What is Dry Eye?

Dry Eye is a common disease affecting vision quality and eye comfort. Symptoms of Dry Eye can vary widely from patient to patient. People with Dry Eye may experience one or more of the following symptoms:

  • Dry, gritty, or itchy sensation

  • Stinging

  • Irritation

  • Light sensitivity

  • Visual fluctuation

  • Watery eyes

At our clinic, we use a number of different technologies to determine whether you may be experiencing Dry Eye and to better understand your symptoms. Dry Eye is a serious condition that can dramatically affect your vision and your eye health.

What Causes Dry Eye?

Dry eye can be influenced by a number of factors related to environment and health that determine tear quality.

Tears have 3 layers:

  • a mucus layer,

  • an aqueous (watery) layer, and

  • a lipid (oily) layer.

If there’s an imbalance in these layers, your vision and comfort of your eyes may be affected. For example, if not enough lipid layer is being produced, tears may evaporate too quickly and cause symptoms ranging from discomfort to extra tear production and poor quality of vision.

Poor tear quality is often caused by Meibomian Gland Dysfunction (MGD), a condition that impacts the production of oils in your tears. The most common form of MGD is obstruction of the oil-producing glands in the eyelids. At Iris Bright Optometry we will test your tear quality to determine whether MGD is contributing to or causing your dry eye symptoms and create a customized treatment plan to address it.

How Do We Treat Dry Eye?

Each case of Dry Eye is unique. We consider the factors causing your dry eye as well as your tear quality to develop a custom dry eye treatment plan.

​​​​​​​Management considerations for Dry Eye include artificial tears/lubricant drops which provide short-term relief of symptoms. Other options include prescription anti-inflammatory drops and in-office obstruction removal with medical devices like The TearCare® System.

Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017;15(3):276-283. doi:10.1016/j.jtos.2017.05.008

​​​​​​​What is TearCare®?

TearCare® is an innovative Dry Eye procedure that targets the blocked meibomian glands in your eyelids that produce oils to keep your tears healthy. When these glands become blocked or have reduced function, your tears may evaporate more quickly. Unblocking these glands with The TearCare® System can help restore their function and stabilize the tear film. This may improve the quality of tears and reduce symptoms like dryness, gritty or scratchy sensations, blurry vision, and watery eyes.

At your appointment, we will determine whether your dry eye symptoms are caused by Meibomian Gland Dysfunction (MGD) and would benefit from the use of The TearCare® System.

Screen Time and Your Vision

It’s no secret that we spend more time looking at our screens than ever before. When we’re looking at our devices, we may blink only half as often as we would normally. As a result, we may be doing damage to our tear quality. Have you been spending extra time in front of a screen lately?

At Iris Bright Optometry, we know managing Dry Eye is an important part of protecting your vision. If you experience Dry Eye symptoms like the ones shown below, including blurriness, stinging or gritty sensation, or even watery eyes, your tears may be unhealthy

​​​​​​​Schedule an appointment where we can evaluate your tear health and, if needed, talk through ways to address the root causes of Dry Eye: (949) 585-9403​​​​​​​


There are currently only 4 treatment options available on the market that are based on the tried and true method of applying heat to the lids and expressing the meibomian glands:

  1. Lipiflow® from Johnson & Johnson Vision

  2. TearCare® from Sight Sciences

  3. iLux® from Alcon

  4. Thermoflo I and Thermoflow IIx dual from MiBo Medical Group

Our office has selected TearCare® as the best treatment for our patients due to its:

  • Proven effectiveness

  • Ability to work equally well with both large or small eyelids

  • Open-eyes system which allows patients to keep the eyes open during the treatment

Other adjunct meibomian gland therapies exist but they use different pathways for dry eye relief. Most of them are based on lid debridement and/or reduction of inflammatory markers. You can find them named as: BlephEx, NuLids, IPL (Intense Pulsed Light)… etc.

Please consult your optometrist or ophthalmologist to discuss which would work best for you. Not all therapies will be available in your area or at your local eye doctor’s office.

Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017;15(3):276-283. doi:10.1016/j.jtos.2017.05.008


Normal functioning meibomian glands secrete clear oil. Clogged meibomian glands produce crusty, toothpaste-like or pus-looking meibum.

Clogged meibomian glands will make your eye easily sensitive to environmental factors such as wind, dust, air conditioning etc… Your vision won’t be as crisp because the tear film is unstable, which does not allow the light to reflect correctly and consistently onto your retina.


Studies have shown TearCare® can provide dry eye relief from meibomian gland dysfunction (MGD) for 6 months to a year. Some patients who’ve tremendously enjoyed TearCare® have asked how often they can do it. Based on their individual needs, we can do another treatment every 3 months.


Meibomian gland dysfunction, when left untreated, can have long-term health and lifestyle consequences:

  • Inability to maintain stable and sharp vision, regardless of your prescription power or the quality of the lenses you purchased

  • Constant watery eyes

  • Contact lens intolerance (you can no longer wear contacts)

  • Decrease in quality of life due to your inability to enjoy activities that are affected by wind, air, dust, air conditioning… such as biking, running, traveling by airplane or car

  • Increase frequency of blepharitis or other eye infections

  • Higher risk of complications from LASIK surgery

  • Increased monthly cost in temporary relief treatments such as eye drops, heat masks… etc

  • Tired or fatigued eyes

  • Burning or stinging of the eyes

At the beginning stages of meibomian gland dysfunction (MGD), you may not have any symptoms. As MGD progresses, your meibomian glands will have decreased function, which is when you feel discomfort and dry eye.

At its worse, meibomian glands that are left inflamed or clogged for too long will eventually atrophy (die off) and our eye doctors may not be able to revive them or bring them back.


A moist warm compress or heated eye mask functions with the same underlying principle as TearCare®:

  1. Heating the lids to liquify any clogged oil

  2. Clearing out obstructions in the meibomian glands

Though they target the meibomian gland dysfunction (MGD) root cause of dry eye and provide relief, they are less effective on both counts due to:

  • Inability to reach measurable therapeutic temperature of 41-45°C (105.8-113°F) to melt meibum since each microwave has non-uniform power levels and timer settings

  • Inability to maintain consistent therapeutic temperature for at least 10 minutes. You constantly have to reheat the warm compress every few minutes as it cools off very quickly

  • Less than optimal contact between the warm compress and eyelids

  • Difficulty for you to effectively express the meibomian glands through lid massage with your fingers. Most people forget and don’t do the finger lid massage after using the warm compress.

In addition, squeezing meibomian glands with your fingers is like squeezing toothpaste out of tube on a pillow. The back of your eyelids is your eye, which is soft tissue (like the pillow). Anything you manage to squeeze out won’t come out easily.

During your TearCare® treatment, our eye doctor uses forceps (a flat tweezer-like surgical instrument) to provide equal pressure on both sides of your meibomian glands to unclog them. Think of it as squeezing toothpaste out of a tube while placing it on a hard tabletop or counter. It is much easier and faster!


Medications like Xiidra™, RESTATIS® or Cequa™ address the persistent inflammation component of the ocular surface and tear film but does not resolve your clogged meibomian glands or eyelid inflammation. For blepharitis (eyelid inflammation), a hypochlorous acid spray such as Avenova® is faster acting and more effective.

Our eye doctor will determine when Xiidra™, RESTATIS® or Cequa™ is adequate for your dry eye treatment. Depending on your symptoms and cause of dry eye, these medications can be complimentary to TearCare®. Please note that these medications are not always covered by medical insurance, usually require pre-authorization, tend to be expensive and typically take at least 1-3 months to show result.

Starting a regimen on one of these medication is a long-term treatment option and patients should not start it unless they can commit to it.


No, TearCare® does not hurt.

​​​​​​​When heat is applied to your lids, patients have described it as a spa-like experience. You will feel an almost immediate heat wave similar to you entering a hot tub. The smart lids will start at 41°C (105.8°F) and will increase 1°C (1.8°F) every 30 seconds until it reaches its maximum therapeutic temperature of 45°C (113°F). If the heat feels uncomfortable to you, we can adjust it and dial it back down.

For the manual expression of your meibomian glands, our eye doctor will apply numbing eye drops and you will feel a gentle squeeze on your eyelids every time the doctor clears your glands with the forceps. Patients describe it as feeling pressure being applied to the lids. It is normal for patients to experience watery eyes and tearing during this portion of the procedure.

TearCare®, similarly to Lipiflow® and iLux®, is considered one of the most effective treatments for dry eye caused by meibomian gland dysfunction (MGD).

You can watch TearCare being performed on “The Doctors” Show. We use the same Mediworks S390L Firefly WDR slit lamp and TearCare technology in our office.