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Dry Eye

DRY EYES: Raised to a SCIENCE! Dry eyes could present with mild to persistent discomfort in the form of a relentless disorder affecting millions of patients throughout the globe. For over 3 decades, Dr. Gulani’s custom designed dry eye management using his proprietary m.o.i.s.t.™ therapy has helped thousands of patients worldwide not only in their symptoms but also in many cases, improving their vision.


Most common symptoms of this condition could include: dry eyes, irritation, reflex tearing, itchiness, blurry vision, red eyes, sand-like feeling or grittiness, heavy eyes, tired eyes, burning, and in extreme cases even painful eyes. As a world destination for second opinions and complication management, Dr. Gulani has witnessed patients with a wide range of symptoms that are less distinct and even camouflaged due to their inadequate or failed therapies elsewhere.

Diagnostics and Treatment:

In a detailed personal consultation with advance technology, Dr. Gulani evaluates not only the anatomical and physiological impacts of dry eyes, but also any associated pathology (like pterygium, pinguecula, or corneal scars) and visual status to then custom designs his treatment and surgical plans to each patient to deliver the best outcome with the safest approach in that patient’s best interest.

Unshakable by industry hype or new technology promises, Dr. Gulani who is always years ahead of his peers worldwide with his international privileges and technology innovations, will perform a thorough consultation and after a detailed diagnostic evaluation pick among his full range of techniques and technologies, KLEARTM, to include chemically and osmotically balanced artificial tears, meibomian gland recanulization, temporary or permanent lacrimal plugs, amniotic therapy (including Prokera), correcting Lipiflow and IPL therapy, and even no-stitch surgical techniques either in single, staged or combined management approach for your eyes.

   Accredited Dry Eye Center - Gulani Vision Institute  Ophthalmology Times - Decision pyramid helps clinician in diagnosis of dry eye

Featured: Read Excerpt from our Patient Jelena’s Book: Dry Eyes, Causes, and Cures

Dr. Gulani and Jelena

There are a plethora of over the counter relief drops and remedies for Dry Eye but it is essential that you have a thorough exam with an expert to have a treatment strategy best tailored for your condition. This is also vital to rule out any local surgeries as a cause ie. Lasik or associated systemic disease of which this could be the first indicator ie. Sjogren’s syndrome, arthritis, thyroid disorders, drug side effects, etc. Additionally, there is a direct correlate between tears and vision, not only naturally but also in converting “Not a Candidate” patients to “Candidates” by correcting their dry eyes and then allowing them an opportunity to qualify for Laser Vision surgery to see without glasses and contact lenses.

Dr. Gulani teaches DRY EYE management in his instructional courses for eye surgeons globally and provides an in-depth diagnostic evaluation along with a full spectrum of care from medical/pharmaceutical to advanced surgical applications including amniotic membrane surgeries with stem cell transplants for patients with this condition. He approaches Dry Eye as a Specific entity with a Specific cause which warrants a Specific treatment. He teaches causes of dry eyes to be categorized among primary causes and secondary causes:

  • Primary
    • Age, Genetic, Hormone related etc.
  • Secondary
    • Local:
      • Disease: i.e. of lacrimal glands
      • Post Surgical: i.e. after Lasik
    • Systemic:
      • Disease: Sjorgen syndrome, collagen vascular diseases like Lupus, arthritis
      • Lifestyle: smoking, vaping, excessive screen use (computer or phone)
      • Drugs: contraceptive pills, hypertension, allergy, chemotherapy, etc

Using this dedicated methodology, he has successfully helped people suffering from all levels of dry eyes who travel to our institute from all over the world. He explains that the tear film is actually about 7 microns thick and is made up of three layers:

  1. The Innermost, Mucin Layer (produced by the Conjunctival Goblet cells on the surface of the eye) and this layer makes the tear film “Stick” to the eyeball.
  2. The Middle, Aqueous Layer (produced by the Lacrimal glands which are located on the upper and outer side of your eye socket). This is the real Tear Film if you may and contains all of the chemicals and nutrients that are needed for the ocular health and safety.
  3. The Outermost, Lipid layer (produced by the Meibomian glands which are arranged along the eyelid margins vertically in rows like “Tooth Paste Tubes” with their “Mouths” opening at the lid margin close to the eye lashes. This layer actually provides surface tension to the tear film and hence maintains its vertical distribution on the eye despite gravity.

 Dr. Gulani classifies Dry eyes at various levels for eye care practitioners based on severity, symptomatology, cause and vision impact.

Essentially though he explains that there are two basic kinds of dry eyes:

  1. Deficient: decreased production of one or multiple tear film layers.
  2. Evaporative: excessive loss due to anatomical, physiological, and lifestyle impact factors.

Some Pearls:

  1. The tear film is actually dependent on the nerve sensation of the cornea (that is why people have Dry eyes following a certain kind of Lasik surgery where the nerves get cut during surgery) and inflammatory cycles related to allergy, infections etc.
  2. The tear film leaves the eye via tear ducts (in each lid) and goes into the nose on a normal basis (remember how some eye drops taste nasty).

The above explanation is Dr. Gulani’s way of simplifying the dry eye concept for all his patients and then he gets to work further investigating the root cause of dry eye and planning an effective treatment regimen.

So lets say someone has a decreased production but good quality of tears, they can have temporary or permanent  intra-canalicular punctual plugs inserted into their tear ducts and thereby “Retain” whatever little tears they produce (a Plumbing issue – Block the drain since the tap is producing less water so the water remains in the sink for a longer time). This can further be augmented by tear producing eye drops like Restasis or Xiidra.

If the quantity produced  is good but the loss is excessive (Evaporative Dry eyes) then he addresses that abnormal layer effectively with appropriate eye drops, medications and techniques. For example, if the Lipid layer is affected because of the Meibomian glands being blocked by repeated inflammation and allergy, he can detect this problem and actually re-open these glands with a brief, in-office procedure using new technologies he keeps innovating and honing over decades of experience. Meibomian (“my-boh-mee-an”) glands are 20 – 40 toothpaste tube (slightly crooked though) shaped glands, lined along eye lashes in our eye lids which secrete the oil layer of our tear film to prevent evaporation of our tears too quickly by creating surface tension (making a film of water  stay vertical despite gravity).

Blockage, disease or inflammation of these glands results in Meibomian Gland Dysfunction (MGD). You can imagine then that a faulty oil layer can allow our tears to evaporate quickly and cause dry eyes (Evaporative kind of dry eye) and in many cases is associated with lid inflammation (Blepharitis).

Most common causes of MGD include, repeated or incorrectly managed lid inflammations including allergies, gender as in more prevalent in females, advancing age, ethnic background as in Asians have a higher propensity. Wearing eye makeup is another contributing cause of MGD. Eyeliner and other makeup can clog the openings of meibomian glands especially if you don’t thoroughly clean your eyelids and remove all traces of eye makeup before sleep. Wearing contact lenses for especially long durations also is a risk factor. Medical situations can also increase the chances of this infliction and history of arthritis, Sjogrens, Thyroid dysfunction, diabetes etc are important and need control for overall success. 

With 3 decades of experience in working with dry eye patients from around the world, Dr. Gulani’s clinical acumen along with cutting edge diagnostic technologies including one of the first Oculus Keratographs in the country can detect all levels of dry eyes from quantitative to qualitative whereby he then designs an individual plan of attack for that dry eye patient.

Besides an array of technologies like LipiView, LipiFlow, iLux, Tearcare, Blephex and IPL to treat dry eyes, Dr. Gulani’s personal experience in using customized, differential Meibomian Gland recanalization technique done in-office in less than 5 minutes with a blunt probe and proprietary numbing gel made in a pharmacy in California has resulted in near 100% success. 

This followed by an individually time-planned warm compression of the eyelids and medication protocol of eye drops results in melting and expressing the thickened oil and also changing it chemically to the more user friendly version.

Oral supplements like Omega-3 supplements, Flaxseed oil etc. and also tear enhancing eye drops like Xiidra and ReStasis can also be used along with PH balanced artificial tears. 

In more serious cases of dry eyes with associated pathology and complications, Dr. Gulani can raise the bar to perform “No-Stitch” human placenta surgery, transplants etc.

Thus we can see how approaching the dry eye complaint in a systematic manner can actually make sense of the situation, rule out any associated diseases and effectively plan for a customized solution for each individual eye.

The Gulani m.o.i.s.t.™ therapy therein identifies the exact kind of dry eye to then custom-design a treatment plan for that individual patient in single or combined and even staged protocols for successful outcomes.

ophthalmologist with individual patients after eye surgery

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Jacksonville, Florida 32216
Phone: (904) 296-7393
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