Red, Dry Eyes – Differentiating Meibomitis (Meibomian Dysfunction) from Dry Eye Syndrome

Patients with dry eye, either from decreased tear production or increased evaporation of tears, most frequently complain of chronic sandy-gritty irritation in their eyes. Also, patients with dry eye typically note that their symptoms get worse as the day goes on. This is because eye closure during sleep forms a watertight seal over the tear film and gives the ocular surface a chance to recover. When the eyes open, evaporation begins, which increases tear-film osmolarity as the day goes on. If a person has these symptoms for more than 3 months and if the onset was gradual, the patient has dry eye unless the physician proves otherwise.

People with Meibomitis (known also as Posterior Blepharitis) also complain of chronic sandy-gritty eye irritation. But in these people, the irritation is worse upon awakening because the inflammation is in the eyelids. During sleep, tear production decreases, eye closure brings the inflamed lids right up against the eye, and the released inflammatory mediators act on the cornea all night, creating a symptom peak upon eye opening. When these people awake, tear flow increases, the lids pull away from the cornea, and their symptoms improve as the day goes on.

Eventually the chronic meibomian gland inflammation leads to meibomian gland dysfunction. When that happens, these patients develop a second peak in symptoms from dryness toward the end of the day. Finally, when the meibomian gland inflammation and secondary healing obliterate the meibomian glands, the morning symptoms resolve and patients are left with symptoms from dryness alone, with sandy-gritty irritation that gets worse as the day goes on.

Treatment of Meibomitis (Meibomian Dysfunction) and Dry Eye Syndrome

Many years ago, demulcents (polymers) were added to artificial tear solutions to improve their lubricant properties and change their viscosity. In 1975, a classic study demonstrated that demulcent solutions (all containing a preservative at the time) transiently increased tear-film stability in normal subjects. These solutions, whether of high or low viscosities, act by temporarily mimicking cell-surface glycoproteins, which are lost late in the disease. Solutions of higher viscosity remain in the eye longer. The effectiveness of preserved demulcent solutions hinges on their ability to temporarily stabilize the cornea-tear interface.

The next treatment advance – preservative-free demulcent solutions- occurred about 15 years ago, shortly after researchers recognized that preservatives increase corneal desquamation. A recent study showed that traditional preservative-free demulcent solutions improve but don’t normalize corneal barrier function in dry-eye patients. Improved corneal barrier function reflects decreased corneal epithelial desquamation and improved corneal cell junctions. Treatment with a preserved demulcent solution, while briefly increasing tear-film stability, actually diminished corneal barrier function. Preservative-free solutions established a new benchmark in artificial tear solution treatment.

Knowing what we know now about the mechanism and natural history of dry eye, we can anticipate that the next advance in treatment would address decreased conjunctival goblet cells, decreased corneal glycogen and elevated tear film osmolarity. Thera tears is the first eye drop shown in preclinical studies to restore conjunctival goblet-cell density and corneal glycogen with four-times-a-day dosing for 12 weeks. A preservative-free demulcent solution the product accomplishes this effect through two mechanisms Reprinted From Optometric Management Magazine, February, 2002 Article written by Jeffrey P. Gilbard, M.D., N. Andover, Mass.



Patients have crusting irritation at the base of lashes without variation throughout the day– onset is insidious.


Patients complain of burning and irritation without variation throughout the day. Symptoms are equivalent throughout the day because overuse of topical medications promotes damage. You should suspect this condition in all those who use traditional artificial tears more than four times a day. People generally have a history of escalating tear use.


Patients often have symptoms of tearing with actual and demonstrable tear overflow. Patients with meibomian gland dysfunction may feel like their eyes are tearing, but these patients have frank epiphora (overtearing).


The primary symptom for this condition is itchy eyes. Patients’ eyes may also exhibit increased mucus production. Onset of this condition is commonly seasonal, and it may be associated with hay fever, asthma and eczema.


Patients’ eyes may burn upon awakening. Patients frequently have a history of lid surgery or thyroid eye disease.


Symptoms include burning and irritation without daily variation. Abrupt onset and remissions characterize this condition. Patients often have a history of thyroid dysfunction.


Patients with this condition experience insidious onset of photophobia, eye irritation and decreased vision. The condition is episodic and recurring.


Patients complain of “dry eyes.” This condition underscores the importance of accurate localization of symptoms.


Patients experience a chronic sensation of having a foreign body in their eye. This sensation results from exogenous material or an exposed meibomian-gland derived conjunctival concretion (calcium deposit just beneath the conjunctiva that acts as a foreign body)


Symptoms include chronic eye irritation, redness (particularly inferior) and increased mucus production. Patients who reach into their eye to remove mucus strands caused by conjunctival trauma (eye rubbing) initiate the condition. A vicious cycle can develop.


Patients may complain that their eyes feel “tired.” Careful questioning reveals that patients are experiencing an involuntary closure of the eyes, rather than eye irritation. Driving, reading and exposure to sunlight worsen symptoms.


Normal eyes, abnormal environment. Eye irritation in response to smoke would be a typical example.


This condition is uncommon. A careful history that fails to mesh with the examination can provide the first clue to its presence.


An inflammation of the lids attributed to a common mite that inhabits the follicle of the lash, especially in the elderly. It has the potential to destroy the glandular cells, produce granulomas and plug meibomian glands. Symptoms include itching and burning, possible lid margin crusting and loss of lashes, along with the classic lash cuffing.
Reprinted from Optometric Management Magazine, February, 2002

Not Fun! See your eye doctor

Not Fun! See your eye doctor




Shady Grove Eye and Vision Care teams with Izon Hi Definition Eyeglass Lenses

Shady Grove Eye and Vision Care is proud to announce a partnership with Izon lenses, the only truly “aberration reducing” lens on the market. The Izon lens is manufactured based on the findings of the Izon Aberrometer, a machine that reads the microscopic “lumps and bumps” in your prescription that standard methods of prescription reading (like the “what’s better, 1 or 2 test) aren’t sophisticated enough to read. The reading is then translated into an eyeglass lens, the result being best described as high definition vision. The Izon machine is exclusively at the Rockville office where your eye doctor will test you and determine if you are a candidate for the best lens on the market.

Courtesy of the Doctors at Shady Grove Eye and Vision Care; Optometrists, Ophthalmologists and Opticians working together to help you see better.  Serving the Rockville, Potomac and Gaithersburg Maryland suburbs of Washington, DC. For more information visit or call (301) 670-1212

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What is Voluntary Nystagmus?

Nystagmus generally refers to an involuntary rapid movement of the eyes frequently observed in people with conditions that affect the midbrain, albinos or people with genetic conditions. The term “voluntary nystagmus” refers to the ability of a person to make their eyes appear to vibrate in a rapid, horizontal motion at will. A survey of a college age population revealed that 8% could produce voluntary nystagmus. It seems to be genetic to some degree, as 79% of those in the survey had relatives who could also perform it. Voluntary nystagmus can be differentiated from other forms of nystagmus by its frequency, duration, and occurrence in individuals whose neuro-ophthalmological examination is normal.

Video of Voluntary Nystagmus


Courtesy of the doctors of Shady Grove Eye and Vision Care; Optometrists, Ophthalmologists and Opticians serving the Rockville, Potomac, Gaithersburg and Germantown Maryland suburbs of Washington DC for over 40 years.  Connect with us on twitter @Eyeinfo, on facebook by clicking this link and visit our youtube channel here


Get Your Eyes Ready for the Beach This Summer . . .

Headed to the beach? Packed your sunscreen and hats? Be sure not to forget your sunglasses. Sunglasses are a necessary part of protecting your body from the harmful effects of UV. Not just any sunglasses, but sunglasses that are labeled as UV Protective, preferably more than 97%.

How can you be sure your sunglasses are more than 97% UV protective? Be sure to purchase them from a qualified eye care practitioner who can demonstrate their UV characteristics with a UV meter. It is also recommended to purchase Polarized lens which are naturally UV protective.

Courtesy of the Doctors of Shady Grove Eye and Vision Care. Optometrists serving the Rockville, Potomac and Bethesda Maryland suburbs of Washington DC for over 40 years. Connect with us on Twitter @EyeInfo. Visit our office website, or call (301) 670-1212 for more information

Night Vision Contacts Helped To Kill Osama?

Almost everyone who has heard anything about military forces know that sometimes the army uses something called night vision goggles to be able to see in the dark. However what most people don’t realize is that those things are so bulky that oftentimes they are limited in their effectiveness.Technology for night vision goggles are rapidly advancing with the goggles quickly getting smaller and more compact.

There is an interesting rumor out right now that Seal Team 6, the elite band of Navy Seals who killed Osama Bin Laden used Night Vision Contacts to be able to maneuver well at night without being laden down by the bulky and inefficient goggles. Night Vision Contacts have been talked about for the last decade or so but our technology has never been able to achieve it. Maybe some top secret government lab has the technology to be able to do this but the public just can’t be sure. However if anyone had access to this amazing piece of technology it would be Seal Team 6.

Courtesy of the doctors at Shady Grove Eye and Vision Care; Optometrists, Ophthalmologists and Opticians serving the Rockville, Potomac and Gaithersburg Maryland suburbs of Washington, DC for over 43 years. Visit our website at  Connect with us on twitter @EyeInfo and “Like” us on facebook Connect with us on Twitter @EyeInfo and subscribe (free subscription) to this blog.  Call (301) 670-1212 for office information and appointment scheduling.

The Danger of Fireworks

To many of us, the most patriotic thing in the world to do on July 4 might be to celebrate by lighting fireworks. However this year many physicians are warning their patients not to do their own fireworks show. Fireworks cancause serious damage to your eyes as well as to the rest of your body. In 2009 US hospitals treated close to 8800 patients because of damages caused by fireworks. More than half of these injuries came from people under the age of 20. The second most common part of the body that these people injured were their eyes.

If an eye injury does occur:

DO NOT try to remove any objects that are protruding from the eye.
Flush your eyes with water to remove any particles present.
Cover the eye loosely for your comfort and immediately seek medical help.

However it might just be best to leave the fireworks to the professionals.

Blind Man Uses Echolocation To See

An inspiring story of a man who overcame the loss of his eyes and can see again. Full credit goes to Katie Moisse of ABC News for the story.

May 26, 2011

Daniel Kish was 13 months old when he lost his eyes to cancer, but that didn’t stop him from getting around. By making a clicking noise with his tongue and listening for the echo, Kish could figure out where things were around him, a skill that baffled his parents.

“I don’t know that they really noticed the clicking right away,” said Kish, 45. “I think they just noticed that I was able to find my way around.”

Kish has since mastered the skill, known as echolocation. Like a bat, he uses sound to see.

“Sound is like light in that they’re both waves of energy,” Kish said. “These waves of sound bounce off things in the environment, and when they return they actually carry with them an imprint of what they’ve encountered.”

Kish of Long Beach, Calif., said his brain learned to interpret the information contained in the echoes and use it to construct images.

“It’s basically a representation of what’s taking up space in the environment based on location, dimension and depth of structure,” meaning the solidness of objects, Kish said. “The image that you get,” which is colorless and has no grayscale, “basically combines those characteristics.”

As president of World Access for the Blind, a non-profit organization based in Long Beach, that helps blind people learn to “get around more effectively and lead their lives with greater freedom,” Kish teaches other blind people how to echolocate. And to better understand how the technique works, he teamed up with Canadian scientists for a brain imaging study.

“Dan was eager to come up and explore the possibility that there may be some interesting things happening in his brain while he’s echolocating,” said Mel Goodale, director of the Centre for Brain and Mind at the University of Western Ontario in London, Canada, and senior author of the study published Wednesday in PLoS One.

Using magnetic resonance imaging, Goodale and colleagues studied the pattern of activity in Kish’s brain when he was listening to clicks and echoes. Instead of activating his auditory cortex, the area responsible for interpreting sound, the clicks and echoes appeared to activate Kish’s visual cortex.

“It was really quite amazing,” Goodale said. “It looked like it was recruiting a good chunk of the primary visual cortex in his brain.”

Kish said he hopes the study adds credibility to his approach, which could attract the resources needed to deliver it more widely.

“Right now, most of the funding goes toward vision preservation and restoration, which is fine for those individuals for whom it will work, but it won’t work for everyone,” Kish said. “We can help blind people see their environment now.”

Kish showed off his incredible talent on the Discovery Channel show “Is It Possible” by finding a rubber ball in the middle of a field. But while echolocation allows him to detect objects up to 100 yards away, he hasn’t ditched his white cane.

“We can kind of think of echolocation as being sort of far vision; it’s good for things that are far away and off the ground,” he said. “The cane is good for things that are nearer and at ground level.”

Kish and Goodale will reconnect for a follow-up study in June aimed at teasing out how the brain system interpreting the echoes is organized.

“Blind people should realize that this is an opportunity; that you can do quite a bit with echolocation,” Goodale said “I think it’s important to get it out there. It may not be for everyone, but it’s worth a try.”

Courtesy of the doctors at Shady Grove Eye and Vision Care; Optometrists, Ophthalmologists and Opticians serving the Rockville, Potomac and Gaithersburg Maryland suburbs of Washington, DC for over 43 years. Visit our website at  Connect with us on twitter @EyeInfo and “Like” us on facebook Connect with us on Twitter @EyeInfo and subscribe (free subscription) to this blog.  Call (301) 670-1212 for office information and appointment scheduling.

How To Avoid Getting Eye Wrinkles

In today’s day and age many people are worried about how to keep up their appearance as they get older without getting crows feet and lines on your face. Wrinkles are a fact of life, but there are ways to try and prevent them without going through expensive botox operations. Here are a few:

1. Use sunscreen: Sunscreen is essential if you want to keep away those wrinkles. However the trick that most people don’t know is that even on cloudy days you have to use it because the radiation can get through the clouds. Also reapply the sunscreen every two hours so that it doesn’t get washed away in your sweat. Lastly, always use SPF 15 or higher, there are only marginal benefits to anything above SPF 15 that aren’t really worth it.

2. Wash your face: Part of the trick to keeping away wrinkles is to not let your skin get so dry. Dry skin is one of the leading causes of wrinkles, so you want to wash your face several times during the day. However, you don’t want to wash away the protective layer of oils that cover your face.

3. Humidifying: Every man and woman can benefit from a good moisturizer. Keep the skin around your eyes healthy and full with a moisturizer that doesn’t use chemicals or synthetic fragrances.

Courtesy of the doctors at Shady Grove Eye and Vision Care; Optometrists, Ophthalmologists and Opticians serving the Rockville, Potomac and Gaithersburg Maryland suburbs of Washington, DC for over 43 years. Visit our website at Connect with us on twitter @EyeInfo and “Like” us on facebook Connect with us on Twitter @EyeInfo and subscribe (free subscription) to this blog. Call (301) 670-1212 for office information and appointment scheduling

The Language Of The Eyes

Many ancient cultures thought that the eyes were the window to the soul. This holds some fact in it even if only for the reason that your eyes have a language all of their own. In conversation with someone your eyes can speak more than your words do to convey how you are feeling.  Here are some quick examples.


Although normally used to show interest in an object, gazing can hold many different connotations depending on where you look. If you look away from the person your talking to or gaze at their forehead it might indicate disinterest on your part. Looking a person up and down also falls into this category, this might indicate a sexual desire or sizing them up as a potential threat depending on where the gaze lingers.

Looking up:

Looking up usually indicates that the person is thinking or trying to recollect something. However be careful with this because looking up can also be a sign of boredom.

Looking down:

This is used in many cultures to signify submission or to show you are not a threat to the person you are speaking to. Looking down is also used when dealing with internal emotions that the person doesn’t want to be shown on their face.


Glancing at something may betray a desire for that thing, for example: if someone glances at a door when you are speaking to them it might indicate a desire on their part to leave. Glancing is also used as an alternative to staring if the object at which they are glancing is forbidden to be stared at. For example, if a beautiful lady walks by the men in the room might shoot quick glances her way instead of staring.

Courtesy of the doctors at Shady Grove Eye and Vision Care; Optometrists, Ophthalmologists and Opticians serving the Rockville, Potomac and Gaithersburg Maryland suburbs of Washington, DC for over 43 years. Visit our website at  Connect with us on twitter @EyeInfo and “Like” us on facebook Connect with us on Twitter @EyeInfo and subscribe (free subscription) to this blog.  Call (301) 670-1212 for office information and appointment scheduling

Shady Grove Eye and Vision Care


Does Eye Color Mean Anything?

What does your eye color mean? Type it into Google and you will get a bunch of sketchy personality quizzes and Yahoo! Answers pages. Oh sure there are some ancient superstitions out there like people with green eyes arepossessed by snakes, or that people with brown eyes are wise and don’t let anyone tell them what to do, but in today’s world we know that to be just old wives tales.

Ever heard of an iridologist? Neither have most people. An iridologist says that he or she can read your iris’s like a map to the body. The different colors and patterns in your iris match up to different organs or body parts. They say that by studying the changes in your iris over the course of your lifetime they can allegedly draw out information about your health and personality. One problem though, your iris doesn’t actually change over the course of your life.

So doesn’t your eye color mean anything about you? Well the truth is, no not really. What eye color you develop in later years (as a baby almost everyone’s eye color is blue) depends on our old friends, biology and genetics. As we get older a certain pigment within our iris begins to develop called melanin. If you have low levels of melanin in your eye, your eyes remain the blue they were as a baby. If you have really high levels of melanin it obscures the light entering your eyes leading to brown or even black eyes. Green and hazel eyes are a happy medium between the two extremes. The amount of melanin that you wind up with later on in life actually depends on your parents eye color genes. So really the only thing eye color actually means is that it serves as a reminder of where you came from. The next time you see your mom and dad, thank them.

Courtesy of the doctors at Shady Grove Eye and Vision Care; Optometrists, Ophthalmologists and Opticians serving the Rockville, Potomac and Gaithersburg Maryland suburbs of Washington, DC for over 43 years. Visit our website at  Connect with us on twitter @EyeInfo and “Like” us on facebook Connect with us on Twitter @EyeInfo and subscribe (free subscription) to this blog.  Call (301) 670-1212 for office information and appointment scheduling

Shady Grove Eye and Vision Care


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