Dry eye occurs when there are insufficient tears to lubricate and nourish the eye. Tears maintain a healthy ocular surface and provide a smooth surface, enabling clear and comfortable vision. Dry eye sufferers either do not produce enough tears or the quality of tears produced is poor. This a problem commonly seen in practice.
During blinking, tears are spread over the cornea to provide lubrication, reduce the risk of eye infection, wash away unwanted debris and keep the surface of the eyes smooth, clear and comfortable. Surplus tears drain into the tear ducts located in the inner eyelid corners, which then drains the excess fluid into the back of the nose.
Tears are produced by several glands in and around the eyelids:
The meibomian glands produce fatty oils called lipids. These smooth the tear surface and slow evaporation of the middle watery layer. If these glands don’t produce enough oil, the watery layer evaporates too quickly . Sometimes these glands get clogged stopping the secretion of these oils. If the edge of the eyelids are inflamed (blepharitis, rosacea) the glands can also get blocked.
The middle layer is made up of mostly water with a little bit of salt. The fluid in this layer is produced by the tear glands (lacrimal glands). The purpose of the middle layer is to cleanse the eyes and wash away debris and irritants. Without this layer the mucus and lipid layer mix and cause a stringy discharge.
The inner layer of mucus spreads the tears evenly over the surface of your eyes. Without this layer dry spots can form on the front surface of the eye (cornea)
What causes dry eyes?
Age-The majority of people over age 65 experience some symptoms of dry eyes.
Medical conditions-rheumatoid arthritis, diabetes and thyroid dysfunction sufferers are more likely to have symptoms of dry eyes.
Inflammation of the eyelids (blepharitis), inflammation of the surfaces of the eye, or the inward or outward turning of eyelids can cause dry eyes to develop.
Side effect of certain medicines-antihistamines, decongestants, blood pressure medications and antidepressants, can reduce the amount of tears produced in the eyes.
Environmental conditions—exposure to smoke, wind and dry climates can increase tear evaporation resulting in dry eye symptoms. Failure to blink regularly, such as when staring at a computer screen for long periods of time, can also contribute to drying of the eyes.
Gender—women are more likely to develop dry eyes due to hormonal changes caused by pregnancy, the use of oral contraceptives, and menopause.
What causes dry eyes?
Other factors—long term use of contact lenses can be a factor in the development of dry eyes. Refractive eye surgeries, such as LASIK, can cause decreased tear production and dry eyes.
Diagnosis of dry eyes at City Eyes Ophthalmic Opticians:
Dry eyes can be diagnosed through a comprehensive eye examination. Testing, with special emphasis on the evaluation of the quantity and quality of tears produced by the eyes, may include:
A full Patient history to determine any symptoms you are experiencing and the presence of any general health problems, medications taken, or environmental factors that may be contributing to the dry eye problem.
External examination of the eye, including lid structure and blink behaviour. This will include photography of the external eye and glands to provide further analysis. In addition evaluation of the eyelids and cornea using bright light and magnification.
Special dyes may be instilled in the eyes to better observe tear flow
and to highlight any changes to the outer surface of the eye caused by
insufficient tear flow. Quantitative measurements can be obtained from
this examination
OCT (Optical Coherence Topography) – To assess tear film meniscus (thickness). Optical coherence tomography (OCT) is a non-invasive imaging test that uses light waves to take cross-section pictures of your Cornea and Retina.
How are dry eyes treated at City Eyes?
Dry eyes can be a chronic condition, but at City Eyes we aim to provide lifestyle changes, and suggest methods to help keep your eyes healthy, more comfortable, and prevent your vision from being affected. The primary approaches used to manage and treat dry eyes include treating the inflammation of the eyelids or eye surface that contributes to the dry eyes, adding tears for comfort, conserving tears, increasing tear production through diet and lid hygiene methods.
Treatment of the contributing eyelid or ocular surface inflammation—Prescription eye drops or ointments may be required in more severe cases. However we do recommend Blephex lid exfoliation treatment for blocked glands.
BlephEx™ is used to very precisely and carefully, spin a medical grade micro-sponge along the edge of your eyelids and lashes, removing dead skin and debris-exfoliating your eyelids. This is a treatment we offer at City Eyes.
Expressing blocked glands- We recommend eye-bags for expressing blocked meibomian glands. We stock microwavable eye-bags which have proven useful for blocked glands which can result in dry eye syndrome. If you use one of these products, make sure you clean the bag before and after use.
Adding tears—Preservative-free artificial tear solutions are recommended because they contain fewer additives that could further irritate the eyes. At City Eyes we recommend Natural Ophthalmics. Two unique eye drops which stimulate the production of all three tear film layers while supporting the health of the cornea, conjunctiva and eye lid. Two separate formulas, one created specifically for women. Both formulas include five powerful broad spectrum ingredients which relieve symptoms caused from inflammation due to aqueous deficiency, including severe dryness. Women experience more dry eye symptoms due to hormonal fluctuations so two of the most commonly prescribed ingredients for these symptoms is included in the Women’s tear stimulation formula. These drops are safe to use over contact lenses and provide great relief for our contact lens wearers.
Increasing tear production—Omega-3 fatty acid nutritional supplements. We recommend and stock Omega eye at City Eyes.
Less common methods:
Conserving tears—An additional approach to reducing the symptoms of dry eyes is to keep natural tears in the eyes for longer. This can be done by blocking the tear ducts through which the tears normally drain. The tear ducts can be blocked with tiny silicone or gel-like plugs (punctual plugs) that can be removed, if needed. A surgical procedure to permanently close tear ducts can also be used. In either case, the goal is to keep the available tears in the eye longer to reduce problems related to dry eyes. This is something we would refer you onwards for if deemed necessary.
Lifestyle changes to reduce symptoms of dry eyes include:
Remembering to blink regularly when reading or staring at a computer
screen for long periods of time
Increasing the level of humidity in the air at work and at home.
Sunglasses outdoors, particularly those with wrap around frame design, to reduce exposure to drying winds and sun.
Diet-Aim to eat at least two portions of fish a week, one of which should be oily fish.
you can also get omega-3s from various nuts and seeds, vegetable oils, soya and soya products, and green leafy vegetables.
Drink plenty of water (8 to 10 glasses) each day
For more information please give us a phone on 0207 638 6192 (24hrs)
Or drop an email at reception@cityeyesopticians.com. Our friendly,
helpful staff will be happy to answer any queries you may have or
arrange an appointment for you with one of our in house Specialists
By Belinda B