Dr Nick Andrew treats Dry Eye
Dr Andrew has found that many of his patients who have come to see him in connection with their cataract and glaucoma problems, often suffer unknowingly from dry eye. He has expertise in dealing with this common problem, which affects both young and old.
What is Dry Eye and how is it treated?
Are your eyes burning, stinging, itchy, ore or red?
Does your vision get blurry when reading?
Do you suffer from chalizia, styes, and eyelid infections?
These are all symptoms of dry eye
Dry eye is chronic, progressive and eventually irreversible.
Apart from causing annoying symptoms,
dry eye can have more serious consequences.
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).
Dry eye is becoming much more common, especially in young people. Symptoms are progressive and usually become harder to treat later in life.
Chronic dry eye can cause irreversible damage to the oil glands of the eye.
Dry eye can cause scarring of the cornea.
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.
What are the symptoms of dry eye?
Eyes that feel sore, itchy, tired, heavy, or have a burning sensation
Eyes that feel gritty or sandy
Blurred vision that fluctuates with blinking or is worse when reading or working on the computer
Red eyes and light-sensitivity (photophobia)
Crusting and discharge around the eyes, especially upon awakening.
Styes, chalazia and eyelid infections
Watery eyes! Eyes that are dry trigger excessive “reflex” tearing.
A foamy tear film
Meibomian gland clapping
Crusting on eyelashes
Corneal surface defects
Blocked meibomian glands
Thick “toothpaste” meibomian secretions
Foamy tear film
(Saponification- bacterial lipase enzymes turn the oily tears to soap!)
What causes dry eye?
The normal tear film is comprised of three layers. An inner mucous layer, a middle aqueous (water) layer, and an outer oil layer. 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. The oily 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 leading cause of dry eye is blocked meibomian glands.
The subtypes of dry eye are:
(aka Meibomian Gland Dysfuction or “Evaporative Dry Eye”)
Demodex infestation (eyelash mites)
What things predispose you to dry eye?
Skin diseases: Acne Rosacea, seborrheic dermatitis
Eye disorders: glaucoma eye drops, poor corneal nerve supply, contact lens wear, previous eye surgery
Eyelid disorders: incomplete blinks or infrequent blinks (e.g. staring at a computer screen or tablet), excessive bacterial colonisation (staphylococcus and corynebacterium)
Patient factors: Older age, female sex, smoking, poor diet
Environmental factors: Air conditioning, pollution
Medications: retinoic acid, antidepressants, oral contraceptive pill, HRT, beta-blockers, antihistamines
Dry Eye Treatments
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.
Dry eye can be controlled but unfortunately it is rare to be able to achieve a pemanent 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.
Dr Andrew is proactive in his management of dry eye, given that it is known to cause 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.
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 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.
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.
My Mask photobiomodulation
Other important treatments for dry eye, 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.
For all appointments and enquiries, please contact
Sight Specialists, Gold Coast.