharitis also have dry eye syndrome.

Periodic treatments with a “meibomian” clamp by an ophthalmologist to squeeze the oil contents out of the lid margin openings.  This can be helpful, but never works well by itself.   It also can be quite uncomfortable. Other fat liquefying and loosening approaches are also necessary.  The oil glands to be compressed effectively have to have some loosening of the thickened oils within the glands.

Lipiflow is a novel treatment approach for posterior blepharitis where the oil glands are thick and “constipated.”  It uses a massaging heat device that goes on the outside and inside of the eyelids.  These treatments have to be performed at an eye doctors office.  Many patients have had significant improvement while others have had minimal or short duration of improvement.  It is a very costly procedure that requires periodic costly re-treatments.  Dr. Burroughs researched this technology, but felt it didn’t provide sufficient improvement at an affordable cost.

What Is the Importance of Managing Dry Eye In Regards to Cosmetic Surgery or Appearance?

Our eyes are the predominant first feature that other see when they are meeting, greeting, or seeing us.  Red, irritated eyes can give a wrong impression of someone that is unhealthy, has slept poorly, or may even be on drugs.  Red eyes often portray anger when others see it in you.

Surgery of the eyelids and even the face can impact proper eyelid closure.  This can impact the normal function of the eyelids to properly cover the eye surface and evenly spread the tear film across the surface.  Also if your eyes are dry before eyelid surgery they will almost always worsen after surgery.  This worsening is often temporary and can be managed conservatively with judicious use of artificial tears/lubricants.  However, some patients can have significant discomfort from postoperative dry eyes and visual problems from a tear film deficient state on their corneas.

Temporary weakening of the eyelid muscles from surgery is common, and this can cause some temporary incomplete closure of the eyes during blinking or even while sleeping.  Sutures may further tighten the eyelid skin further exacerbating the problem of inadequate eyelid function and closure.

With an ophthalmic background, and the necessary slit lamp equipment, Dr. Burroughs evaluates for dry eye in each of his eyelid surgery patients even if symptoms aren’t currently present.  If symptoms and concerning corneal finding are present then more conservative surgery should be performed.  Furthermore, patients need to be counseled to expect this so they can manage it well at home.  At times, Dr. Burroughs will perform adjunctive eyelid surgery procedures to improve and maintain eyelid closure function following surgery.  Additionally, he is skilled at closing the outgoing tear drain holes, which helps slows tear drainage off of the eye keeping them more moist.

As described earlier, Dr. Burroughs and the Springs Aesthetics team have multiple treatments to help dry eye that are not available at most plastic surgical practices.  He is also an expert at diagnosing and managing dry eye should it be present to ensure the best opportunity for a safe eyelid surgery outcome.

Blepharitis can be painful and unrelenting.

What is Blepharitis?

Blepharitis is a painful and chronic condition that can worsen over time if left untreated. Aesthetic plastic surgeons, such as Dr. John R. Burroughs of Colorado Springs, regularly see patients with blepharitis suffering effects such as itchy eyelids, sensitivity to light, red and swollen eyelids, watery eyes, burning sensation in the eyes, flaky or scaly skin, and crusting of mucus around the eyes. Blepharitis is very common. A study in 2009 showed that ophthalmologists noted that 37 percent of their patients had the condition and that optometrists reported that 47 percent of their patients were suffering from it as well. Not only does the occurrence of blepharitis lead to chronic eye discomfort, but there are other negative consequences as well. A study published in 2013 showed that individuals with blepharitis had significantly higher risk of anxiety and depression. DEBS patients can also suffer painful corneal ulcers that can cause scarring of their corneas and difficult to eradicate red, swollen eyes.

Is There a Cure for my Blepharitis?

While there is no cure for blepharitis, there are treatment options. Experienced oculofacial plastic surgeon specialists, such as Dr. Burroughs of Colorado Springs, had long been resigned to offering treatments such as warm compresses, antibiotics, eye drops, specialized lid scrub solution (Hypochor) and improved hygiene for the affected areas. However, a new treatment option, BlephEx, has arrived and is offering an exciting, innovative method for treating blepharitis and keeping the condition under control with regular treatments. BlephEx is a procedure that uses a patented handpiece, under the supervision of a medical professional, that uses a medical grade micro-sponge to carefully and precisely spin along the edge of the eyelids and lashes, which exfoliates the eyelids and removes the troublesome debris and bacteria. BlephEx is the first and only doctor procedural treatment for dry eye and blepharitis as it actually removes the causes of the inflammation. This new treatment option only takes a few minutes to complete and is relatively pain-free.

Dr. Burroughs notes, “Many of the patients that I see on a daily basis suffer from dry eyes and blepharitis as these two conditions commonly occur together and at a very high concentration in the dry, arid climate of Colorado. The sad reality is that there is no cure for Dry Eye/Blepharitis Syndrome (DEBS), and our treatments were not able to actually impact the root causes. However, this has dramatically changed with the introduction of BlephEx to the market. This new and innovative technology allows me to fight blepharitis directly by using the handpiece to remove the bacteria and biofilm buildup along the eyelids and eyelashes that are the root of the problem.” In addition to bacteria, many patients acquire Demodex (a mite) infestations of their eyelashes and lid margin further contributing to their dry eye and blepharitis problems. Traditionally this mite infestation has been very difficult to completely treat requiring specialized lid scrubs that could take months to improve. Because BlephEx utilizes a specialized soap that is effective for the bacteria as well as the mites, through its mechanical cleaning and debridement of the biofilm buildup, allows a more thorough approach that lasts for up to 6 months.

What Does BlephEx Do for Blepharitis?

BlephEx allows Dr. Burroughs to ensure that my patients no longer have to suffer the effects of DEBS ever again as long as they have regular treatments every four to six months, and these treatments only take six to eight minutes to complete. Patients are ecstatic knowing that only a combined thirty minutes of treatment per year means the suffering effects from blepharitis and dry eyes are greatly reduced. Of course, those who have suffered from DEBS for some time may require a few treatments to see an effect. BlephEx is a godsend for wearers of contact lenses as they are ten times more likely to suffer inflammatory damage to their tear glands. The condition known as Contact Lens Intolerance, in which the eye begins to reject the wearing of contact lens, can be avoided by having a BlephEx procedure done every six months. Overall, we now have a proven treatment method that targets the causes of DEBS and helps ensure its remission through regular treatments.

Is Blepharitis Bad For Eyelid Surgery?

Blepharitis can adversely affect the tear film.  This can make your eye exposure risks after surgery more serious and uncomfortable.  Severe anterior (eyelid margin & eyelash) blepharitis can increase wound infections.  Blepharitis debris can get onto the ocular surface and into a healing conjunctival incision used for a hidden incision (“transconjunctival”) approach lower eyelid fat bag blepharoplasty.  These are reasons, that both the ocular surface and eyelid health is important for comfortable and safe cosmetic eyelid surgery healing.

For more than 20 years, Dr. John Burroughs helps men and women in Colorado Springs, South Denver, Castle Rock and other areas of Colorado, as well as internationally, by providing exceptional care in plastic surgery and eyelid surgery. At his practice, he also offers medical spa treatments that are performed by his aestheticians to complement surgical results and speed healing.. To learn more about blepharitis and dry eye treatments, contact us today to schedule a consultation.