Dry eye is among the most common and most undertreated conditions in eye care. At Berg-Feinfield, we diagnose the root cause — and match you with treatments that actually work, not just drops that mask symptoms.
Dry eye develops when your eyes don't have the right quantity or quality of tears to stay comfortable and clear. Most patients have a combination of two types — but identifying the dominant cause is the most important step in getting effective relief, because treating the wrong type produces little benefit.
That's why we start with diagnosis. TearLab osmolarity testing measures the salt concentration of your tears — the most objective, quantifiable biomarker for dry eye severity available. Combined with a slit lamp exam, meibomian gland evaluation, and a thorough medication review, it lets us confirm your diagnosis, assess severity, and track your response at every visit.
Understand the Two TypesYou may have dry eye if you regularly experience any of these:
Most patients have a combination of both, but identifying the dominant cause is the key to effective relief. Treating the wrong type produces little benefit.
The lacrimal glands are not producing enough water-based tears. The eye surface dries out because there simply isn't enough tear volume, regardless of how well the oil layer is functioning.
Treated with: preservative-free tears, Meibo, Lacrifill, Restasis, Cequa, Xiidra, and Tryptyr — along with a thorough medication review.
The meibomian glands in the eyelids are not producing enough protective oil. Without a healthy lipid layer, the water-based tears evaporate within seconds, even if tear production is completely normal.
Treated with: iLux thermal pulsation, Intense Pulsed Light (IPL), and BlephEx — in-office procedures that address the gland blockage and inflammation that artificial tears cannot reach.
A significant number of dry eye patients take one or more medications that reduce tear production or degrade tear quality. Identifying them is often the single highest-yield step in the evaluation.
Among the most potent contributors to aqueous deficiency dry eye. Both oral antihistamines and antihistamine eye drops reduce secretory gland activity, including the lacrimal glands. Examples: diphenhydramine, cetirizine, loratadine, fexofenadine, olopatadine eye drops.
Tricyclic antidepressants and SSRIs have anticholinergic properties that reduce lacrimal gland secretion. Many patients on long-term therapy develop progressively worsening dry eye. Examples: amitriptyline, sertraline, fluoxetine, paroxetine, duloxetine.
Beta blockers reduce lacrimal gland secretion by blocking beta-adrenergic receptors involved in tear production. Diuretics reduce overall body fluid volume, affecting tear quantity and quality. Examples: metoprolol, atenolol, propranolol, hydrochlorothiazide, furosemide.
Declining androgens are strongly linked to meibomian gland dysfunction. Oral contraceptives and anti-androgen therapies can accelerate this effect, particularly in younger women. Examples: oral contraceptives, hormone replacement therapy, anti-androgen medications.
Directly suppresses meibomian gland secretion and can cause lasting changes to gland structure. Dry eye during and after use is extremely common and may persist long after the medication is stopped. Examples: isotretinoin (Accutane, Absorica, Claravis).
Reduce all secretory gland activity, including tear production. Found in medications for overactive bladder, motion sickness, Parkinson's disease, and certain psychiatric conditions. Examples: oxybutynin, tolterodine, scopolamine patches, benztropine.
Important: Never stop or change a medication based on dry eye concerns without consulting your prescribing physician. However, identifying medication contributors allows coordination with your other providers — a timing adjustment, dose change, or medication switch can sometimes significantly improve dry eye without compromising your other health conditions.
Berg-Feinfield offers the full spectrum of dry eye therapy, built around your specific diagnosis — not a one-size-fits-all protocol. These options restore and supplement tear production.
The foundation of dry eye management. Preservative-free formulations are essential for patients using drops more than four times daily, since preservatives accumulate on the ocular surface and worsen dry eye over time.
A preservative-free, water-free drop that targets the lipid layer of the tear film, effective for both aqueous deficiency and evaporative dry eye by stabilizing the oil-water interface.
Hyaluronic acid gel instilled directly into the canaliculus (the tear drainage channel), providing continuous, sustained lubrication from within the eye's own drainage system. An excellent option for severe aqueous deficiency when drops alone are insufficient.
Reduces the chronic inflammation that suppresses tear production. Takes 3–6 months of consistent twice-daily use for full benefit. Best for moderate-to-severe aqueous deficiency with ocular surface inflammation.
Higher-concentration cyclosporine using nanomicellar technology for deeper corneal penetration. An option for patients with inadequate response to Restasis or requiring stronger anti-inflammatory therapy.
Blocks LFA-1 integrin, a different inflammatory pathway than cyclosporine. Some patients see symptom improvement faster than with cyclosporine-based drops. Used twice daily; works well as an alternative or add-on therapy.
Activates the nasal-lacrimal reflex arc to directly stimulate aqueous tear secretion. Unlike immunomodulators, it does not work through the inflammatory pathway — it prompts the glands to produce more tears naturally. An option for patients who have not responded to topical prescription therapies.
In-office procedures that restore meibomian gland function and the lipid layer — addressing the underlying blockage and inflammation that drops cannot reach.
Applies controlled heat and gentle pressure to both surfaces of the eyelid, melting the thickened, waxy secretions blocking the meibomian glands and expressing them to restore normal oil flow. About 8 minutes per eye; many patients notice improvement within 2–4 weeks. Typically repeated every 6–12 months.
Broad-spectrum light pulses target the abnormal blood vessels (telangiectasias) around the eyelid margins that drive the MGD inflammatory cycle, while applying heat that liquefies blocked secretions. Standard course: 4 sessions, 3–4 weeks apart. Particularly effective for rosacea-related ocular surface disease. Annual maintenance recommended.
A precision instrument that removes biofilm, bacterial debris, and crusting from the eyelid margins — the accumulation that contributes to meibomian gland obstruction and blepharitis. Takes 6–8 minutes; commonly combined with iLux or IPL for comprehensive MGD management.
For evaporative dry eye caused by meibomian gland dysfunction, iLux applies controlled heat and gentle pressure to both surfaces of the eyelid — melting the thickened, waxy secretions blocking the meibomian glands and expressing them to restore normal oil flow.
Each treatment takes approximately 8 minutes per eye. Many patients notice improvement within 2–4 weeks, and treatment is typically repeated every 6–12 months. iLux is often combined with IPL and BlephEx for comprehensive MGD management.
Schedule a Dry Eye EvaluationMost dry eye patients have managed symptoms with drops for years. What they haven't had is a diagnosis — and knowing which type of dry eye you have changes everything about the treatment.
We identify the root cause of your dry eye rather than masking symptoms, so treatment targets what's actually driving it.
The most objective, quantifiable biomarker for dry eye severity — used to confirm diagnosis, assess severity, and track your response at every visit.
Advanced in-office procedures that address the gland blockage and inflammation that artificial tears cannot reach.
Expertise in both major types of dry eye — because most patients have a combination, and identifying the dominant cause is essential.
Comprehensive dry eye care across Burbank, Sherman Oaks, Beverly Hills, Arcadia, and Valencia.
If drops aren't cutting it, it's time for a proper evaluation. We'll identify exactly what's driving your dry eye and build a treatment plan around it — not a one-size-fits-all protocol.
Los Angeles Dry Eye Center · Burbank · Sherman Oaks · Beverly Hills · Arcadia · Valencia
