The tear film has 3 layers.

  1. Mucin Layer (Inner layer)
  2. Tears cannot stick to a vertical surface. Therefore, the mucin layer acts like Velcro that helps the tear film to stick to the eye

  3. Aqueous Layer (Middle Layer)
  4. This is the watery tear layer and is the thickest layer of the tear film. Similar to the lens inside the eye, the tear film also helps us to focus.

  5. Lipid Layer (Outer Layer)
  6. This is an oily layer that coats the surface of the tear film. It prevents the tear film from drying up. It also allows the eyelid to glide smoothly over the eye when we blink.

Any pathology in one or more of these layers can cause dry eyes.

Meibomian Gland Dysfunction (most common cause)


Decreased blinking such as prolonged reading or Parkinson disease

Contact lens wear

Lax eyelid

Sebaceous cell carcinoma (cancer of meibomian glands)

Sjogren Syndrome

Autoimmune diseases such as rheumatoid arthritis and lupus


After bone marrow transplantation

After radiation treatment

Chemical Burns

Thermal Burns

Drug Reaction such as Steven Johnson Syndrome

Vitamin A Deficiency

Vitamin C Deficiency

After eye infection


For patients known to have dry eyes, we can visualize the tear film dynamics such as

  • the behaviour of the outer lipid layer

  • the stability of the tear film (so called break up time)

  • the severity of meibomian gland dysfunction (meibography)

  • the irregularity of the surface of the eye (cornea topography) as a result of dryness


Gradual Dropout of Meibomian Glands in Meibomian Glands Dysfunction (MGD)


There are many causes of dry eyes. At Windsor Dry Eye Centre, our goal is to identify the cause of your dry eyes and discuss the treatment options with you.

  1. Wet Warm Compresses and Lid Scrub
  2. You can soften the thick meibomian secretions by applying wet heat (around 45oC) to the eyelids for 10 minutes. After the meibomian secretion is softened, you can massage them out and wipe it away with over the counter lid wipes or diluted baby shampoo on a face cloth. You must be careful not to burn your eyelids.

  3. Dietary Modification
  4. In general, increasing Omega-3 intake helps. Fishes such as salmon, sardines and mackerel are good sources of Omega-3. You can also take an Omega-3 supplement. You should also avoid foods that increase Omega-6 such as alcohol and spicy food.

  5. Environmental Modification
  6. There are many reasons in your daily life that enhances evaporative dry eyes, such as air blowing on your face when driving. If your house is too dry, having a humidifier in your room will also help. We shall review potential causes with you and recommend ways of modification.

We shall review potential causes with you and recommend ways of modification.

These treatments are effective depending on the cause of your dry eyes. Some of these treatments must be monitored as they are associated with potential side effects.

4. Artificial Tears

5. Oral Tetracyclines

6. Restasis eye drops

7. Steroid eye drops

8. Antibiotic ointment

Intense Pulsed Light (IPL) treatment for Meibomian Gland Dysfunction (MGD)

Dr, Chiu Doing IPL
Before Treatment
After Treatment

IPL is an FDA approved treatment for Meibomian Gland Dysfunction, so called Evaporative Dry Eye Disease. This is the most common cause of dry eyes. The meibomian glands produce the oily layer of the tear film, which is the outer layer of the tear film. Abnormal oily layer allows the tear film to evaporate quickly causing dry eyes. IPL not only helps to regulate the meibomian secretion, but it also decreases inflammation caused by dry eyes. IPL can also be used in rosacea, hair removal, skin pigmentation and skin rejuvenation. Unlike most centres where IPL is performed by technicians, at the Windsor Dry Eye Centre, IPL is performed by Dr. Chiu herself. Therefore, each session of IPL is tailored to your medical condition. In general, patients need 4 to 5 monthly treatments. A maintenance treatment may be needed every 6 to 12 months.