What is Dry Eye?
Dry eye or keratoconjunctivitis sicca is one of my favourite optometry topics; not only do I suffer this myself but it is also the most common eye condition I diagnose and treat in my practice on a day to day basis.
It may cause any or all of the following symptoms;
· Gritty or itchy eyes
· Foreign Body sensation
· Sore, stingy or red eyes
· Watery eyes
· Tired eyes
· Variable vision or glare sensitivity
What are the causes?
Generally there a 2 types of dry eye.
· Aqueous deficiency; the lacrimal gland fails to produce enough basal tear layer.
· Evaporative dry eye; due to (MGD) meibomian gland (oil glands of the eyelids) dysfunction resulting in a reduced oily component to the tears.
Causes may include;
· Age; evaporative dry eye is more common as we get older
· Gender and Hormones; with females more commonly affected than men, menopause, and hormone imbalance being associated.
· General health; Rheumatoid arthritis, thyroid dysfunction, Sjogren’s syndrome, Rosacea.
· Medication; antihistamines, antidepressants, some blood pressure medicines, Parkinson's medication and oral contraceptives.
· Environment; dry, dusty or windy climate, air conditioning, contact lens wear and computer use.
How is it diagnosed?
Your eye care professional can diagnose dry eye by way of the following;
· Asking specific questions with relation to your symptoms
· Measurement of the aqueous (watery layer) of your tears
· Measurement of your natural tear break up time; basically how long it takes between blinks before your tear film begins to evaporate
· Thorough assessment of your eye lids, tear film, cornea and conjunctiva using specific diagnostic dyes and a slit lamp biomicroscope to detect micro changes to the ocular surface.
· Careful assessment will be made to ensure there is no underlying condition causing your symptoms such as foreign body, infection, allergy or eye cancer.
Dry Eye Treatment
Depending on the cause there are a number of measures that can be taken to help relieve your dry eye;
Self Help for Dry Eye
Improve your Blink; consciously blink more frequently, particularly when reading and using a computer or digital device. Consider the quality of your blink, if your eyes begin to feel gritty; relax and take 10 slow, complete blinks.
Get Hydrated; you can hydrate your eyes from both the inside and out by ensuring your own fluid intake is sufficient while reducing alcohol and caffeine. Tear supplement eye drops can also help to replenish the tear film while some include electrolytes to enhance the hydration effect. You can also wear wrap around glasses which have a ‘moisture seal’ creating a more humid environment for eyes and increasing comfort.
Clean me; remove eye make-up thoroughly to ensure there is no debris clogging the meibomian glands. Furthermore, if you have been told you have blepharitis, a special eyelid cleanser may be recommended to clean the lids and lashes thoroughly.
Warm me up; Hot compresses work exceptionally well for evaporative dry eye. Your Optometrist will be able to supply you with a special heat pack for your eyes to maximise the effect. Otherwise just try a warm facecloth held over your eyes for up to 10 minutes, twice daily.
Topical eye drop medication; this may include an anti-inflammatory eye drop, specific tear supplements or even autologous eye drop serum- eye drops made from a small amount of your own blood product!
Oral medication and supplements; certain oral antibiotics can reduced eye lid and meibomian gland inflammation improving the eye appearance, comfort and tear film consistency. Furthermore clinical trials have shown evidence that a combination of both fish and flaxseed oil supplements can reduce dry eye symptoms.
Still not enough?
Punctal Plugs; A small sterile device is inserted into one of the small openings of the tear drainage ducts that are located in the inner corner of the upper and lower eyelids. These help to retain the tears in the eye for longer before draining away.
Blephasteam treatment; An in office ‘facial for the eyes’ which involves wearing specialised steam goggles for a 10 minute period. This gently helps to soften the oil within the blocked meibomian glands along the edge of each eyelid. This may then be followed by manual expression of the oil from previously blocked glands.
IPL treatment; the use of intense pulsed light may help to treat ocular rosacea; a condition whereby tiny blood vessels become dilated along the eyelid margin with associated meibomian gland dysfunction.