Dry Eye Consultation
Dry eye is caused by either a patient not secreting enough water into their tears (often a problem post-menopause or associated with certain inflammatory conditions), or excessive evaporation of the watery component of the tears (often due to blocked oily glands on the lid margin).
Dry Eye signs and symptoms can include:
· Dryness of the eye
· Mucous discharge
· Redness
· Sandy or gritty feeling
· crusty or salty lid margins
· Itching
· Burning
· Constant or occasional tearing
· Watery eyes
· Light sensitivity
· Eye pain or soreness
· Lid infections
· Styes
· Tired eyes
· Contact lens discomfort
About 85-86% of dry eye patients have a significant underlying evaporative component. A recent study found pure Evaporative Dye Eye (EDE) in 35% of patients with only 10-14% having pure Aqueous deficiency Dry Eye (ADDE). The remaining 55% had a mixed or unknown classification (Lemp et al. 2012). This overlap between the two primary causes of dry eye it means that most patients, even those with predominantly aqueous deficiency, will benefit from treatments that improve meibomian lipid secretions thereby helping to conserve the aqueous layer of the tears by reducing the evaporative component of their dry eye.
Treatments like IPL have many benefits, such as reducing inflammatory mediators in the aqueous secreting lacrimal and lipid secreting meibomian glands, lid margin and ocular surface, improving their health. IPL also stimulates the cells in the meibomian glands to secrete more, better quality oils that can flow more freely into the tears and reduce evaporation. Patients with a severe dry eye in Sjögren’s syndrome which primarily effects the aqueous secreting primary and accessory lacrimal glands, can further benefit from IPL treatment as they can develop a much more severe form of MGD than normal due to this inflammatory condition.
The openings of the Meibomian glands on the lid margin get narrower as we get older and the lipids in the glands tend to stagnate and become more viscous. This means that lipid secretions are reduced and can solidify, effectively plugging the openings. This is called Meibomian Gland Dysfunction (MGD).
These blocked glands often become inflamed and infected. This is called posterior blepharitis which can make your eyelids red, itchy, burning, sore or sting. In severe cases, when the lash follicles are also affected (anterior blepharitis), the eye lashes may fall out, the eyelids become swollen and you can develop corneal ulcers and styes. The symptoms can often be worse in the morning and when you wake up you may find your lids are stuck together.
Paradoxically, watery eyes are often caused by the release of reflex tears due to the irritation caused by dry eye damage to the cornea. Reflex tears don’t provide a good, balanced tear film (unlike background tears). Often the eye is less well lubricated after a period of reflex tearing.
When dry or watery eye symptoms are experienced for the first time or increase significantly, we recommend an assessment by our optometrists. At Eyecare Specialists we offer consultations to discuss the management of your dry eye symptoms. This examination involves assessing both the quality and the quantity of the tears as well as investigating the wider health of the ocular surface and eyelids. We can then make personalised recommendations based on your specific symptoms.
At Eyecare Specialists, we also offer in-practice treatments for moderate to severe dry eye - for example Intense Pulsed Light (IPL) and punctal occlusion. IPL treatment reduces inflammation and stimulates the lipid glands by PhotoBioModulation. This enables better secretions whilst also killing mites and bacteria living in the oily glands. Punctal plugs can reduce the speed the tears drain away, usually by occluding the larger lower duct. This can be helpful when a very low tear volume is present. In more severe, aqueous deficient dry eye the upper puncta are often occluded as well. In cases where totally occluding a puncta is too much, a perforated plug can be fitted, which reduces drainage though the puncta, rather than arresting it completely.
Another in-house Dry Eye treatment offered at Eyecare Specialists is the ZEST procedure which uses a derivative of the okra plant, Abelmoschus esculentus in a gentle, painless exfoliation process of the eyelids, lid margin and lashes. The whole process takes about 10 minutes from start to finish. It provides immediate and quite long lasting relief, having anti-inflammatory, antibacterial and anti-demodex properties. By removing biofilm and microbial exotoxins ocular comfort can be greatly improved in most cases.
For questions and to book a dry eye consultation please contact our Four Marks or Alton practices. For more details on the products we recommend for dry eye treatment, please visit our dry eye products page. Further, in-depth information on dry eye can be found here.
