Do you suffer from Dry Eyes?
Dry Eye syndrome now affects a large number of the population on a global scale. As our society becomes more digitally immersed, we have seen dry eye rise exponentially – many practitioners term this computer vision syndrome.
Most of us will be affected by dry eyes at some stage in our lives. Many believe environmental factors have a key role in exacerbating the condition. Some of the most common factors are:
- Artificial lighting
- Driving and concentration
- Extended periods on tablets or computer screens
- Wearing contact lenses
- Air conditioning
- Dust and air pollution
- Windy environments
Dry eye is a significant problem for many New Zealanders, and cases continue to rise year on year.
The most common symptoms of dry eye are:
- Red eyes
- Burning or itchy eyes
- Pain on waking
- Discharge from the eyes
- Light sensitivity
- Discomfort on screens or when reading
- Vision that intermittently blurs
- Feeling as if there is something lodged in your eye
- A gritty sensation like sand
Dry eye tends to be more common in the following groups:
- The elderly
- Post-menopausal women
- Those who have had laser or other eye surgery
- Those who wear contact lenses
- Those with a pro-inflammatory diet
- Those prescribed certain medications
What causes dry-eye syndrome?
To understand the cause of dry-eye, it’s good to first have an understanding of the tear layer. There are three primary components:
- The mucin layer acts like a bonding agent. Produced by goblet cells in the conjunctiva, it lies directly in contact with the ocular surface.
- The aqueous layer is considered the ‘salt water’ layer. It is produced by the lacrimal gland and also carries cells important for immunity.
- The meibum layer is the top most layer of our tears. This is produced by the meibomian glands in our upper and lower eyelids. Meibum acts to prevent evaporation, and maintain a state of ocular hydration.
The way each of these layers interact to maintain a balanced state, is termed the tear equilibrium. A loss of the normal tear equilibrium results in dry eye.
Most patients are of the understanding that dry eye is due to a reduced tear output. This form of dry eye is termed aqueous deficiency. Contrary to this popular belief, only around 20% of dry eye cases are aqueous deficient in nature.
The majority of dry eye cases are in fact due to meibomian gland dysfunction. This type of dry eye accounts for up to 80% of cases. The meibomian glands have a reduced or altered function, leading to tear evaporation and a drying out of the ocular surface.
What treatments are available for those with dry-eyes?
To treat dry eye successfully we must identify the underlying cause. Artificial tear drops are useful in a number of circumstances, such as after laser eye surgery or in mild dry eye. However these usually provide only brief symptom relief, and often don’t treat the underlying cause.
At Hawera Eyecare, we recommend a complete Dry Eye Assessment for any of our patients’ with symptoms of dry eye. This gives us time to undertake a detailed analysis of your symptoms, isolate the underlying factors and develop a custom treatment plan for your care.
The following Treatments for Dry Eye are available at Hawera Eyecare:
- IPL (Intense Pulse Light)
IPL is a safe treatment for dry eye that is used by thousands across the globe. IPL is a cost effective, fast-acting and a relatively pain free treatment for dry eye and associated symptoms.
The IPL uses calculated pulses of light to stimulate the Meibum producing glands. Evidence suggests this may act to improve outflow or quality of oil expression, and in turn improve symptoms of dry eye.
Commonly asked questions from those considering IPL
Is IPL uncomfortable?
Most feel no discomfort. Some have a very short sensation of warmth. The IPL pulses are not directed at the eyes themselves but at the meibomian glands which are located in the upper and lower eyelids. For safety and protection, all patients wear opaque eye shields during treatment.
How longs do treatments take?
The treatment itself can take anywhere from 5-15 minutes for both eyes. After each treatment we examine your glands, and often express them to assess oil production.
How many treatments will I require?
Your IPL treatment consists of three sessions, each carried out at two week intervals over six weeks in total. Because the results are cumulative, many notice an improvement in time. Some notice an immediate improvement.
Is the IPL treatment suitable for everyone?
IPL is suitable for most people who suffer from Meibomian Gland Dysfunction or evaporative dry eye. This treatment can be effective for all severities of dry eye, from mild cases to those with significant symptoms. We may not recommend IPL if you are taking certain medications or have specific general health conditions.
Those with the aqueous deficient form of dry eye alone may not benefit form IPL. This is why we recommend Dry Eye Assessments for all our patients. We can isolate the underlying causes and tailor a treatment regime that will best help you.
- Punctal Plugs
Punctal plugs are used mostly for those with aqueous deficiency – inadequate tear production.
Your punctum is located nasally, on the upper and lower eyelids. It is an opening which leads to your nasolacrimal canal. Tears drain through the punctum and into the back of the nose and throat. By inserting a punctal plug, tears remain on the ocular surface for longer to improve hydration and dry eye symptoms.
Punctal plugs are often disposable. Some last a few days while others last a few months. This depends on the material. We usually begin with dissolvable punctal plugs to determine whether this is a treatment that will benefit you.
If you benefit from disposable punctal plugs, we may consider permanent plugs. Many of these are made from silicon and remain in the tear duct indefinitely, though can be removed if required.
- Prescripton Anti-Inflammatory Medicines
Prescription medications can be very useful in dry eye. These are used primarily for their anti-inflammatory properties; dry eye is increasingly considered an inflammatory disease. By breaking this cycle, we can improve tear production and consistency or improve inflammatory lid disease.
- Blephasteam Goggles
This is a non-invasive treatment for dry eye. A gentle warming heat stimulates the meibomian glands, to improve oil outflow. This can be useful in evaporative dry eye, and is a great way of supplementing conventional hot compresses.
- Dietary Modification
Several practitioners believe a pro-inflammatory diet can contribute to dry eye and exacerbate the inflammatory cycle. Many patients benefit by incorporating supplements into their diet such as Omega 3. Some prefer to incorporate these naturally, and increase their uptake of certain foods such as Salmon.
- Lid Hygiene
Eyelid health is an important and often under-diagnosed factor in dry eye. Dedicated scrubs are especially useful in cases of blepharitis or to help those with Demodex. Scrubs are a combination of natural and anti-inflammatory agents to improve lid health and combat dry eye.
- Gland Expression and Margin Debridement
In office expression of the oil glands or debridement of inflamed lid margins, can be very useful for those suffering from inflammatory dry eye.
- Scleral Contact Lenses
Scleral RGP Contact lenses create a lake of fluid which remains in contact with the eye. This can improve corneal hydration for those with dry eye.