Advanced Dry Eye Treatment in Omaha, Nebraska
Personalized dry eye workup and treatment by Dr. Ivey L. Thornton, MD — Board-Certified Ophthalmologist.
If over-the-counter drops aren’t cutting it, there is a reason. A thorough evaluation of tear film, lids, and surface — then a targeted plan, not a guess.
Dry eye is a diagnosis, not a symptom.
“Dry eye” is the catch-all patients use, but the condition has several distinct underlying causes — and each requires a different treatment approach. Pouring more artificial tears on a meibomian gland dysfunction, or treating aqueous deficiency as if it were evaporative disease, is why so many patients feel they’ve tried everything without lasting relief.
The work is diagnostic before it is therapeutic. Dr. Thornton’s dry eye evaluation at Truhlsen Eye Institute looks at tear film stability, meibomian gland architecture, tear osmolarity, inflammation markers, eyelid function, and ocular surface health. The plan that follows actually addresses your specific pattern.
Two main types.
Aqueous Deficient Dry Eye
Your lacrimal glands aren’t producing enough tears. Common with autoimmune conditions (Sjögren’s, rheumatoid arthritis, lupus), aging, certain medications (antihistamines, antidepressants, blood pressure medications), and after LASIK or refractive surgery.
Evaporative Dry Eye / Meibomian Gland Dysfunction (MGD)
Your tears evaporate too fast because the oily outer layer of the tear film is missing or abnormal. Comes from blocked meibomian glands in the eyelids. Accounts for 80%+ of dry eye cases. Common with rosacea, age, screens, and Demodex infestation of lashes.
Many patients have mixed dry eye — both mechanisms contribute. The treatment ladder looks different for each, which is why diagnosis matters.
Dry eye symptoms.
- Gritty, sandy, or burning sensation
- Redness
- Blurred vision that clears with blinking
- Excessive tearing (paradoxical — the eye reflexively tears from irritation)
- Light sensitivity
- Fatigue with reading or screen use
- Stringy mucus around the eyes
- Contact lens discomfort or intolerance
- Morning crustiness along the lid margins
Symptoms can be worse in dry climates, with low humidity, near fans or vents, with prolonged screen use, or after long hours of reading.
Diagnostic evaluation.
A comprehensive dry eye workup includes:
- Tear film break-up time (TBUT) — how quickly the tear film becomes unstable
- Schirmer’s test — measures tear production volume
- Tear osmolarity — elevated in dry eye
- Matrix metalloproteinase-9 (MMP-9) testing — detects inflammation
- Meibography — imaging of meibomian gland architecture
- Slit-lamp exam of lid margins, conjunctiva, and cornea with fluorescein and lissamine green dyes
- Interferometry — measures tear film lipid layer thickness
Treatment options.
A staged approach matched to severity and cause:
Preservative-Free Drops
Refrigerated artificial tears without preservatives, applied consistently. Often underutilized or misused by patients — dose and timing matter.
Restasis, Xiidra, Cequa
Anti-inflammatory prescription drops that treat underlying inflammation rather than just symptoms. Effects build over weeks.
Punctal Plugs
Tiny silicone plugs in the tear ducts keep tears on the eye longer. Reversible, in-office placement.
LipiFlow / iLux / TearCare
In-office thermal treatments that unblock meibomian glands. Restore natural oil production for 6-12+ months.
Intense Pulsed Light (IPL)
Light therapy to reduce lid inflammation and improve gland function — especially effective for rosacea-associated dry eye.
Autologous Serum Tears, Amniotic Membranes
For severe dry eye unresponsive to other treatments — biologically-derived lubricants and healing agents.
Lid hygiene & lifestyle foundation.
Even with all the prescription and procedural options, the fundamentals matter:
- Warm compresses (moist heat) for 10 minutes, 1-2 times daily for MGD
- Lid scrubs or tea-tree-based wipes for Demodex and lid-margin inflammation
- Omega-3 supplementation (not all omega-3s are equal — look for re-esterified or phospholipid forms)
- Blink exercises during screen work (20-20-20 rule)
- Humidifier use in dry indoor environments
- Review of systemic medications that contribute to dryness
Dr. Thornton will help prioritize which of these will make the biggest difference for your specific pattern.
Frequently asked questions.
Will I have to use drops forever?
Usually not. The goal of a comprehensive treatment plan is to reduce drop dependence over time — procedures like LipiFlow, IPL, and punctal plugs often mean patients can reduce or stop daily drops entirely once gland function is restored.
Why did my dry eye start after LASIK?
LASIK temporarily disrupts the corneal nerves that signal tear production. Dry eye after LASIK is common for 6-12 months and usually resolves. If it persists or is severe, a dedicated workup often reveals an underlying MGD or aqueous deficiency that was subclinical before surgery.
Is dry eye treatment covered by insurance?
Most medical dry eye treatments (prescription drops, punctal plugs) are covered. Newer procedures like LipiFlow and IPL may be out-of-pocket depending on insurer and whether they’re coded as medical or cosmetic.
Can diet really affect dry eye?
Yes, though modestly. Omega-3 supplementation has the best evidence for improving meibomian gland function. Staying well-hydrated matters. Excessive caffeine and alcohol can worsen dryness.
My eyes water all the time — how can that be dry eye?
Reflex tearing. When the ocular surface is chronically irritated, it triggers floods of watery reflex tears — which evaporate quickly and leave the eye drier than before. Counter-intuitive but very common.
Should I stop wearing contacts?
Not necessarily, but contact lens use often reveals underlying dry eye. Treatment can usually restore contact lens tolerance; in some cases, switching lens material or modality helps.
About Dr. Thornton & advanced dry eye care.
Dr. Ivey L. Thornton is Board-Certified by the American Board of Ophthalmology with fellowship training at Harvard (neuro-ophthalmology) and Cincinnati Eye Institute (anterior segment surgery). Dry eye spans both subspecialties — neuro-ophthalmology informs understanding of the tear reflex and corneal nerve involvement, anterior segment expertise informs the mechanics of meibomian glands and tear film.
Her approach is diagnostic-first: define what kind of dry eye this is, treat the mechanism, and measure improvement objectively.
Dry Eye Care Locations.
- Truhlsen Eye Institute — Omaha, Nebraska. Full diagnostic workup and in-office procedures.
- Consultations also available at Harlan Ophthalmology (Harlan, IA) and Burgess (Onawa, IA).
See the Contact & Locations page for specifics.