"Dry eye" is caused by deficiency of one or more of the the three layers of the tears which are

  • the oily (lipid) layer produced by the meibomian glands in the eye lids  
  • the watery (aqueous)  layer 
  • mucus layer  

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Meibomian Gland Dysfunction (MGD); Evaporative Dry Eye  

Most patients with "dry eye" do not have reduced aqueous tear production but rather faulty tear function, in which the tear film is unstable and prone to rapid evaporation. In the majority of cases the evaporative dry eye is typically the result of Meibomian Gland Dysfunction (MGD) alone or combined with  aqueous deficiency (Lemp, Crews et al. 2012). Researchers found that; 86% of patients who were diagnosed as having a Dry Eye Disease (DED) showed MGD. They concluded that evaporative dry eye from MGD was far more common than purey Aqueous Deficient Dry Eyes (ADDE)''. (Lemp, Crews et al. 2012).

It has beeen estimated that MGD occurs in over 19 %  of Caucasian individuals over 40 years of age (Nichols, Foulks et al. 2011).

The Problem

Although MGD is a very common and significant condition in terms of its prevalence, morbidity and negative effect on the quality of life of individuals, research into treatment modalities has proceeded slowly. Until recently the treatment for this condition was the use of artificial tears, poorly controlled home treatments; warm compresses and lid scrubs and the use of topical and systemic antibiotics.Beyond discomfort, it has been clearly established that MGD significantly degrades the quality of vision (Mijianovic et al 2007). Dry eye conditions, including MGD, do not resolve on their own but are become chronic and progressive (Rao, 2010). 

The Solution; Modern Diagnosis and Treatment

Initial treatment of anterior blepharitis and lid margin disease may still include drug therapy but in addition your optometrist at Barnard Levit may advise an in-practice cleaning of your lid margins using Blephex.

The diagnosis and treatment of MGD has been transformed by the TearScience system, which consists of the LipiView Ocular Surface Interferometer and the LipiFlow Thermal Pulsation system.  For the first time we have an opportunity to treat MGD in a holistic way, which has the potential to offer patients relief from this chronic disorder.

Barnard Levit Optometrists is one of a few practices with the TearScience LipiView which provides diagnostic information on the meibomian glands and LipFlow an advanced system that delivers a highly effective method of cleansing the meibomian glands. 


Aqueous deficiency

The watery layer has the function of keeping the cornea wet and forming a "tear lens". Deficiency of this layer will produce dry eye. Deficiency of the watery layer can be caused by many conditions and an example of which is Sjogren syndrome. On way of keeping what tears are present from draining away is for punctum or intracanalicular plugs to be fitted. Barnard Levit Optometrists stock and are able to fit a range of temporary and permant punctum and intracanalicular plugs.

Mucus deficiency

The function of the mucus layer is to coat the surface of the cornea and conjunctiva to allow the watery layer to spread smoothly. Deficiencies in the mucus layer can sometimes be helped with nutritional supplements. 



1. LEMP, M.A., 2011. Tear Film Evaluation. In: J. KRACHMER, M. MANNIS and  E. HOLLAND, eds, 2011. Cornea, Fundamentals, Diagnosis and Management. 3 edn. New YorkUSA: Mosby Elsevier, pp. 119-123.

2. LEMP, M.A., CREWS, L.A., BRON, A.J., FOULKS, G.N. and SULLIVAN, B.D., 2012. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea, 31(5), pp. 472-478.

3. NICHOLS, K.K., FOULKS, G.N. and BRON, A.J., 2011. The International workshop on Meibomian Gland Dysfunction. Investigative ophthalmology & visual science, 52(4), pp. 1922-1929.

4. Mijianovic B, Dana R, SullivanDA, Schaumberg DA. 2007, Impact of dry eye syndrome on vision related quality of life. Am J. Ophthalmol. 143(3);405-15

5. Rao, SN. 2010, Topical cyclosporine 0.05% for the prevention of dry eye disease progression. J Ocul Pharmacol Ther. 26(2); 157-63

6. Yu, J. Asche, CV. Fairchild, CJ. (2011), The economic burden of dry eye disease in the United States: A decision tree analysis. Cornea 30(4): 379-87

7. Lane, SS. 2012, A new system, The LipiFlow, for the treatment of Meibomian Gland Dysfunction (MGD). Cornea31: 396-404.