Dry eye disease describes a spectrum of conditions that feature ineffective lubrication of the eye. Symptoms range from discomfort through to disabling pain, redness and fluctuating vision and can impact on many visual activities.
The underlying causes of dry eyes are complex and numerous and need a thorough examination for your optometrist to determine the cause and most appropriate treatment. At our Adelaide and Woodville practices our therapeutic optometrists are equipped with the technology to appropriately diagnose and treat dry eye disease.
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The tear film is made up of three elements:the mucin (mucous) layer, the watery aqueous layer and the oily lipid layer . 1 Specialised cells (such as goblet cells) embedded throughout the surface of the eye create the mucin component. The lacrimal gland under the bony aspect of the eyebrow secretes the watery aqueous component. The meibomian glands in the upper and lower eyelids secrete oil to make up the lipid component.
In most dry eye cases, the watery aqueous component is produced at normal quantities but evaporates too quickly. This is called evaporative dry eye. There are three main causes: blepharitis, meibomian gland dysfunction and environmental factors. 1
Severe cases of dry eye are due to low production of aqueous tears, referred to as aqueous deficient dry eye. This is less common than evaporative dry eye, and may be due to autoimmune disease, dehydration, poor sleep, medication or prior eye surgery. 1
Dry eye disease can be treated. Lubricating eye drops are helpful but are ineffective on their own for the most cases. Dry eye disease is best treated with a comprehensive, step wise, management system 2 which involves restoring proper function to meibomian glands, maintaining good eyelid hygiene, protecting the eyes, and using lubricants.
Adequate water intake and sleep. Chronic dehydration or poor quality sleep most certainly causes dry eyes and depending on the circumstances, may be relatively easy to address. 1
Minimise environmental triggers. Screen use is the biggest external factor on dry eyes. People stare more and blink less when concentrating, particularly when looking at screens so reducing unnecessary screen time, taking regular short breaks or even just being conscious of staring can reduce dry eye symptoms. Also, if appropriate, minimising drying medications, use of air conditioning or forced air heating, alcohol intake and ceasing smoking can be helpful.1 Commercially available air humidifier devices may also offer relief.
Lubricating drops replenish the deficient tear film and are a fundamental component of dry eye disease management. There are many eye drops with varied ingredients and your optometrist will discuss the best option for you. Preservative free drops are essential to avoid further aggravation of the inflamed ocular surface. Often just switching to a preservative free lubricating drop can make a dramatic difference.
These are only beneficial for individuals that don’t get enough omega 3 in their diet which typically means less than 2 serves of fish a week. In these cases ~1200mg/day of high quality fish oil can improve the quality of oil produced by the meibomian glands. 4
A warm compress helps to clear blocked meibomian glands by liquefying the thickened oil inside. The glands need to be heated to only 40-50 degrees but for a full 10 mins 5 , followed by 1 minute of blink training. Performed regularly, this process helps to maintain regular function of the glands for an adequate protective lipid layer.
Proper blinking keeps your tears healthy by spreading tears and releasing oil from eyelid glands into the tears. Blink training, described on the last page, both promotes more complete blinks and also maximises the effect of warm compresses.
Medical grade manuka honey is antibacterial, reduces swelling and promotes healing and these qualities make it useful in treating meibomian gland disease . 6 It is easy to use but honey is mildly acidic which may cause temporary stinging on application - it doesn’t cause harm to the eyes on application.
Sunglasses are crucial for the health of everyone’s eyes but are particularly helpful protecting dry eyes from the harsh effects of wind. Clear glasses can be helpful for the same reason to protect from air conditioning even when no prescription is required.
The eyelids are a difficult part of the body to adequately clean since soaps cause stinging if they get into the eyes. But good eyelid hygiene is an important element of managing dry eye disease . 1 Antibacterial lid foams or washes cleanse the eyelids and lashes while conditioning the skin around the eyes without any stinging or irritation.
The blephasteam is an electronic eyelid warming device that guarantees optimal heating temperature of the eyelids for the correct length of time. Combined with in-office manual expression with your optometrist, it can be a useful addition or replacement to at-home lid warming and massage . 2
For more severely irritated eyelids, an in-office exfoliation with the Blephex device, an electric brush, comprehensively cleans the eyelid skin of persistent built up debris and dry hardened skin. 3
Innovative Eye Care is the first practice in South Australia to offer Intense Pulsed Light (IPL) treatments for dry eye disease. IPL technology generates an intense pulsed light directed at the lower eyelid, providing a deep warming effect to the oil glands and reducing inflammation. 4 Four treatments are required to best manage MGD over a 10 week period.
Tears should continually wash across the eye to keep it clean and comfortable and to drain away into a duct through the lower eyelid into the nose. It’s why your nose runs when you cry. When tear production is low, dissolvable or permanent (but removable if needed) plugs can be placed into the duct opening to improve dry eye symptoms and reduced reliance on lubricant drops. 1
Inflammation and dry eyes are related in a complex way. Anti-inflammatory drops are used short term to break the cycle between inflammation and dryness, or allow other therapies to work. In some cases, over-the-counter mast-cell stabilizers can counteract inflammation as a result of friction that a normal tear layer would prevent. 7
Particularly useful for symptoms of dry eyes that are worse on waking in the morning, thick, long-lasting lubricants protect the eyes throughout the night. 2
Low dose antibiotic tablets prescribed in conjunction with your GP can be effective in controlling the deeper inflammation within the meibomian glands and improve gland functioning. 4
Eye drops made from the serum of a person’s own blood, which has anti-inflammatory and repair functions, can soothe severely dry eyes and are prepared through the public hospital system. 4
Contact lenses are able to protect the surface of dry eyes by acting like a bandage and keeping moisture on the surface of the eye during lens wear or protecting the surface of the eye from the rubbing action of the upper eyelid during blinks. 4
In severe dry eye disease, inflammation becomes the primary problem and the long term use of prescription-only, preservative-free, anti-inflammatory eye drops is needed.
The final stage options include surgery to permanently block tear drainage, to smoothen or tighten eyelid shape or gland transplantation. 2