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Understanding Dry Eye Disease

Do your eyes burn? Are they red, irritated, sandy or gritty? Perhaps your eyes seem to water excessively? These are all signs of dry eye disease.

Dry eyes occur when not enough tears are produced or the quality of tears is unhealthy, causing rapid evaporation. The lack of tears leads to ocular surface disease and chronic inflammation. Dry eye disease is very common, and many treatments exist. Despite this, far too many patients are merely given artificial tears, warm compresses, and told to tough it out.

At The Norwalk Vision Center, we take dry eyes very seriously, and have many tools to help you feel better.



TearFilm Before and After
Learn About the Most Common Cause of Dry Eye


Our Dry Eye Treatment Philosophy

Dry eye is notoriously difficult to treat because there are usually multiple factors causing the dryness. Every case is different, but comprehensive dry eye treatments may need to address four distinct problems:

Obstructed meibomian glands

Meibomian Gland Dysfunction (MGD) causes insufficient oil in the tear film and evaporation of tears. Chronic obstruction leads to gland atrophy and cell death.


The bacteria, mites, and micro-organisms that live on our skin can fester in and around eyelids and lashes, leading to chronic inflammation. Eyelid hygiene plays a role in controlling eyelid inflammation.


Dryness causes inflammation, and inflammation causes more dryness. Anti-inflammatory tools can take the form of supplements, oral medications, topical medications, light therapy, and biologic drops or membranes.

Tear film

Oftentimes, there are just not enough tears. This can be from insufficient tear production, poor lid closure, biochemical instability, or excessive evaporation.

What tools do we have to combat dry eye diseases?


Mild Green


Omega 3s (Fish Oil)
Steroid eyedrops
Non-steroidals (NSAIDS, Azithromycin)

Tear Film

Artificial tears or gel
Increase hydration
Environmental changes


Blink exercises
Moist heat compress
Eyelid debridement


Hypochlorous acid
Eyelid cleansers
Tea Tree Oil


Moderate Orange


Oral doxycycline or minocycline
Immunomodulator drops (Xiidra, Restasis, Cequa, Cyclosporine)
Intense Pulsed Light Therapy (IPL)

Tear Film

Punctal plugs
Lacrimal gland stimulation (Tyrvaya)
Overnight eyelid seals or moisture goggles


Thermal expression (Tear Care, LipiFlow)
Red low level light therapy (LLLT)
Intense Pulsed Light Therapy (IPL)


Blepharoexfoliation (ZEST, NuLids, Bleph-Ex)
Blue low level light therapy (LLLT)
Intense Pulsed Light Therapy (IPL)


Severe Red


Amniotic membranes
Cytokine extract drops (RegenerEyes)
Autologous Serum Tears

Tear Film

Scleral Contact Lenses
Oral Evoxac
Autologous Serum Tears

Which Treatment is Right for Me?

If you are reading this, and have been searching Doctor Google for answers, then your dry eye is probably moderate to severe. The first step is to schedule an appointment with Dr. Folman or Dr. Arkin to be evaluated for dry eye disease. We will identify which areas we need to focus on, and discuss which therapies are most appropriate.

Learn More About Our Dry Eye Specialist Doctors
Schedule Your Dry Eye Consultation


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Our popular dry eye treatments at the Norwalk Vision Center

Click on each to learn more

Intense Pulse Light (IPL) by OptiLight

Intense pulsed light (IPL) is the most exciting thing to happen to eyecare in 20 years! At home dry eye treatment is annoying and costly. IPL offers an in-office, drug-free alternative with months-long benefits.

IPL has been used in dermatology since the 1990s in the treatment of rosacea, and in the aesthetics industry for photofacials. It was observed that patients who received IPL also experienced significant relief from symptoms of dry eye disease. In 2021, OptiLight IPL by Lumenis received FDA approval for the treatment of dry eye disease. The Norwalk Vision Center is proud to offer this amazing technology to our patients.

IPL targets the source of inflammation by selectively destroying irregular blood vessels that leak inflammatory compounds. It also kills micro-organisms that inhabit the skin around the eyes, further decreasing inflammation. The heat generated from therapy also heats up the clogged meibomian oil glands, clearing obstruction and allowing the glands to heal and even regrow.

As an added bonus, IPL will make your skin look amazing! Treatments get rid of unwanted brown spots and red spots on your skin, and tighten the epidermis to reduce fine lines and wrinkles.

Dry eye patients typically experience significant relief after 2-3 treatments. However, 4 treatments provides the most lasting benefits. Touch-up treatments are recommended every 6-12 months.


If your glands are clogged, and a warm compress makes them feel better, then this in-office treatment is for you. This spa-like therapy supplies a steady heat to the eyelids through an electric thermal adhesive. The feeling is akin to the warmth of a hot tub. For most patients, TearCare plus gland expression provides 6-12 months of dry eye relief.

Because TearCare provides a better thermal effect than IPL, but IPL reduces inflammation and biofilm, the two therapies may be combined for a truly rejuvenating dry eye treatment.

Scleral Lenses

Are your eyes so dry, you’ve wished you could just keep them in a water bath all day? That’s scleral contact lenses; a large diameter, rigid contact lens that’s filled with preservative-free saline, keeps your eyes hydrated all day long, and corrects your vision. Some insurance plans even cover the cost of these custom lenses.

Amniotic Membranes

If your ocular surface is heavily bruised from chronic dryness, amniotic membranes can give you a fast reset to healthy eyes. Harvested from scheduled c-sections, and thoroughly screened for disease, these membranes are rich in human stem cells that will regrow your cornea. Prokera membranes or cryopreserved membranes are put on the eye for a few days, then removed in office. The procedure is painless, though some patients complain of mild discomfort while wearing the membranes, for which the eyelid can be temporarily taped shut. It is done one eye at a time, and can be repeated every 6-12 months as needed.


Zocular Eyelid System Treatment (ZEST) is an in office blepharoexfoliative procedure. That means that ZEST cleans up oils, debris and residues that accumulate on the eyelids and lashes, while exfoliating the skin and gland openings. Zocular products contain a unique and effective active ingredient derived from okra extract. This is a fantastic alternative to the commonly used tea tree oil cleansers, which, in certain concentrations, can damage meibomian glands. For patients with demodex infestations and/or blepharitis, this treatment can go a long way in cleaning up and reducing inflammation.

Punctal Plugs

Not enough tears? Put a plug in the drain to keep them there longer. A one minute, minimally invasive procedure is done in office, and can provide years of relief.


Tyrvaya is a first-in-its-class nasal spray that, within minutes, stimulates tear production in the lacrimal gland. This is a wonderful pharmacologic alternative for patients who have not done well with Restasis or Xiidra. While the primary effect of this drug is to increase tear volume, there is actually a fantastic anti-inflammatory effect achieved by the increased immunomodulating agents found naturally in our tears.


Similar to amniotic membranes but in an eye dropper, RegenerEyes is composed of placenta-derived proteins, including natural anti-inflammatory cytokines and growth factors for repairing and regenerating damaged cells and corneal nerves. Safer and more effective than steroids, RegenerEyes is a preservative free, lubricating, restorative anti-inflammatory drop. It is not covered by any insurance, but is often more affordable than Restasis or Xiidra.

Restasis, Cequa, and Cyclosporine

For decades this eyedrop, in various forms, was the only potent non-steroidal eye-drops for treating dry eyes. For some patients, it is very helpful. For others, it is not. The drug acts by locally decreasing the eyes’ immune response to decrease inflammation. Since becoming available as a generic, insurances companies have largely stopped paying for the better name brand versions, leaving some patients with hefty bills for old drugs.


A more recent alternative to Restasis (cyclosporine). It operates under the same concept but through a different mechanism of action. Some patients find it more effective than Restasis, but it’s not for everybody.

Autologous Serum Tears

What’s better than preservative free artificial tears? Only your body’s own natural tears. Natural tears contain anti-inflammatory cytokines, growth factors, and immune cells. These are the same helpful compounds found in your blood. For some patients, it may be worth it to have blood drawn monthly to create natural tears derived from your own blood serum.

Nutritional Counseling and Integrative Medicine

At the Norwalk Vision Center, we practice integrative medicine – acknowledging that the eye is part of the brain, and part of the body. As such, treating any condition of the eye needs to be examined in the context of whole-body health. If there is inflammation in the body, there can be inflammation in the eye. We will review diet, exercise, hydration, stress and sleep. Omega-3, vitamin, and antioxidant supplementation is an often ignored, but often essential part of comprehensive dry eye and ocular disease management.

Get In Touch With Us Today!

Don’t wait for dry eye syndrome to deteriorate. Take action today by booking an appointment with Norwalk Vision Center today.



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