Ocular Surface & Dry Eye
Lasting relief from Medi Eslani, MD, FAAO (a fellowship-trained surgeon and published ocular surface researcher), using the most advanced therapies available, from autologous serum and amniotic membrane to LipiFlow and IPL.
Understanding the Problem
Ocular surface disease affects how comfortable you feel and how clearly you see, and it's far more common than most people realize.
Your tears aren't just water. They're a finely balanced film of water, oil, and mucus that keeps your eye smooth, clear, and comfortable. When that film breaks down (too few tears, poor-quality tears, or blocked oil glands known as meibomian gland dysfunction), the surface becomes inflamed and unstable. That's ocular surface disease (OSD); dry eye disease is its most common form.
Types
Dry eye is not one condition, and this is the single most useful thing to understand about it. Treatment that works beautifully for one type does very little for the other, which is why so many people cycle through artificial tears for years without real improvement. Working out which mechanism is driving your symptoms is the first job of the evaluation.
The most common form
Your eye makes enough tears, but they evaporate too quickly because the oil layer that should seal them in is missing or of poor quality. The usual cause is meibomian gland dysfunction, where the oil glands along your eyelid margins become blocked or their secretions thicken. Adding more watery drops achieves little, because the problem is the oil rather than the water.
Less common
The lacrimal glands simply do not produce enough tear volume. This is the type most associated with autoimmune conditions such as Sjogren's syndrome and rheumatoid arthritis, with age, and with certain medications. Here, conserving and supplementing tears genuinely does help.
Very common in practice
Many people have both, and the balance between them shifts over time. That is why a good plan is reviewed and adjusted rather than set once and left alone. Sorting out the proportion is precisely what the testing is for.
Diagnosis
Symptoms alone are a poor guide. Some people with significant surface damage report surprisingly little discomfort, while others with mild findings are genuinely miserable, and the two types of dry eye can feel identical from the inside. Objective measurement is what separates a real plan from guesswork.
Tear quality
A small amount of dye shows how long your tear film stays intact between blinks. A film that breaks up within a few seconds points strongly toward the evaporative type and toward oil gland dysfunction as the driver.
Surface damage
Dyes reveal where the surface cells of your cornea and conjunctiva have been damaged. The pattern of that staining indicates not only how severe the disease is, but frequently what is causing it.
The glands themselves
Your eyelid margins and the oil glands within them are examined directly, and the glands can be imaged to show whether they are blocked, shortened, or have dropped out altogether. Gland loss is permanent, which is why finding it early matters.
Volume and inflammation
Tear volume is measured where aqueous deficiency is suspected, and testing can confirm whether active inflammation is driving your symptoms. That answer changes whether anti-inflammatory treatment is likely to help you.
The point of testing is not thoroughness for its own sake. It is to identify which mechanism is driving your symptoms, so the treatment chosen actually addresses it.
For Glaucoma Patients
Most patients on glaucoma drops develop ocular surface disease. Years of daily drops (especially preserved ones containing BAK) inflame and damage the surface, causing burning, redness, and fluctuating vision. It can even make your glaucoma harder to monitor and your drops harder to tolerate.
As both a fellowship-trained glaucoma specialist and a published ocular surface expert, Dr. Eslani treats the whole picture. He can reduce, or even eliminate, your drop burden with SLT laser, sustained-release implants (Durysta, iDose), and MIGS, while simultaneously healing your ocular surface with advanced therapy. Very few surgeons offer this combined expertise.
Advanced Treatment
When over-the-counter drops aren't enough, Dr. Eslani offers the full range of modern, evidence-based dry eye treatment.
Anti-inflammatory drops and prescription treatment to calm the surface and restore your natural tears.
Gentle thermal pulsation that clears blocked oil (meibomian) glands, treating the most common cause of dry eye at its source.
In-office light therapy that reduces inflammation and restores oil-gland function for lasting relief from evaporative dry eye.
Custom drops made from your own blood, rich in natural healing factors, for moderate-to-severe dry eye that resists standard drops.
A regenerative graft that rapidly heals a damaged ocular surface, reducing inflammation and scarring.
Tiny plugs that preserve your natural tears, and specialty lenses that bathe the eye in moisture for severe cases.
What to Expect
Dry eye treatment works as a ladder, and most people need more than one rung of it. Here is what the main in-office therapies involve in practice, so you know what you are agreeing to before you agree to it.
One in-office visit
Applies controlled warmth to the inner surface of the eyelid while gently massaging the outer surface, melting and expressing the hardened oil that is blocking your glands. The treatment takes about twelve minutes. Improvement builds over the following weeks rather than arriving immediately.
A short series
Intense pulsed light is applied to the skin around the eyes, reducing inflammation and improving oil gland function. It is normally given as a series of sessions a few weeks apart, with occasional maintenance afterward, and it is particularly useful when rosacea is part of the picture.
Made from your own blood
A blood sample is processed into eye drops carrying the natural growth factors your own tears contain. They are used several times daily and are reserved for moderate-to-severe disease that has not responded to standard drops, including surface damage following surgery.
For a damaged surface
A regenerative graft placed on the eye to promote healing and reduce inflammation and scarring where the ocular surface is significantly damaged. Dr. Eslani has published peer-reviewed research on amniotic membrane transplantation.
Expectations
Dry eye is a chronic condition. That word disappoints people, but it is the truth, and knowing it at the start is what allows a plan to succeed. Ocular surface disease is managed the way blood pressure is managed, rather than cured the way an infection is cured.
What changes with proper treatment is the trajectory. Symptoms come under control, the surface heals, vision stops fluctuating through the day, and the underlying drivers are addressed rather than masked. Many patients reach a point where they need very little ongoing maintenance.
Realistic timeline
Treatments that address the cause, rather than lubricating the symptom, take several weeks to show their full effect. Gland function recovers gradually and inflammation settles gradually. Judging a treatment after a few days is the most common reason people conclude that nothing works.
What cannot be undone
Meibomian glands that have completely atrophied do not grow back. That is the strongest argument for treating dry eye properly rather than managing it with lubricating drops for a decade, and it is why imaging the glands early is worth doing.
A Foundation in the Science
Long before he was your surgeon, Dr. Eslani helped advance the science of the ocular surface. He trained under two of the world's leading cornea and ocular surface experts, Dr. Edward Holland and Dr. Ali Djalilian, and built an internationally recognized research career in stem-cell therapy and ocular surface reconstruction.
His work on limbal stem cells, corneal healing, and amniotic membrane transplantation appears in 70+ peer-reviewed publications and the field's leading textbook. Your dry eye and ocular surface care is guided by someone at the very forefront of the field.
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Dr. Eslani provides the full range of surgical and medical eye care across San Diego County and the Imperial Valley.
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