What is Dry Eye?

Dry eye disease (keratoconjunctivitis sicca) is a very common condition. It affects one in five adults. For your eyes to be comfortable, you need an adequate supply of tears.  When you don’t have enough tears to provide lubrication, or they dry too quickly (for example, riding a bike), dry eye will develop. You may experience dry eye when flying, after reading or looking at a computer screen, or being in an airconditioned room.

What are the symptoms of dry eye?

  • Your eyes will feel sore, itchy, tired, heavy, or have a burning sensation
  • Your eyes feel gritty or sandy
  • You may have blurred vision that fluctuates with blinking, or is worse when reading or working on the computer
  • Your eyes are red and possibly sensitive to light (photophobia)
  • You discover that there is discharge or crusting around your eyes, especially first thing in the morning.
  • You are increasingly susceptible to styes, chalazia and eyelid infections
  • Your eyes are very watery! Eyes that are dry trigger excessive “reflex” tearing
  • You may develop a foamy tear film over your eyes
Posterior blepharitis dry eye is progressive from meibomian gland blockage requiring artificial tears

Is dry eye a serious disease?

Yes.

Dry eye is chronic, progressive and irreversible.

Apart from causing annoying symptoms, dry eye can have more serious consequences:

  • Dry eye is becoming much more common, especially in young people. Symptoms are progressive and usually become harder to treat later in life.
  • Eye inflammation, abrasion of the cornea, corneal ulcers and even vision loss: yes, you could go blind.
  • Dry eye can cause scarring of the cornea.
  • Increased risk of eye infection.
  • Difficult to enjoy life, as it can be difficult to read, sew, do crafts or hobbies, or exercise.
  • Dry eye is occasionally a sign of serious underlying disease. Examples include autoimmune diseases and scarring disorders of the conjunctiva (cicatricial conjunctivitis).
  • Dry eye reduces the success of future cataract surgery or laser vision correction (e.g. LASIK).
  • Chronic dry eye can cause irreversible damage to the oil glands of the eye.
  • Dry eye can cause eyelid notching (tylosis). Eyelashes can grow in the wrong direction, lose their colour, or fall out.
  • Dry eye reduces your ability to wear contact lenses.
Red eyes and red conjunctiva caused by dry eye

Red eyes

Conjunctival injection

Treat anterior blepharitis and dry eye gold coast with eyelid scrubs and blephex

Inflamed eyelids

how to unblock meibomian glands to treat blepharitis and dry eye in Gold Coast

Meibomian gland clapping

Eyelash colarettes and crusting are signs of blepharitis and demodex or dry eye

Crusting on eyelashes

Dry eye treatment in Gold Coast to reduce corneal dryness and fluorescein staining

Corneal surface defects

Meibomain gland dysfunction causes dry eye treated with Lipiflow and specialist management Gold Coast

Blocked meibomian glands

Thick blocked meibomian glands expression with hot compression or Lipiflow for dry eye in Gold Coast

Thick “toothpaste” meibomian secretions

Foamy tear film is due to saponification of the tear film oils by staphylococcal lipase

Foamy tear film

(Saponification- bacterial lipase enzymes turn the oily tears to soap!)

What is dry eye?

The normal tear film is comprised of three layers:

  • An inner mucous-like (mucin) layer,
  • A  watery (aqueous) middle layer
  • An outer oily (lipid) layer.

Each layer serves a particular purpose. The oily layer is critically important. It prevents the water layer from evaporating and its high surface tension sticks the tears onto the surface of the eye. This layer is produced by meibomian glands (the oil-secreting glands of the eyelid). These glands are like tiny tubes of toothpaste (5mm long) that drain onto the eyelid margin.

Dry eye is caused by either inadequate production of watery tears by the lacrimal gland (which is rare), or inadequate production of oily tears due to blockage of the meibomian glands (which is more common).

The oily component is produced by meibomian glands in the eyelids.

The watery component is produced by lacrimal glands located behind the outer aspect of the upper eyelids.

The mucin component is produced by goblet cells in the conjunctiva that covers the white of the eye (sclera).

A problem with any of these sources of tear film components can result in tear instability and dry eyes.

dry eye layers of healthy tears

What causes dry eye?

Dry eye is often associated with ageing or with extended periods of eye strain, such as staring at a computer screen.  There are other reasons why you might develop dry eye, and these include:

  • Certain medications, notably antidepressants, retinoic acid, HRT,antihistamines, diuretics, oral contraceptives and beta-blockers
  • Dry air or wind
  • Infrequent blinking (especially when looking at computer screens).  Sufferers from Parkinson’s disease have noticed this
  • Trauma to the eye
  • Irritants like cigarette smoke or dust
  • Laser surgery
  • Cataract surgery
  • Allergies
  • Preservatives in eye drops

But the most common cause is Posterior blepharitis (or blocked meibomian glands).

Evaporate dry eye treatment and meibomian gland dysfunction cure in Gold Coast targets blocked oil glands

Image courtesy of E-Eye

Am I at risk of developing dry eye disease?

  • Eyelid problems, such as when the eyelids turn outward (ecrtropion) or inward (entropion)
  • Medical conditions such as arthritis and autoimmune diseases, hepatitis C, thyroid
  • Ageing – in particular, being over 50
  • A diet that low in vitamin A or omega-3 fatty acids
  • Menopausal woman
  • Wearing contact lenses
  • Skin diseases, such as Acne Rosacea,  seborrheic dermatitis
  • Previous eye surgery
  • Glaucoma eye drops
  • Poor corneal nerve supply
  • Infections, in the form of excessive bacterial colonisation (staphylococcus and corynebacterium)
  • Smoking
  • Lagophthalmos: facial nerve palsy, proptosis, vertical lid shortening

Are there different kinds of dry eye?

These different types of dry eye have been identified.

  • Posterior blepharitis (aka Meibomian gland dysfuction or “evaporative dry eye”)
  • Anterior blepharitis
  • Seborrheic blepharitis
  • Demodex infestation (eyelash mites)

Each of these types requires different treatment.

What is the treatment for dry eye?

There are numerous treatments for dry eye but no ‘one size fits all’ or ‘cookie-cutter’ approach works. Optimal management begins with a correct diagnosis and a management plan tailored to your specific examination findings. As part of my eye examinations, I will consider whether my patients suffer from dry eye, so that it can be treated immediately.  This is because of the risk of progressive destruction of the meibomian glands. The goal is to get your eyes feeling comfortable again, while also preventing more disabling symptoms later in life.

Dry eye can be controlled but unfortunately it is rare to be able to achieve a permanent cure.

Dry eye care is like brushing your teeth – a single deep clean at the dentist will certainly help you, but on-going management is also required. If you stop brushing and flossing, tooth decay will return. Dry eye care therefore involves periodic specialist input by an ophthalmologist or optometrist, backed up by simple things that you can do at home to maintain the benefits.

The first step, if you suffer from mild dry eye, to treat the symptoms with artifical tear supplements, which lubricate the eye.  I will also consider adding a lipid layer stabiliser.  It is also necessary to clean the eyelids, and eradicate any infection with antibiotic ointment.  Patients sometimes find warm eye masks to be soothing. In my review of your medical history, I will take note of medications that you take that may be making your dry eye condition worse.

If your dry eye condition deteriorates, or if it has been diagnosed at a late stage, there are surgical interventions that can be considered.  In the meantime, more common therapies include LipiflowThermopulsation and Intense Pulsed Light (IPL) Treatment.

Eyelid Hygiene

The goal of eyelid hygiene is to unblock the meibomian glands and remove bacteria and skin cells from around the eyelashes. This can be achieved with in-office. The benefits are then maintained with simple routines that you can do at home.

Blephasteam goggles treat meibiomian gland dysfunction dry eye and blepharitis
Blephex treatment for dry eye anterior blepharitis to reduce eyelid bacteria and demodex for comfortable eyes

Lubricating Eye Drops

Artificial tear drops are used to lubricate and protect the surface of the eye while more effective treatments have time to work. Patients with dry eye also have abnormally salty tears, therefore lubricants also help by diluting this high-salt concentration.

Artifiical tears can provide temporary relief but if you manage your symptoms with artifical tears alone you may not be treating any existing underlying eye disease.

Dr Andrew focuses on treatments that correct the underlying causes of dry eye.  The goal is to improve your dry eye so that you are free from artifical tear drops.

Artificial tear drop lubricants to treat sore red uncomfortable eyes on Gold Coast

LipiflowThermopulsation

LipiFlow Thermopulsation is a 12-minute procedure performed in the office to clear the blocked meibomian glands. It precisely heats the glands to 42.5 degrees to melt the blocked secretions while simultaneously applying pulsating waves of pressure to express the blocked glands. The treatment is painless – in fact some patients describe it as feeling like a “spa treatment for the eyes.”

For a long time Lipiflow has been the only device approved by the United States Federal Drug Administration for the treatment of meibomian gland dysfunction, which reflects its strong performance in over 30 clinical trials.

Lipiflow treatment for dry eye blepharitis and meibomian gland dysfunction in Gold Coast
Lipiflow treats dry eye by heating and expressing blocked meibomian glands in Gold Coast

Lipiflow image courtesy of Johnson & Johnson

Intense Pulsed Light (IPL) Treatment

Intense Pulsed Light (IPL) is an extremely bright, broad spectrum non-laser light. Wavelength filters are applied to target the desired tissue response.

IPL has been shown to improve dry eye by treating both meibomian gland obstruction and eyelid inflammation. It treats gland obstruction by melting the trapped meibomian oil so that the glands can be freely expressed. It treats inflammation by triggering a potent anti-inflammatory tissue response. The bright light photocoagulates inflamed and leaky blood vessels. IPL is also thought to rupture bacteria and demodex mites arond the eyelids.

An additional potential benefit of IPL is its anti-ageing efffects. IPL can reduce eyelid redness, shrinks dilated blood vessels (telangiectasias) and can soften skin blemishes and sunspots.  These ‘photo-rejuvenation effects’ was what IPL was originally developed for.

Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Intense Pulsed Light for meibomian gland dysfunction blepharitis and dry eye in Gold Coast

Other Treatments

Other important treatments for dry eye disease include:

Anti-inflammatory medications:  These include topical steroid eye drops, and various non-steroidal medications. Certain low-dose oral antibiotics have been shown to have an anti-inflammatory effect by altering the way bacteria on the eyelids interfere with meibomian gland function. Dr Andrew may prescribe some of these anti-inflammatory treatments depending on your specific examination findings.

Omega-3 and Omega-6 supplements: Emerging research indicates that in some circumstances, omega supplements can help blepharitis and dry eye by producing anti-inflammatory prostaglandins and improving the composition of meibum (meibomian gland oil).  In some cases, this can result in a more effective tear film and more comfortable eyes.

Omega supplementation is a controversial topic due to varying scientific evidence of the ideal ratio of mega-3 to omega-6, whether the omega should be supplied in an alcohol or re-esterified form, and where the omega should be sourced.

For these reasons, Dr Andrew is particular about the omega supplements that he usus as different products may yield significantly different results.

Punctal plugs: Punctal plugs reduce tear drainage from the eye. They may prolong the time that your natural tears or artifiical lubricants are in contact with the eye. However, if your tear composition is inflammatory then punctal plugs can trap these inflammatory mediators on the surface of the eye and thereby exacerbate  redness and dry eye symptoms. They are an excellent treatment option but for select patients and for a specific period of time in the treatment journey.

Emerging treatments: Low Level Light Therapy (LLLT) photobiomodulation treatments (‘My Mask’, pictured).

Any treatment or combination of treatments should always be in consultation with a medical practitioner and specific to your individual medical needs.  You should always seek a second opinion from a qualified medical practioner.

My mask photobiomodulaion treatment for specialist dry eye treatment Gold Coast

My Mask photobiomodulation

How  can I prevent developing dry eye disease?

  • If you live or work in an air-conditioned space, make sure that you keep the air moist.
  • Be sure to rest your eyes (and the rest of your body!) regularly during prolonged stints in front of the computer. Keeping your screen low also helps.
  • If you are flying long-distance, be sure to use lubricating eye drops.
  • Don’t let fans or hairdryers blow directly into your eyes.
  • Wearing sunglasses that protect your eyes from UV light, as well as wind and dry air, are invaluable.
  • Don’t smoke.  And don’t go into smoky enclosed spaces.
  • Use eyedrops.

I have found that many of my patients who come to see me with problems associated with either cataract or glaucoma are, unknowingly, suffering from dry eye disease.  This, of course, makes your life uncomfortable, besides the risks mentioned above.  I have found that, with the extensive use of computers nowadays, dry eye affects both young and old.

As a consequence, I have extensive experience in treating this very widespread complaint.

Medical disclaimer

This content is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of such advice or treatment from a personal physician.

All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions.

Neither Dr. Andrew nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content.

All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.