dr nick andrew, ophthalmologist, eye specialist, eye surgeonDr 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.

Posterior blepharitis dry eye is progressive from meibomian gland blockage requiring artificial tears

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

Sore red itchy tired eyes symptoms of dry eye and blepharitis and meibomian gland dysfunction in Gold Coast
Red eyes and red conjunctiva caused by dry eye in Gold Coast

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 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).

Healthy tear film has meibomian oil layer secreted by meibomian glands and aqueous water layer produced by lacrimal gland

The leading cause of dry eye is blocked meibomian glands.

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

Image courtesy of E-Eye

The subtypes of dry eye are:

  • Posterior blepharitis

    (aka Meibomian Gland Dysfuction or “Evaporative Dry Eye”)

  • Anterior blepharitis

  • Seborrheic blepharitis

  • Demodex infestation (eyelash mites)

What things predispose you to dry eye?

  • Autoimmune disease

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

Lipiflow image courtesy of Johnson & Johnson

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

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.

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

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.

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

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 photobiomodulaion treatment for specialist dry eye treatment Gold Coast

My Mask photobiomodulation

Other Treatments

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.

Why see Dr Nick Andrew for dry eye treatment?

Exceptional Training

Dr Andrew was trained by the founder of the Kyklos Dry Eye Program  in Toronto, Canada. This is a specialist dry eye program that is now used in ophthalmology offices across North America.

State-of-the-art approach

Dr Andrew introduced the state-of-the-art Lipiflow thermopulsation treatment to South Australia in 2019. He offers a range of specialised dry eye tretaments.

Experience

Extensive experience treating dry eye disease.  As a specialist in cataract, glaucoma and refractive surgery, many of Dr Andrew’s patients also have dry eye.

For all appointments and enquiries, please contact

Sight Specialists, Gold Coast.

Opening hours

Monday to Friday: 8am – 4.30pm

Contact Sight Specialists