Aqueous-Deficient Dry Eye
The lacrimal glands aren't producing enough tears. Common with age, certain autoimmune conditions, some medications, and after LASIK.
The Dry Eye Center at Berg-Feinfield
Comprehensive dry eye disease care, available at our Burbank and Sherman Oaks offices — serving Los Angeles, Beverly Hills, Studio City, Encino, Toluca Lake, Pasadena, Arcadia, and Valencia.
When First Treatments Don't Work
Most patients arrive at our Dry Eye Center after two or three failed attempts elsewhere — a string of artificial tears, six months on a drop with little effect, a warm compress and a sample of something. They're tired of the burning and blurred vision, and tired that no one has explained why it's happening.
Dry eye disease is complicated, and early treatment usually fails because no one has identified which mechanism is actually driving the case. A drop that stimulates tear production won't fix a tear that evaporates in three seconds. Our job is to identify the mechanism first, then match the treatment to it.
See Our TreatmentsWhat Dry Eye Actually Is
Dry eye disease is driven by more than one mechanism — and most cases involve a combination. Identifying which one dominates is what determines the right treatment.
Evaporative Dry Eye (MGD)
Tears are produced normally but evaporate too fast because the meibomian glands aren't making enough oil to hold the tear film in place. Meibomian Gland Dysfunction is the most common cause of dry eye today.
Both, in Combination
Most patients have some of each. An anti-inflammatory drop won't help much if your glands are clogged, and a gland-clearing treatment won't help much if inflammation is driving your case. We test for both.
Symptoms of Dry Eye Disease
If you recognize three or more of the following, dry eye disease is likely contributing to what you're experiencing.
Burning & Grittiness
A burning, stinging, or scratchy feeling, or a gritty sensation like there's something in your eye.
Fluctuating Vision
Blurred or fluctuating vision, often worse in the evening or after screen time.
Watery Eyes
Paradoxical reflex tearing — watery eyes triggered in response to the underlying dryness.
Redness & Sensitivity
Stringy mucus, redness, or sensitivity to light and wind.
Contact Lens Trouble
Increasing difficulty wearing contact lenses comfortably.
Tired Eyes
Eyes that feel tired by mid-afternoon. If several of these sound familiar, a short questionnaire before your visit helps us classify the severity.
How We Diagnose
A full dry eye evaluation isn't just “you have dry eye, here's a drop.” We combine objective and validated tests to identify which mechanism is driving your case.
01
Symptom Assessment
The Ocular Surface Disease Index — a validated questionnaire that scores severity and gives us a baseline to track change over time.
02
Tear Osmolarity
A quick, painless point-of-care test that measures the salt concentration in your tears. Elevated osmolarity is one of the most reliable objective markers of dry eye.
03
Tear Breakup Time (TBUT)
Measures how quickly the tear film breaks apart between blinks. A short breakup time points specifically to evaporative dry eye.
04
Meibomian Gland Evaluation
Imaging and expression to assess for MGD and the quality of oil production in your eyelid glands.
05
Corneal & Conjunctival Staining
Using fluorescein and lissamine green to visualize surface damage on the cornea and conjunctiva.
06
Schirmer Test
When appropriate, to measure aqueous tear production directly.
We use this combination to identify which mechanism is driving your case, so we choose the right treatment instead of guessing.
Prescription Drops for Dry Eye
Each prescription drop has a different mechanism. Most patients land on one — or a combination — after we identify the dominant problem driving their case.
Restasis
Cyclosporine 0.05% · anti-inflammatory · twice daily. The original immunomodulator, approved in 2003. Reduces the chronic inflammation behind much of dry eye disease. Effective but slow — 3 to 6 months for full effect — and can sting on instillation.
Cequa
Cyclosporine 0.09% · nanomicellar · twice daily. A higher-concentration cyclosporine in a nanomicellar formulation. Same mechanism as Restasis, better delivered, and faster-acting in some patients.
Vevye
Cyclosporine 0.1% · water-free · twice daily. The newest cyclosporine and the most tolerable — water-free and preservative-free, with far less stinging. Onset as early as two weeks. Usually our next try if Restasis failed or burned.
Xiidra
Lifitegrast 5% · LFA-1 blocker · twice daily. A different mechanism from cyclosporine, blocking the LFA-1/ICAM-1 inflammatory pathway. Approved in 2016. Some patients respond after failing cyclosporines, and vice versa.
Tryptyr
Acoltremon 0.003% · TRPM8 activator · twice daily. Approved in 2025. A first-in-class drop that activates TRPM8 receptors on the corneal nerves, prompting your body to produce more natural tears. Useful for aqueous-deficient dry eye. Stored refrigerated.
Miebo
Perfluorohexyloctane · anti-evaporative · four times daily. Approved in 2023 — the first FDA-approved drop targeting tear evaporation. Forms a stable monolayer that keeps water from evaporating. Useful for evaporative and MGD-driven dry eye.
In-Office Procedures for Dry Eye
When drops aren't enough — or when the problem is mechanical, like clogged glands — we move to procedures that address the underlying cause directly.
iLux
Thermal MGD treatment · 1–2 sessions. Applies controlled heat and gentle compression to the eyelids to liquefy the hardened oil clogging the glands and express them. The handheld device lets the doctor target the specific glands that need it. Improvement is common within a week.
Punctal Plugs
In-office · no anesthesia · reversible. Tiny silicone or collagen plugs placed in the tear drainage openings so your existing tears stay on the eye longer. Placed in minutes. Silicone plugs are removable; collagen plugs dissolve over weeks to months.
Lacrifill
Canalicular gel · ~6 months · reversible. A cross-linked hyaluronic acid gel placed in the tear drainage canals. Unlike standard plugs that block only the opening, it fills the entire canalicular system for a more complete block. Lasts about six months and can be irrigated out if needed.
Why Combination Treatment Works
Most patients with moderate to severe dry eye benefit from more than one treatment at a time. We're not trying to put you on a long list of products — we're trying to address every mechanism driving your case so the result is dramatic rather than incremental.
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Diagnosis First, Then Treatment
We identify which mechanism dominates before choosing a drop or procedure, so the plan is matched to your case instead of guessed.
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A Tiered, Layered Plan
A typical combination might be Vevye for inflammation, Miebo for evaporation, an iLux session for MGD, and an artificial tear for breakthrough days.
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Ophthalmologist-Led Care
An ophthalmology practice with 30+ years of experience, treating dry eye as a serious condition rather than dispensing artificial tears and sending people home.
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Help With Access & Cost
We help navigate prior authorizations and manufacturer copay-assistance programs for newer drops like Vevye, Miebo, and Tryptyr.
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Post-Surgical Dry Eye
We treat dry eye as a primary condition and in patients who developed it after LASIK or cataract surgery, whether performed here or elsewhere.
Dry Eye FAQs
Because dry eye has multiple mechanisms — inflammation, tear-production deficiency, tear evaporation, and gland dysfunction — and a single drop can only address one of them. A full evaluation figures out which mechanism is driving your case so we match the treatment to the problem instead of cycling through options.
It depends on the treatment. Tryptyr and Miebo can show effects within days, Vevye in about two weeks, and Restasis and Cequa take longer — one to three months for full effect. iLux often produces noticeable improvement within a week, and Lacrifill effects start the same day.
Most dry eye is chronic and doesn't resolve on its own, but the goal isn't always lifelong daily drops — it's a plan that controls your symptoms and protects the cornea. Some patients wean off prescription drops once the underlying mechanism, like MGD, is addressed with an in-office treatment. Others need maintenance therapy indefinitely.
All three are cyclosporine, all reduce inflammation, and all work — the differences are in delivery. Restasis is the longest-established but stings the most, Cequa is faster in some patients, and Vevye is the most tolerable and fastest in onset. If you've failed Restasis or stopped because of burning, Vevye is usually our next try.
LASIK can cause transient dry eye, especially in the first three to six months, because the procedure temporarily affects corneal nerves involved in tear production. Most cases resolve. Patients with pre-existing dry eye should be evaluated and treated before considering LASIK, and we screen for it at the LASIK consultation.
Long-lasting but not permanent. Silicone plugs can be removed in-office if needed, and dissolvable collagen plugs absorb within weeks to months. Lacrifill, the newer gel option, lasts about six months and dissolves on its own — or can be irrigated out earlier if needed.
Manufacturer copay-assistance programs are available for most newer drops, including Vevye, Miebo, and Tryptyr. We help patients navigate prior authorizations and savings programs, and older options like Restasis and generic cyclosporine are widely covered.
Yes, if untreated. Chronic dry eye can cause corneal damage and scarring over time, and severe cases can produce permanent vision changes. The earlier we intervene, the better the outcome — which is why we take it seriously rather than just dispensing artificial tears.
Yes. We treat dry eye as a primary condition and in patients who developed it after LASIK or cataract surgery, whether the surgery was performed at our practice or elsewhere.
The Dry Eye Center is at our Burbank and Sherman Oaks offices, both in the San Fernando Valley. They serve patients from Beverly Hills, Studio City, Encino, Toluca Lake, Universal City, Valencia, Pasadena, and Arcadia.
Schedule a Dry Eye Evaluation
If you're tired of the burning, grittiness, and blurred vision, a diagnosis-first evaluation is the key to lasting relief. Call us or request a consultation online — Burbank and Sherman Oaks appointments available across our five Los Angeles-area locations.