When our eyelids are open, the exposed surface of the eye is covered by a thin film of tears, known as the tear film. Tears are a complex liquid secretion, composed of various substances, secreted by several glands around the eye. The tear film provides an environmental barrier, protection as well as lubrication to the external part of the eye, facilitating clear vision and comfortable movement of the eyelids over the ocular surface during blinking. If this tear film is inadequate or insufficient, the ocular surface becomes exposed. This imbalance in the tear film leads to symptoms of ocular irritation or signs of an unhealthy ocular surface.
- Sensations such as grittiness, stinging, burning
- Watery eyes
- Tired eyes
- Tears that feel sticky
- Blurry vision
- Light sensitivity
- Mild crusting around the eyelids on waking
Aqueous Deficient dry eye is when the eye produces an insufficient volume of tears. The aqueous layer is produced by the lacrimal gland. If the lacrimal gland is not producing enough aqueous, the eye will become dry.
Evaporative dry eye occurs due to a deficient tear film component. This deficiency causes an increase in tear evaporation. Meibomian Gland Dysfunction (MGD) is the most common cause of evaporative dry eye. Meibomian glands secrete the oily component of tears that slows down evaporation. Poor secretions of oil into the tear film cause increased tear evaporation.
Factors that can contribute to imbalance in the tear film include:
- A dry environment: The dry air in an overheated room in winter or an over- airconditioned room in summer may be sufficient to cause dry eye symptoms.
Smoky environments can also cause dryness symptoms.
- Infrequent blinking (often associated with prolonged screen time)
- Existing medical conditions (such as diabetes, rheumatoid arthritis, Sjogren’s syndrome and thyroid disorders)
- Inflammatory skin disorders (such as Rosacea) and eyelid disorders and blepharitis (an infection/inflammation of the eyelid) may cause Dry Eye by affecting the production of the lipid layer of the tear film.
- Gender: Dry Eye is more prevalent among women, particularly with increasing age. Symptoms may also be particularly prevalent during pregnancy.
- Aging: As we age, there is a decrease in the quantity of tears we produce. This may lead to dry eye.
- Taking certain medications (These include glaucoma medication, antihistamines, decongestants, antidepressants, hormone replacement therapy, diuretics, some treatments for Parkinson’s Disease and some blood pressure lowering medications).
- Contact lens wear: People who wear contact lenses tend to be more at risk for developing Dry Eye.
- History of laser eye surgery (For up to 6 months after laser eye surgery, corneal sensitivity may be decreased which can lead to a decrease in the blink reflex during the early post-laser surgery period).
- Damage to tear glands from inflammation or radiation
A proper diagnosis of dry eye condition requires a comprehensive clinical examination with an eye care professional. The session should involve a thorough case history of your symptoms and their severity. Our team of professionals have access to the latest technology in dry eye diagnostics and treatment.
Corneal Evaluation – Examining the cornea. This includes measuring tear meniscus height, tear film break-up time, and tear consistency.
Lid Evaluation – Examining the eyelid margins and glands for conditions such as Blepharitis and Meibomian Gland Dysfunction (MGD). A comprehensive lid evaluation may include LipiView® ® digital imaging and meibum expressions.
A wide range of treatments are available to alleviate Dry Eye symptoms, with the treatment protocol often tailored to the severity of signs and symptoms. Not all treatments work for all people. You may need to try more than one before finding a treatment that works for you, which is why it is best to consult a professional to discuss treatment options.
- Lubricants \ Artificial tears
- Warm compresses
- Home based lid hygiene
- Altering environment
- Omega 3 fatty acids
- Punctual plugs
- Blephex (in house lash cleaning)
- Sleep goggles
- Moisture chamber spectacles
- Prescription only eye drops (consider options available in the UK if we want to list them)
- LipiFlow Thermal Pulsation System
- Intense pulsed light (M22™ Lumenis)
- PRGF/ Endoret eye drops
- Lid surgery
Apart from ocular irritation, dry eye may lead to more serious ocular surface inflammation, infection and decreased visual performance affecting ones overall quality of life. For this reason, it is important to seek professional advice.