Dry Eyes
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.
Why You’re Here
When First Treatments
Don’t Work
Most patients arrive at our Dry Eye Center after two or three failed attempts at fixing the problem somewhere else. They’ve tried a string of artificial tears. They’ve been on Restasis for six months and felt almost nothing. They’ve been told to use a warm compress and given a sample of something. They’re tired of the burning and the blurred vision, and tired of the fact that no one has explained why this is happening.
Dry eye disease is complicated. The reason most early treatment fails is that nobody has figured out which mechanism is actually driving your case — and there are several. Our job is to identify the mechanism first, then match the treatment to it.
“Identifying which mechanism dominates determines which treatments will actually help you. A drop that stimulates tear production won’t fix a tear that evaporates in three seconds.”
— The Dry Eye Center at Berg-FeinfieldWhat Dry Eye Actually Is
Aqueous-Deficient Dry Eye
Your lacrimal glands aren’t producing enough tears. Common with age, certain autoimmune conditions, some medications, and post-LASIK.
Evaporative Dry Eye (MGD)
Tears are produced normally, but evaporate too fast because the meibomian glands aren’t producing enough oil to hold the tear film in place. Meibomian Gland Dysfunction (MGD) is the most common cause of dry eye today.
Both, in Combination
Most patients have some of both. An anti-inflammatory drop won’t help much if your glands are clogged. A gland-clearing treatment won’t help much if inflammation is driving your case. We test for both.
Common Signs
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, stinging, or scratchy feeling
- A gritty sensation, like there’s something in your eye
- Fluctuating or blurred vision, often worse in the evening or after screen time
- Watery eyes (paradoxical reflex tearing in response to underlying dryness)
- Stringy mucus, redness, or sensitivity to light and wind
- Difficulty wearing contact lenses
- Tired eyes by mid-afternoon
Before Your Visit
If you’re nodding to three or more of these, complete one of our short questionnaires and bring it to your visit. The scores help us classify the severity and track your response to treatment.
A Complete Workup
How We Diagnose
A full dry eye evaluation isn’t just “you have dry eye, here’s a drop.” We use a combination of objective and validated tests to identify which mechanism is driving your case.
Symptom Assessment
The Ocular Surface Disease Index — a validated questionnaire that scores severity and gives us a baseline to track change over time.
Tear Osmolarity (Osmo)
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.
Tear Breakup Time (TBUT)
Measures how quickly your tear film breaks apart between blinks. A short TBUT points specifically to evaporative dry eye.
Meibomian Gland Evaluation
Imaging and expression to assess for MGD and the quality of oil production in your eyelid glands.
Corneal & Conjunctival Staining
Using fluorescein and lissamine green to visualize surface damage on the cornea and conjunctiva.
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.
Treatments at the Dry Eye Center
A Tiered Approach, Matched to Your Mechanism
Dry eye is treated in tiers. Most patients land on a combination of two or three of the following — chosen specifically for the mechanism we identify during your evaluation.
Over-the-counter lubricants that hydrate the eye. Useful as bridge therapy and for mild dry eye. Preservative-free single-use vials are gentler on the surface than multi-use bottles if you’re using drops more than four times a day. Different formulations target different problems — some address the aqueous component, others have lipid emollients for evaporative dry eye. We’ll recommend a specific brand based on your evaluation.
Six Targeted Drops, Each With a Different Job
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.
The original immunomodulator, approved in 2003. Reduces the chronic inflammation that drives a lot of dry eye disease. Twice daily. Takes 3 to 6 months to reach full effect. Effective but slow, and the original formulation can sting on instillation.
A higher-concentration cyclosporine in a nanomicellar formulation. Same mechanism as Restasis, better delivered, and faster-acting in some patients. Twice daily.
The newest cyclosporine, and the most tolerable. Water-free, preservative-free, with no pH or osmolarity to balance — which means significantly less stinging on instillation. Onset as early as two weeks. Twice daily. If you’ve failed Restasis or stopped because of burning, Vevye is usually our next try.
Different mechanism from cyclosporine. Xiidra blocks the LFA-1/ICAM-1 inflammatory pathway specifically involved in dry eye. Approved in 2016. Twice daily. Some patients respond to Xiidra after failing cyclosporines, and vice versa.
Approved in 2025. A first-in-class drop that works differently from everything else on this list — it activates TRPM8 receptors on your corneal nerves, which triggers your own body to produce more natural tears. Useful for aqueous-deficient dry eye where the goal is to increase production rather than reduce inflammation. Twice daily. Stored refrigerated.
Approved in 2023. The first FDA-approved drop targeting tear evaporation specifically. Forms a stable monolayer on the tear film that prevents water from evaporating. Four times daily. Useful for evaporative dry eye and MGD-driven cases.
Beyond Drops
In-Office Procedures for Dry Eye
When drops aren’t enough — or when the mechanism is mechanical, like clogged glands — we move to procedures that directly address the underlying problem.
A thermal, in-office treatment for Meibomian Gland Dysfunction. iLux applies controlled heat and gentle compression to the eyelids to liquefy hardened meibum (oil) clogging the glands and physically express them. Most patients need one or two sessions. Dr. Feinfield was featured on CBS Los Angeles performing the procedure — watch the CBS LA news clip.
Tiny silicone or collagen plugs placed in the tear drainage openings (puncta) so your existing tears stay on the eye longer. Placed in-office in minutes, no anesthesia required. Useful for patients with reduced aqueous tear production. Silicone plugs are removable; collagen plugs dissolve on their own over weeks to months.
A newer alternative to traditional punctal plugs. Lacrifill is a cross-linked hyaluronic acid gel placed in the tear drainage canals. Unlike standard plugs that block just the punctal opening, Lacrifill fills the entire canalicular system, providing a more complete block. Effect lasts about 6 months. In-office procedure. Reversible — can be irrigated out if needed.
The Real Answer
Why Combination Treatment
Is Usually the Answer
Most patients with moderate to severe dry eye benefit from more than one treatment at a time — for example, Vevye twice daily for inflammation, plus Miebo for evaporation, plus an iLux session for MGD, plus an artificial tear for breakthrough days.
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.
“We’re trying to address every mechanism driving your case so the result is dramatic rather than incremental.”
— The Dry Eye Center at Berg-FeinfieldWhere We Are
The Dry Eye Center · Burbank & Sherman Oaks
The Dry Eye Center is based at our Burbank and Sherman Oaks offices, both in the San Fernando Valley. Patients travel to us from Beverly Hills, Studio City, Encino, Toluca Lake, North Hollywood, Universal City, Pasadena, Arcadia, Valencia, and across greater Los Angeles.
Burbank
Serves the eastern San Fernando Valley, Toluca Lake, Studio City, and the Pasadena/Arcadia corridor. Valencia and Santa Clarita patients are about 30 minutes south of Burbank on the 5.
Burbank office detailsSherman Oaks
Closer for patients coming from Beverly Hills or the Westside — 20 to 25 minutes north on the 405. Also serves Encino, Studio City, and the central San Fernando Valley.
Sherman Oaks office detailsPatients we see at our Beverly Hills, Arcadia, or Valencia offices can schedule dry eye evaluations at Burbank or Sherman Oaks through the same front desk.
Questions We Hear a Lot
Frequently Asked
The questions we hear most often from patients researching dry eye treatment in Los Angeles, Burbank, Sherman Oaks, and Beverly Hills.
Schedule a Dry Eye
Evaluation
If you have been diagnosed with keratoconus, or if you are experiencing the frustrating symptoms of progressive vision loss, proactive, specialized treatment is the key to preserving your eyesight for the future. With state-of-the-art facilities across five Los Angeles area locations, Berg-Feinfield is your trusted partner for world-class corneal care.
