Why Your Dry Eye Treatment Isn’t Working — And What to Do About It in Los Angeles
Most dry eye patients in Los Angeles have already tried something before they find the right doctor. Artificial tears. Restasis for six months with no noticeable improvement. A warm compress. A sample of something from an optometrist. They’re still burning, still blurring out by mid-afternoon, and still waiting for someone to explain what’s actually going on.
The most common reason dry eye treatment fails is that no one has identified which type of dry eye is driving the problem before reaching for a prescription. That’s the starting point at the Dry Eye Center at Berg-Feinfield Vision Correction — the first diagnosis-first dry eye practice in the Los Angeles area, with dedicated dry eye care at their Burbank and Sherman Oaks locations.
What Causes Dry Eye Disease?
Dry eye disease is caused by one of two mechanisms — or, in most cases, a combination of both. Understanding which mechanism is dominant is the single most important factor in choosing the right treatment.
Aqueous-deficient dry eye occurs when the lacrimal glands don’t produce enough tears. It’s more common with age, autoimmune conditions like Sjögren’s syndrome, certain medications (antihistamines, antidepressants, blood pressure medications), and sometimes after LASIK surgery.
Evaporative dry eye is caused by meibomian gland dysfunction (MGD), where the oil-producing glands in the eyelids become clogged or underperform. Without a healthy oil layer, tears evaporate too quickly — even when production is normal. MGD is the most common cause of dry eye disease today and the form most frequently missed in a routine eye exam.
Most patients have elements of both. An anti-inflammatory drop designed to increase tear production won’t help if the real problem is that tears are evaporating in three seconds because the meibomian glands are blocked. A gland-clearing treatment won’t resolve symptoms driven primarily by inflammation. Artificial tears — regardless of brand or frequency — only manage symptoms without addressing the underlying cause.
What Are the Symptoms of Dry Eye Disease?
The most common symptoms of dry eye disease include burning, stinging, or a scratchy sensation in the eyes; a persistent gritty feeling like something is in the eye; fluctuating or blurred vision that worsens in the evening or after extended screen time; excessive watering (a paradoxical reflex response to underlying dryness); stringy mucus, redness, or sensitivity to light and wind; difficulty wearing contact lenses comfortably; and eye fatigue by mid-afternoon.
If three or more of these symptoms are present, dry eye disease is likely contributing to the problem — and a comprehensive evaluation, not another bottle of artificial tears, is the appropriate next step.
How Is Dry Eye Diagnosed in Los Angeles?
A proper dry eye diagnosis requires more than a brief slit lamp exam and a prescription. At Berg-Feinfield’s Dry Eye Center in Los Angeles, every evaluation includes six diagnostic tests designed to identify which mechanism is driving each patient’s case.
Tear osmolarity testing measures the salt concentration in the tears — elevated osmolarity is one of the most reliable objective markers of dry eye disease. Tear breakup time (TBUT) measures how quickly the tear film destabilizes between blinks, pointing directly to evaporative dry eye when the result is short. Meibomian gland imaging and expression assesses the structure and function of the oil-producing glands, identifying MGD. Corneal and conjunctival staining with fluorescein and lissamine green reveals actual surface damage on the eye that may not be visible without dye. Schirmer testing measures tear production volume directly when aqueous deficiency is suspected. And the Ocular Surface Disease Index (OSDI) questionnaire provides a validated severity score that serves as a baseline for tracking treatment response over time.
This combination tells the full story — which mechanism is dominant, how advanced the disease is, and which treatments are appropriate — before anything is prescribed.
What Are the Best Dry Eye Treatments Available in Los Angeles?
The Dry Eye Center at Berg-Feinfield offers 11 targeted treatments for dry eye disease, organized in tiers and selected based on what the diagnostic workup reveals. Most patients in Los Angeles who visit the center end up on a tailored combination of two or three treatments matched to their specific mechanism.
For inflammation-driven dry eye, prescription options include Restasis (cyclosporine 0.05%), Vevye (a newer water-free cyclosporine 0.1% formulation that is better tolerated and shows efficacy in as few as four weeks), and Tryptyr — a newer mechanism of action for patients who haven’t responded to traditional anti-inflammatory drops.
For evaporative dry eye caused by meibomian gland dysfunction, Miebo is a first-in-class, preservative-free, water-free drop that directly reduces tear evaporation by stabilizing the lipid layer — it’s not an anti-inflammatory and addresses a completely different part of the problem. iLux thermal gland expression is an in-office procedure that heats and clears blocked meibomian glands in a single visit, treating the root cause of evaporative dry eye rather than just managing symptoms.
For aqueous-deficient dry eye, punctal plugs — tiny devices inserted into the tear drainage ducts — help retain more natural tears on the ocular surface. Berg-Feinfield also offers Lacrifill, a hyaluronic acid canalicular gel that conforms to each patient’s anatomy, stays effective for approximately six months, and dissolves naturally — without the extrusion, sizing issues, or foreign body sensation common with traditional plugs.
Preservative-free artificial tears serve as foundation and bridge therapy for mild cases and between treatments.
What Is Meibomian Gland Dysfunction (MGD)?
Meibomian gland dysfunction is a chronic condition in which the meibomian glands — small oil-producing glands located along the upper and lower eyelid margins — become blocked, atrophied, or produce poor-quality oil. Because the oil (meibum) layer is responsible for preventing tear evaporation, MGD leads to an unstable tear film that breaks apart too quickly between blinks. This is the primary driver of evaporative dry eye, which accounts for the majority of dry eye disease cases.
MGD is frequently underdiagnosed because it doesn’t always present with obvious redness or discomfort in early stages, and standard eye exams don’t always include gland imaging or expression testing. By the time symptoms become significant, structural gland damage may already be present — which is why early diagnosis and treatment matter.
In Los Angeles, Berg-Feinfield’s Dry Eye Center evaluates meibomian gland function as part of every dry eye workup, using both imaging and manual expression to assess gland health before recommending treatment.
What Is the Difference Between Restasis, Vevye, Miebo, and Tryptyr?
These four prescription dry eye medications each work through different mechanisms and target different aspects of dry eye disease. They are not interchangeable, and the right choice depends on which type of dry eye a patient has.
Restasis (cyclosporine 0.05%) is an anti-inflammatory immunomodulator that increases natural tear production over time. It has been available the longest but can take three to six months to show full effect and causes stinging on instillation for many patients.
Vevye (cyclosporine 0.1%) is a newer, water-free formulation that delivers a higher concentration of cyclosporine in a perfluorobutylpentane vehicle. Because the formulation contains no water, it has no pH and no osmolarity — making it significantly more comfortable on instillation. Clinical data shows efficacy in as little as four weeks.
Miebo (perfluorohexyloctane) is not an anti-inflammatory. It is the first FDA-approved drop specifically designed to reduce tear film evaporation in patients with meibomian gland dysfunction. It works by supplementing the lipid layer of the tear film, addressing the evaporative mechanism directly.
Tryptyr (acoltremon ophthalmic solution 0.003%) represents a newer mechanism of action for dry eye disease, particularly for patients who have not responded adequately to cyclosporine-based therapies.
A diagnosis-first practice like Berg-Feinfield’s Dry Eye Center in Los Angeles determines which of these medications — alone or in combination — is appropriate based on objective testing, not trial and error.
What Is Lacrifill and How Does It Compare to Punctal Plugs?
Lacrifill is a cross-linked hyaluronic acid canalicular gel that provides punctal occlusion — the same function as traditional punctal plugs — through a different delivery method. Instead of inserting a solid silicone or collagen plug into the punctum, the gel is injected into the canalicular system where it conforms to the individual anatomy of each patient’s tear drainage ducts.
Lacrifill stays effective for approximately six months and dissolves naturally. It does not cause the foreign body sensation, self-extrusion, or sizing complications associated with traditional plugs. Because hyaluronic acid is a natural component of the tear film, the gel is well tolerated and provides continuous lubrication as it gradually breaks down.
At Berg-Feinfield’s Los Angeles Dry Eye Center, Lacrifill is offered as an alternative to traditional punctal plugs for patients with aqueous-deficient dry eye who need tear conservation but have had issues with conventional plug approaches.
Who Should See a Dry Eye Specialist in Los Angeles?
A dry eye evaluation at a dedicated center like Berg-Feinfield is appropriate for anyone in the Los Angeles area who has tried over-the-counter drops or a single prescription without meaningful improvement; experiences burning, stinging, grittiness, or blurred vision that worsens through the day or with screen use; has been told they have dry eye but was never told which type; has watery eyes that seem contradictory to a dry eye diagnosis; wears contact lenses that have become increasingly uncomfortable; or is preparing for LASIK or cataract surgery and needs to optimize the ocular surface before the procedure.
Where Is the Berg-Feinfield Dry Eye Center Located?
The Dry Eye Center at Berg-Feinfield Vision Correction offers comprehensive dry eye evaluations and treatment at two dedicated locations in Los Angeles: Burbank and Sherman Oaks. The practice serves patients throughout Los Angeles, Beverly Hills, Studio City, Encino, Toluca Lake, Pasadena, Arcadia, and Valencia. Berg-Feinfield has been in practice for over 30 years.
To schedule a dry eye evaluation, visit bergfeinfield.com/los-angeles-dry-eye-center or call 866-2-SEE FAR.
