Dry Eye Syndrome
Dry eye disease is a very common and multifactorial condition that occurs when insufficient or poor quality tears are produced, thereby not sufficiently providing the lubrication needs of the eye. It is estimated to affect up to 33% of the Melbourne population (McCarty et al. 1998). Typically, a chronic and progressive condition, it results in a wide range of irritating symptoms which may disrupt everyday activities and hobbies. Depending on the cause, severity and chronicity of the dry eyes, it may not be completely curable, but in most cases, dry eyes can be successfully managed.
Dry eye causes and symptoms
- Dryness, general eye discomfort or burning sensation.
- Foreign body sensation in the eyes.
- Excessive eye irritation when exposed to smoke or wind.
- Red eyes.
- Watery eyes.
- Mucus discharge accompanied by blur or fluctuation to vision.
- Itchiness and stinging, often compounding allergy related symptoms.
- Discomfort when wearing contact lenses especially at the end of the day.
- Intermittent blurred or fluctuating vision.
- Light sensitivity.
- Increased discomfort in air conditioning or heating.
What factors cause dry eye?
Tear production normally diminishes with age. Meibomian gland and eyelid abnormalities also increase as we grow older.
Exposure to wind, dust, cosmetics and air pollution are common causes of dry eyes. Office workers with prolonged exposure to heaters or air conditioner, along with long demanding visual tasks are at increased risk. As we spend more time on digital devices (smartphones, tablets, TV or other gaming devices), dry eye symptoms become more prevalent due to a decrease in blink rate when looking at screens. Reduced blinking or poor blinking technique may disrupt the normal tearfilm.
Some medications such as decongestants, acne medication, diuretics, antihistamines, antidepressants, contraceptives, and medications to treat high blood pressure can cause a decrease in the tear production.
Systemic conditions such as rheumatoid arthritis, thyroid eye disease, lupus, sarcoidosis and some allergies and skin conditions (rosacea) are highly linked to dry eye syndrome. Sjogren’s syndrome is a relatively common autoimmune disease that results in immune system cells, lymphocytes, and autoantibodies attacking the moisture producing glands in the eyes, salivary glands and other parts of the body. People with diabetes also commonly suffer from dry eyes as their corneal sensitivity can diminish and lead to reduced blinking rate.
Types of Dry Eye
The tear film is composed to an outer lipid layer, middle aqueous layer, and an inner mucin layer. Any, or a combination of the layers not being optimal can result in dry eyes.
The outermost lipid layer prevents evaporation of the tearfilm and is produced by rows of meibomian glands within our eyelids. Inflammation, blockage or atrophy of these glands lead to faster evaporation of the tearfilm and is termed Meibomian Gland Dysfunction. Our latest Oculus Keratograph® 5M utilizes infrared light to painlessly image and evaluate the health of the meibomian glands (Meibography) to aid the management of your dry eyes. This is the most common cause of dry eye, accounting for up to 80%.
The lacrimal glands of the eye fail to produce enough of the watery component of the tear film. It is common in women, particularly during times of hormonal change such as during pregnancy, and menopause.
The mucin layer is the thinnest layer of the tear film but responsible for the tear film adhering to the eye. Without this layer, tears would not adhere to the surface, making the cornea susceptible to damage. If there is damage to the goblet cells in the eyelids, the mucin layer is affected.
Frequently, dry eye will be a combination of definiencies in two, or even all three tear layers.
At Sanctuary Lakes Eyecare, we will perform a Comprehensive Dry Eye Assessment to identify the causes and severity of your dry eyes. Our optometrist will provide you with a specific and tailored treatment plan to relieve you from dry eye symptoms. Our diagnostics and treatments follow the latest evidence-based research from the International Dry Eye Workshop (DEWS 2007) and (DEWS2017).
Control/condition your environment
Avoid places/environments that can increase the symptoms of dryness in the eye, such as direct exposure to fans, being near air conditioners or heaters, smokes etc. On sunny or windy days always wear protective eyewear or sunglasses.
Likewise, remember to drink more water and reduce diuretics such as coffee or tea. If you are dehydrated, your eyes are too.
Depending on what type of dry eye you have, a wide range of tear supplements (artificial tears) are available to replace the missing components in the tear film. Sometimes manuka honey derived eye drops, anti-inflammatory eye drops or a compound pharmacy formulated eye drop will be beneficial.
Intense Pulse Light(IPL)
Intense Pulse Light with meibomian gland expression
IPL treatment an exciting new treatment for dry eye disease. We use a Lumenis M22 Optima IPL to provide a series of photochromatic pulses of light, customised for individual skin pigmentation, following a well researched treatment protocol. Typically treatment involves four treatments over a three month period.
Potential mechanisms whereby IPL could achieve clinical improvement include thrombosis of abnormal blood vessels below the skin surrounding the eyes, heating the meibomian glands and liquefying the meibum, activation of fibroblasts and enhancing the synthesis of new collagen fibers, eradication of Demodex and decreasing the bacterial load on the eyelids, interference with the inflammatory cycle by regulation of anti-inflammatory agents and Matrix metalloproteinases (MMPs), reducing the turnover of skin epithelial cells and decreasing the risk of physical obstruction of the meibomian glands, and changes in the levels of inflammatory mediators. It has been shown to be highly effective in evaporative dry eye, rosacea associated dry eye, and demodex blepharitis.
Blephasteam with eyelid debridement and Meibomian gland expression
Blephasteam goggles are an eyelid warming medical device that provides relief to patients with meibomian gland dysfunction by heating the oil the glands, which when combined with lid margin debridement and therapeutic meibomian gland expression, improves the thickness and quality of the tears, which consequently will ease the evaporative dry eye symptoms.
Other treatment options include occlusion of tear drainage channels with punctal plugs or punctal cautery to keep tears longer in the eye.
Omega 3 supplements have been shown to be very beneficial for dry eye, blepharitis and meibomian gland dysfunction as they help in reducing inflammation, and improve the quality of the oils secreted by the meibomian glands (Bhargava et al. 2013; Kangari et al. 2013). Studies by Bhargava et al. (2013) and Kangari et al (2013) found a 71% improvement in subjective and objective just by increasing omega 3 in the diet. It has also been shown to help with computer vision syndrome related dry eye (Bhargava et al. 2015).
Often omega 3 supplements sold at pharmacies or supermarkets may not have the potency or formulation for maximum benefit to tear film function so before you buy, please make sure to always consult with one of our optometrists and seek advice before commencing as care needs to be taken when you are taking certain medications, particularly anticoagulant medication.
What to do if you suspect you have dry eye?
If you suspect you could be suffering from dry eye or are experiencing symptoms like the ones mentioned above, please contact us today to book an appointment for an assessment with one of our optometrists.
Blepharitis is a common and chronic condition in which the eyelids are inflamed as a consequence of the accumulation of deposits, oils, mites and bacteria on the eyelid margin.
Demodex Blepharitis is caused by a common eyelid mite that lives within the eyelash follicle.
Similar to dry eye, symptoms of blepharitis include:
- Red, itchy and swollen eyelids.
- Itching, stinging or burning sensation in the eyes.
- Excessive tearing.
- Red eye.
- Blurred Vision.
- Foreign body sensation.
- In severe cases crusts on the eyelid margin and flaky skin.
- In some cases thickening of eyelid margins may result in an ailment known as trichiasis, in which the eyelid turns inwards causing eyelashes to produce abrasion to the cornea and conjunctiva.
- Malfunction of the meibomian glands in your eyelids.
- Bacterial infection.
- Dermatitis, such as seborrheic dermatitis (where there is flaky skin and dandruff on the scalp of the eyebrows).
- Acne Rosacea, condition consisting of redness of the skin.
- Demodex, a common eyelash mite.
Meibomian Gland Dysfunction (MGD), the leading cause of dry eye, is a progressive disease characterised by duct obstruction or alterations of the meibomian glands, which causes anomalies in the quality and quantity levels of the tears. Although asymptomatic at the beginning, symptoms escalate with time making it extremely uncomfortable, generating quality of life issues to patients who have this condition. Early treatment can reduce the likelihood of gland atrophy over time.
Applying warm compresses to the affected area, attempts to liquefy, solidified secretions that might be blocking the glands.
This in-office procedure gently removes bacterial debris, and biofilm along the eyelid margins, reducing the most common causes of eyelid inflammation. The procedure is commonly combined with a tea tree oil based solution, to effectively control the demodex mite population. The procedure is well tolerated and patients often report immediate improvements in symptoms.
Intense Pulse Light(IPL)
Intense Pulse Light with meibomian gland expression
IPL treatment an exciting new treatment for dry eye disease. Potential mechanisms whereby IPL could achieve clinical improvement include thrombosis of abnormal blood vessels below the skin surrounding the eyes, heating the meibomian glands and liquefying the meibum, activation of fibroblasts and enhancing the synthesis of new collagen fibers, eradication of Demodex and decreasing the bacterial load on the eyelids, interference with the inflammatory cycle by regulation of anti-inflammatory agents and Matrix metalloproteinases (MMPs), reducing the turnover of skin epithelial cells and decreasing the risk of physical obstruction of the meibomian glands, and changes in the levels of inflammatory mediators. It has been shown to be highly effective in evaporative dry eye, rosacea associated dry eye, and demodex blepharitis.
At Home Maintenance Eyelid Hygiene
There is a variety of cleaning products and eyelid scrubs specifically designed for blepharitis, because they eliminate, oil, bacteria and debris but also stimulate the glands. Maintaining the eyelid margins clean will control build up and will reduce symptoms. If necessary our optometrists will advise which is the most indicated for you.
Oral or topic antibiotics are prescribed,according to each individual case.
Blephasteam with eyelid debridement and Meibomian gland expression.
Blephasteam goggles are an eyelid warming medical device that provides relief to patients with meibomian gland dysfunction by heating the oil the glands, which when combined with lid margin debridement and therapeutic meibomian gland expression, improves the thickness and quality of the tears, which consequently will ease the dry eye symptoms.
A variety of supplements such as Omega 3 and others directed to patients with dry eye conditions can be intake to improve the quality of the tears and preserve the health of the eye.