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The continuous production and drainage of tears is important to the eye’s health. Tears keep the eye moist, help wounds heal and protect against infection. The tear film smoothes the surface of the cornea giving it a polished appearance and helping visual clarity.
Dry eye syndrome is very common, especially in women after the menopause.
Meibomian gland dysfunction has been identified as one of the main causes of dry eye syndrome. Tears are made mostly by the lacrimal gland (in the upper outer part of the eye socket). Tears leave the eye either by evaporation or drainage.
The tear drainage system runs from the inner corner of both eyelids and drains into the nose. Most commonly, dry eye is caused by excessive evaporation due to an insufficiency of the external lipid layer of the lacrymal film secreted by the Meibomian glands..
It can also occur due to eyelid problems such as blepharitis and meibomitis when the tear quality is poor. Dry eyes can occur in climates with dry air, as well as with the use of some drugs, including antihistamines, nasal decongestants, tranquillisers and anti-depressant drugs.
People with connective tissue diseases such as rheumatoid arthritis; can also develop dry eye. Dry eye syndrome is sometimes a symptom of Sjögren’s syndrome, a disease that attacks the body’s lubricating glands, causing dry eyes and dry mouth.
Patients with dry eye syndrome complain of chronic discomfort, usually described as a burning, gritty sensation. Some describe a scratchy or sandy feeling as if something is in the eye. Other symptoms include stinging, stringy discharge, heaviness, blurred vision or even watering (if the quality of the tears is poor).
The eyes can become red and loose its shiny appearance. You might also see stringy mucus strands and filaments. The tear film on the lower eyelid maybe reduced. The tear break up time may be rapid.
Adding a dye to the eye: fluorescein (orange) or lissamine (green) may identify dry/damaged areas on the cornea. A Schirmer’s test (the amount of moistening of a strip of blotting paper placed in contact with the inside of the lower eyelid) can measure the amount of tear production.
The latest treatment we are able to offer for dry eye syndrome is Intense Pulsed Light (IPL) Therapy. IPL is a painless procedure and each treatment only takes a few minutes. It involves wearing shields to protect the eyes from the light. Then a thin layer of cooling gel is applied to the treatment area.
Next, a small handheld device is used to administer pulses of light to the eyelids and surrounding area. The stimulation leads to the meibomian glands returning to their normal function in a short time following the treatment. Three sessions are normally recommended.
Other treatments include lubricating drops or artificial tears. They are generally available over the counter as drops. Sterile ointments are sometimes used at night, but they can make the vision misty first thing in the morning.
Examples of artificial tears are: Hypromellose®, Liquifilm®, Tears Naturale®, Viscotears®, Hypotears® , Gel Tears® and ointments: Lacrilube®, Simple Eye Ointment® Each patient will prefer different drops, and will need them at different frequencies – from once daily right up to every 15 minutes.
The drops are often cheaper to buy than a prescription charge – but are available on prescription if necessary. Using humidifiers, wearing wrap around glasses when outside and avoiding outside windy and dry conditions may aid relief.
For people with severe cases of dry eye, temporary or permanent closure of the tear drains may be helpful. Some people even use swimming goggle type of protection to reduce evaporation.
Many people prefer Hyaluronic acid based drops and ointments like Vitapos which are more recent developments. Cyclosporine drops like Restasis® or Iverkis are also available for serious cases.
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