Dry Eyes.

Do you suffer from any of the following symptoms?

  • Foreign body sensation - "scratchy" eyes?

  • Redness of the whites of the eyes?

  • Eyes feeling 'gritty' - often worse in the mornings?

  • Blurry vision, which usually improves when you blink?

  • Excessive watering?

If the answer to any of above is yes, then you may be suffering from dry eye. Book an appointment to see us for assessment and treatment.


The importance of blinking.

We don’t often pay attention to our blinking habits throughout the day. But, whether we realise it or not, blinking is vitally important to our eye health.

The average adult blinks between 10 and 20 times per minute. Even though a blink only takes one tenth of a second, all those blinks add up to about 10 percent of our waking life! So, what’s so important about blinking that we need to miss out on 10 percent of everything that’s happening right in front of us?

Blinking nourishes and lubricates our eyes: Blinking is necessary to clean and moisturise our eyes. Each time we blink, a thin layer of tears is spread across the eye surface, keeping them from drying out as well as brushing away any small particles of dust or dirt that could otherwise irritate our eyes or impair our vision.

When we focus, we blink a lot less: Did you know that the number of times we blink decreases drastically when we are focused on something? On average we only blink three to eight times per minute when reading, watching TV, listening to a podcast, working on a computer, or another activity that requires intense focus. That’s roughly 60 percent less than our normal rate of blinking! This lack of blinking over time can lead to eyestrain and dry eyes.

Blinking exercises can relieve strain and help dry eyes: For the most part, we may not realise when we’re blinking. However, making a conscious effort to blink more often during high focus activities can do our eyes a world of good.

Make it a habit to close your eyes when you are thinking or doing something that doesn’t require your vision. Set reminders for yourself to do a blinking exercise every hour during periods of focus. One good exercise that will leave your eyes feeling fresher is to simply close your eyes and pause, squeeze them for a moment, open them and relax.

A lot happens in the blink of an eye: The mechanism of our eyes is incredible - different types of tears along with multiple oil-producing sebaceous glands work together all day to nourish and protect our eyes. Truly, a lot happens in the blink of an eye!


Managing Dry Eye: Treatment Options.

If you suffer from dry eyes, there are a number of treatment options. 

In recent years, numerous advances have been made in relation to dry-eye diagnostic markers, technologies and other treatment options. Each dry eye has a very different mode of treatment: purely palliative, to replace or conserve patient tears, or to improve symptoms and ocular comfort but not necessarily to treat the underlying disease process.

Ocular lubricants: Lubricants are a mainstay of management for all types of dry eye. They reduce tear osmolarity (saltiness) and protect the ocular surface. Numerous formulations with claims to improve electrolyte balance and osmolarity and protect the ocular surface are promoted. 

Lipid supplements in drop and spray format are now available. Liposomal sprays have been shown to improve TBUT and lipid layer thickness for up to 90 minutes compared with a saline spray. There are also studies showing that lipid-containing drops can be superior to normal tear supplements and they may help prevent evaporation in low-humidity environments. 

Ointments can increase the lipid layer and expressibility of meibomian glands. 

Those containing a mixture of mineral oil, petroleum and lanolin do allow a longer retention time on the eye but, due to the thickness, these preparations can blur the vision.

One significant problem for many tear substitutes is the inclusion of preservatives, to minimise microbial growth. In vitro studies suggest that prolonged presence of preservatives such as benzalkonium chloride is problematic in dry eye but clinical studies are more mixed. This may be because the dilution of preservative in the tear lm helps reduce their effects. In moderate dry eye preservative-free drops may become more important due to reduced dilution. If patients are using multiple drops on a daily basis (>4–6×) then a preservative-free medicine is preferable. 

Drop compliance is often poor, so for it to help, you need to get into the habit of using them.

Let us tell you which drops will be correct for your specific dry eye condition - it all depends on what is causing the problem!

Hot compresses and lid massage: If your meibomian glands are dysfunctional we may ask you to perform hot compresses and lid massage. Heating of the lids helps to melt meibomian secretions that are blocking the glands. Lid massage helps to encourage the meibum out of the glands allowing them to function normally. 

Hot compresses and lid massage can often be ineffective if the glands are completely blocked. So, we will often perform meibomian expression as an in-house treatment to completely unblock the glands prior to asking you to perform the treatment at home. 

We will show you how to do the hot compresses and lid massage correctly.

Moisture chambers: The relationship between humidity and evaporation of the tear film has been well documented. For instance, typical humidity levels in airplane cabins (9-28%) have been shown to cause increased evaporation in both normal and dry eye subjects. As well as prescribing eyedrops for those in prolonged low-humidity or windy conditions, spectacle wear can increase the measured humidity between the cornea and the lens, with the addition of side shields having an added benefit.

General lifestyle factors: Numerous lifestyle factors may infuence dry eye. Oral alcohol has been shown to affect osmolarity and TBUT in healthy male subjects. Osmolarity increased from 295 to 332 mOsmol/l and was still abnormal after a night’s sleep. Smoking may destabilise the tear film or aggravate allergic disease. 

Poor hydration levels are associated with dry eye; however, the optimum hydration level for decreasing dry eye symptoms is unclear. Interestingly, caffeine use may reduce dry eye. Dry eye was found in 13% of caffeine users and 16.6% of those who avoided it. 


Additional management for severe dry eye

Those suffering from severe dry eye may need additional help. 

Punctal plugs: The most common non-pharmaceutical therapy for dry eye disease is "lacrimal drainage occlusion". A recent review stated that punctal plugs may have a place in dry eye. A key improvement in aqueous-defcient dry eye is plugging of the lacrimal duct or providing a long-lasting non preserved tear supplement. This will improve the spread of the lipid layer and so reduce tear lm evaporation. We fit plugs that dissolve in 3-6 months; this means it is a good way to experience the benefits without it being permanent. The treatment makes a big difference to those very dry eyes. More info

Intense Pulsed Light treatment: The newest and least invasive of all treatments, now available with us after significant investment. This treatment wakes up the glands and nerve control to improve the functioning of the Meibomian glands, which are a major cause of dry eyes. We were part of a multicentre study looking at the efficacy of the treatment, currently the full cost of the treatment will be only £450 for the 3 courses (this includes Mebomian expression as detailed below). More info

Meibomian gland excretion: Special forceps can be used to help unclog the blocked oil producing glands that provide the oily part to the tear layer. This massaging effect has the advantage of providing measurable relief and often needs to be repeated periodically in the clinic to keep the eyes comfortable.

Anti-inflammatory treatment of dry eye: The use of corticosteroids in dry eye disease has been well documented, with some studies reporting moderate to complete relief of symptoms with this treatment (Alves et al. 2013). Cyclosporine 0.5% emulsion eye drops have also been shown to be beneficial and can be used long-term, unlike steroid eyedrops. Systemic anti-inflammatories, such as oral prednisolone, may be required in Sjögren’s, lupus, rheumatoid arthritis and cicatricial pemphigoid. An ophthalmologist would typically prescribe these, if other measures were insufficient.