Dry Eye

Do you suffer from dry eyes?

Dry-eye syndrome is a very common affliction affecting a large proportion of the population. With the integration of technology within society, we have seen a dramatic increase in those who suffer from dry eye. Many practitioners refer to dry eye as computer vision syndrome. It is considered a hallmark of the digital age.

Most people are affected by dry eye at some stage in their life. The condition is often exacerbated by an environmental factor. Some common environmental triggers are:

• Artificial lighting
• Driving and concentration
• Extended periods at computer monitors
• 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
• A burning or itching sensation
• Pain and/or excessive discharge on waking
• Discomfort when reading or on screens
• Sensitivity to bright lights
• Intermittent blurring of vision
• Feeling as if there is something in or around your eye
• A scratchy sensation

Dry eye tends to be more common in the following groups:

• Older individuals
• Post-menopausal women
• Those with a history of eye surgery including laser
• Contact lens wearers
• Those with a pro-inflammatory diet
• Those who take certain medications

What causes dry-eye syndrome?

Our tears are made up of three primary layers:

• The mucin layer is directly in contact with the ocular surface. It acts in a similar fashion to a bonding agent for other tear layers
• The aqueous layer is produced by the lacrimal glands above our upper eyelid. This layer is considered the ‘watery’ layer, and also contains immune factors
• The meibum layer is produced by the meibomian glands in the eyelids. This is an oily layer, which acts to retard evaporation and in doing so maintain a state of ocular hydration.

These layers interact in a way that maintains a state of balance. A loss of the balance between these layers may result in what is termed ‘dry eye’.

Many consider dry eye a disease resulting from lack of tear production. Perhaps counter-intuitively, a low tear production only accounts for around 20% of the cases of dry eye. This type of dry eye is termed aqueous-deficient dry eye.

The majority of dry eye cases are due to dysfunctional meibomian glands. These glands may have a reduced or an altered function: resulting in tear evaporation and a ‘dry’ ocular surface.

What treatments are available for those with dry-eyes?

Successful treatment of dry eye is dependent on the correct diagnosis of the underlying causes. Though useful in mild cases, eye drops are primarily considered symptom relief (much like taking paracetamol for a headache) and usually do not correct the underlying reasons for the dry eye.

At Wanganui Eyecare, we recommend a complete Dry Eye Assessment for all of our patients with dry eye. This allows us to isolate the underlying causes for your symptoms, and to develop a tailored treatment plan for you.

Dry-Eye treatments available at Wanganui Eyecare are:

• IPL (Intense Pulse Light)

  IPL is a safe treatment that has been used by thousands of people globally to reduce symptoms of dry eye. IPL is an affordable, non- invasive, and relatively pain free procedure that can have long lasting results for sufferers of dry-eye.

  Using measured pulses of light, the IPL treatment stimulates the Meibomian glands which lie just below the upper and lower eye lids and are responsible for the production of meibum. By improving the consistency, and outflow of meibimum IPL aims to restore balance to the tear equilibrium and in doing so improve symptoms of dry eye.

  Frequently asked questions on IPL

  Does the IPL treatment hurt?
  Most feel no pain. Some have a very short sensation of heat. The IPL treatment is directed at your Meibomian glands which are situated under your eyelids. It is not directed into the eye itself. As a precaution, every patient wears opaque eye protection goggles during a treatment.

  How longs do treatments take?
  The IPL typical treatment itself takes approximately 5-10 minutes. We often examine your eyes before and after treatment, and check production by expressing your glands.

  How many treatments will I require?
  Typically, three treatments are required over a period of 30 days. The results offer cumulative benefits but you may notice an improvement after your first treatment.

  Is the IPL treatment suitable for everyone?
  Yes for most people. IPL treats dry-eye syndrome caused by Meibomian gland dysfunction, the most common form of dry eye. The treatment can be useful for those with mild ranging to severe Meibomian gland dysfunction. Certain medications and general health conditions may exclude you from treatment with IPL.

  Those with aqueous deficient dry-eye disease are unlikely to benefit from IPL. This is why we recommend all of our patients have a complete Dry-Eye Assessment. We can investigate the source of your discomfort and recommend the best treatment for you.

• Punctal Plugs

  Punctal plugs are useful in aqueous deficient dry eye – the form of dry eye where your eyes produce insufficient tears.

  The punctum is a narrow opening located on the lower and upper eyelids. Tears drain through the punctum, through a duct and down into your nose and throat. By placing a plug in the punctum, we reduce the outflow of tears to prevent the surface drying out.

  Most commonly the plug is placed in the inferior punctum – in your lower lid. Punctal plugs may be dissolvable and made from synthetic materials such as collagen. Dissolvable punctal plugs can last anywhere from a few days to several months depending on the material. They gradually dissolve with time.

  Plugs can also be permanent; many of these are made from silicon and remain in the tear duct indefinitely.

• Prescripton Anti-Inflammatory Medicines

  Prescription medications are often used in dry eye. These may be in the form of eye drops, or medicines taken orally. As dry eye is commonly referred to as an inflammatory process, these act to break the cycle of irritation. In doing so, these medications can reduce lid inflammation and improve the production and consistency of meibum.

• Blephasteam Goggles

  The Blephasteam goggles are a heat-therapy treatment. Gentle moist heat stimulates your meibomian glands and promotes oil production.

• Dietary Modification

  There is increasing evidence that a pro-inflammatory diet may have a role in dry eye. Some find a significant relief when increasing their update of Omega-3 fatty acids naturally into their diet, or through supplementation such as fish-oil.

• Lid Scrubs

  Specialised scrubs are particularly useful in cases of blepharitis or those with demodex. These combine numerous anti-inflammatory agents to help improve dry eye symptoms.

• Gland Expression and Lid Debridement

  In office debridement of the eyelid margin or expression of the meibomian (oil producing) glands can be of great benefit for those suffering from evaporative dry eye.

• Scleral Contact Lenses

  Scleral lenses act to prevent evaporation, and promote the retention of tears under the lens.