Your Dry Eye Treatment

Dry Eyes

Are you suffering from dry eyes? Do you have symptoms such as itchy, puffy or red eyes? Dry eye syndrome occurs when there are not enough tears on the front of the eyes. It can also be difficult to wear contact lenses and the sensation of itching, irritation and grittiness can our optometristresult in reduced quality of life. There are many causes of dry eye syndrome which range from climatic conditions (such as exposure to air-conditioning, pollen or pollution), medical conditions (such as arthritis), age and certain medications. Meibomian Gland Dysfunction (MGD) is also thought to be the leading cause of dry eye disease. For more information on MGD including its symptoms, causes and how we can help diagnose and treat MGD at In2Eyes Optometry please see the Meibomian Gland Dysfunction section on our website here.

Symptoms of dry eye syndrome can be significantly reduced. For more information on dry eye syndrome including symptoms, diagnosis and treatment and to learn what In2Eyes Optometry can do for you, continue reading the information in this article or Contact Us to book an appointment with our optometrist or speak to one of our friendly staff for advice.

What is Dry Eye Syndrome?

A constant flow of tears is essential for good eye health. Sometimes the eye may not produce enough tears or the tear quality is poor. This results in dry eye syndrome. In Australia and New Zealand, about one adult in 10 is affected.   Dry Eye Disease can cause extreme symptoms of discomfort, visual disturbance, and tear film instability that can lead to damage to the ocular surface.

What Are The Symptoms of Dry Eye Disease?

There are many symptoms associated with dry eye syndrome and people with dry eyes will often have more than just one. Most symptoms cause a lot of discomfort so it is essential that the causes of dry eye syndrome are quickly identified while preventative and treatment measures put in place. While dry eye syndrome cannot be cured, it is very easy to treat and, in most cases, dramatic improvements in quality of life can be achieved. If you have any of the symptoms listed below, please speak to our optometrist so he can help you with the appropriate course of action.

• Tired eyes: heavy eyes or a feeling you need to close your eyes
• Itchy eyes: often felt in the corners of the eyes
• Stinging/Burning sensation
• Redness
• Occasional blurred vision
• Mucus: buildup around the eyelids especially upon waking
• Grittiness: a sensation of something foreign in the eye (like sand or an eyelash)

What Causes Dry Eyes?

There are many different causes of dry eye syndrome. These can be environmental, lifestyle-related, age-related, or due to medications or disease. Meibomian Gland Dysfunction is also thought to be the leading cause of dry eye disease.

This list is designed to give you an overview of several causes of dry eye syndrome but does not cover all known causes. If you are feeling any of the symptoms of dry eyes listed above, or are feeling any kind of discomfort in your eyes, please contact our optometrist to make an appointment or discuss your symptoms with us over the phone.

Dry Eye is categorised into two main types:

1. Aqueous Tear Deficient Dry Eye: A failure of lacrimal tear secretion (Sjögren Syndrome Dry Eye or non-SSDE) which can be due to disease or obstruction of the lacrimal glands.
2. Evaporative Dry Eye: is due to excessive water loss from the exposed ocular surface and can have many causes.

Sjögren Syndrome Dry Eye is an exocrinopathy in which the lacrimal and salivary glands, as well as other organs, are targeted by an autoimmune disease.
Non-SSDE may also result from obstruction of the lacrimal glands due to cicatrizing conjunctivitis, reflex hyposecretion due to sensory or motor block, and the use of systemic drugs including antihistamines, beta-blockers, antispasmodics and diuretics.

Evaporative Dry Eye is due to excessive water loss from the exposed ocular surface in the presence of normal lacrimal secretory function. Its causes have been described as intrinsic and extrinsic, although the boundary between these two categories is inevitably blurred. Intrinsic EDE is where the regulation of evaporative loss from the tear film is directly affected, for example, by meibomian lipid deficiency, poor lid congruity and lid dynamics, low blink rate, and the effects of drugs such as systemic retinoids. Extrinsic EDE includes those etiologies that increase evaporation by their pathological effects  on the ocular surface. Causes include Vitamin A deficiency, the action of toxic topical  agents such as preservatives, contact lens wear and a range of ocular surface diseases, including allergic eye disease.

• Climate/Environmental: dry air & wind or low humidity environments (including air conditioning, forced air heating, high altitudes & air cabins)
• Irritants: dust, cigarette smoke, pollution and chemical exposure
• Ageing: tear production slows as we age
• Menopause
• Medical conditions: such as rheumatoid arthritis or Bell’s Palsy
• Medications: many medications are known to cause dry eyes such as antihistamines, diuretics, beta-blockers, antidepressants & oral contraceptives
• Eye trauma: impact injury or burns
• Infrequent blinking: staring with a fixed gaze for prolonged periods (at the television or computer screen) without blinking
• Incomplete blinking
• Nocturnal lagophthalmos: a condition where the eyes don’t fully blink and stay partially open at night
• Recurrent corneal erosions: when the cornea and eye lid stick together at night
• Eye surgery: vision correction/laser eye surgery, cataract surgery
• Lifestyle: diet, smoking and consumption of diuretics without proper hydration

How is Dry Eye Syndrome Assessed?

Looking at the symptoms and potential causes of dry eye syndrome will help determine if you may be suffering from a treatable condition. However, it is important to make an appointment to see our optometrist who will run a number of tests to accurately diagnose your condition.

• Slit lamp exam/biomicroscopy: This exam allows our optometrist to see areas at the surface of the eye at a microscopic level, including the eyelids, conjunctiva, iris, lens, sclera, and cornea. The retina and optic nerve can also be seen.
• Evaluation of the tear film: by putting a drop of sodium fluorescein (a yellow dye) into the eyes which mixes with the tears to give a clearer indication of the quality of tear film.
• Evaluation of tear production: strips of filter paper placed between the lower lid and eye are used to measure tear production.
• Utilising the Oculus Keratograph, your optometrist will assess and record the extent of your dry eyes including Meibography, Tear Film quantification & qualification, Lipid Layer assessment and Red Eye assessment.
• If autoimmune disease is suspected as a cause, blood tests may be required. Your optometrist will refer you to your GP to action this.

The new Keratograph high-definition colour camera makes finest structures visible. NIKBUT (non-invasive Keratograph break-up time), tear meniscus height, lipid layer and tear film particles movement are examined carefully and documented for comparison with post-treatment images. The exams are noninvasive, user-friendly and reproducible.

Your Dry Eye Treatment Action Plan

We personalize the treatment plan depending upon the source of the problem.

A Decision To Have Treatment

As you make the decision whether to have treatment, it is important to make sure that you understand any risks, benefits and limitations of treatment. If you do not have treatment, your symptoms and condition may continue to worsen. Your optometrist will explain the risks, benefits and limitations of dry eye treatment during your consultation.

There are a number of ways we can treat dry eyes depending on the causes and severity of your symptoms. Though there is usually no cure for dry eye syndrome, the condition can be successfully managed and you can return to a much more comfortable state with fewer symptoms. At In2Eyes we aim to improve your quality of living with the latest technology and most up-to-date techniques backed by the best clinical research in line with Optometry Australia Association guidelines.

Treatment for dry eye syndrome may aim to increase tear production, maintain tear film volume or prevent excess loss of tears. In most cases we recommend a change in your behavior (such as blinking more often) and will supply eye drops or gels than lubricate the surface of the eye (aka ‘artificial tears’). In the case of Mybomian Gland Dysfunction we have a specific treatment plan that is outlined here.

A general outline of some treatments of Dry Eye Syndrome is as follows:

• Change of behavior: blinking more often (which can take a conscious effort!); quitting smoking; remaining hydrated
• Artificial Tears: eye drops, gels which lubricate the surface of the eye maintaining a constant lubricated film
• Avoiding dry environments: air conditioning, dry winds and even direct exposure to simple fans can dry out the surface of the eye
• Medications: consult your doctor about the medications you take as side effects may include drying the eyes. There may be alternatives
• MGD: the leading cause of dry eyes requires special treatment which we outline here and is offered by In2Eyes.
• Blephasteam: The Blephasteam® device is convenient, safe, and allows clear vision during use, allowing you to carry out normal task activities such as reading, watching television or playing on your smartphone. We administer Blephasteam treatment in our Surrey Hills Clinic for Dry Eyes patients.
• Supplements: specialty formulation supplement called Lacritec–a proprietary blend of omega fatty acids which supports healthy tear film & reduces inflammation
• Antibacterial Eye Wipes: Blepharitis (inflammation of the eyelids) is caused by bacteria which can be controlled using eye wipes to clean around the eyelids. These are most beneficial when used in conjunction with eye drops
• Antibacterial ointments: in more severe cases of Blepharitis we may recommend antibacterial ointments or tablets
• Punctal plugs: tiny, biocompatible devices inserted into tear ducts to block drainage to increase the eye’s tear film and surface moisture
• Surgery: only in severe cases surgery is considered in consultation with your GP and Opthamologist.

Specialty Warm Compress Products

Blephasteam® delivers a latent moist heat therapy around the eyelids to unblock the Meibomian glands and thus to improve eyelids and ocular health. This has been shown to be far more beneficial than using a warm compress because Belphasteam® delivers a standardised therapy at a consistently safe temperature (which cannot be controlled with warm compress).

Eyegiene is a safe, convenient option designed to assist in stimulating natural tear production and enhance the benefits of artificial tears and ointments, punctual plugs and supplements.

A variety of specialty warm compress kits are available for purchase at in2Eyes. Contact Us to make an appointment. Our optometrist will recommend which kit is best for you.

IPL

Some cases of Dry Eye Syndrome require treatment beyond standard heat therapy. IPL (Intense Pulsed Light) therapy generates a polychromatic pulsed light by producing perfectly calibrated and homogenously sequenced light pulses.  The energy, spectrum, and time period are precisely set to stimulate the Meibomian glands in order for them to return their normal function.

Stimulation with IPL leads to the Meibomian glands returning to their normal function in a very short time and you may feel the benefits within just a couple of hours following treatment.

The decision to begin treatment with IPL will be discussed with your optometrist during your comprehensive dry eye assessment. Typically, IPL treatment requires several sessions and will be tailored to your requirements depending on the severity of your dry eye syndrome. For optimum results, three sessions are usually recommended.

The positive effects of IPL treatment are cumulative. Improvement in Meibomian gland function after treatment with IPL will last for about a week after the initial treatment, two to three weeks after the second treatment, then from a two months onward.

Lipiflow

In2Eyes is one of the few optometry clinics offering LipiFlow® for dry eye treatment caused by Meibomian Gland Dysfunction. Opening and clearing these blocked Meibomian glands can allow them to resume natural production of lipids (oils) needed for a healthy tear film.  Some treatments attempt to add more liquid to your tears, but without the natural oil, tears continue to evaporate faster than produced.

At the heart of the LipiFlow® Thermal Pulsation System is the Activator (eyepiece). The Activator uses patented, precisely   controlled heat applied to the inner eyelid with adaptive pressure encouraging your body to restart the natural production of lipids (oils) needed for healthy tears. Its single-use design and built-in sensors ensure a safe, sterile treatment.

Individually sealed devices called activators are placed around the eyelids. A gentle “massaging” coupled with the precise delivery of heat is applied removing gland blockages and reactivating gland function. The treatment is designed so the eyeball is completely protected.

The effects of LipiFlow depend on the health of your gland structure and the extent of your MGD. Thus, results may vary with each patient. Some patients may notice results within weeks, while for others, it may take up to 90 days to notice results as the glands naturally begin to generate and expel necessary oil levels needed to properly protect the tear film. LipiFlow® may be recommended as part of your Dry Eye Treatment Action Plan: please speak to your optometrist during your comprehensive dry eye assessment to find out if LipiFlow® is right for you.

Omega 3 Supplements

Studies have shown that some people suffering from MGD can benefit by adding omega-3 fats to their diet which can help maintain oil consistency and reduce inflammation. Both Flax Seed Oil and Omega-3 capsules (Fish Oil and Krill Oil) are a source of Omega-3.

Lacritec: Specialty Formulation For Dry Eyes

Lacritec is a new formulation that works from the inside out (rather than topically like eye drops) to provide continuous dry eye relief. Lacritec delivers a proprietary blend of omega fatty acids sourced from Flax Seed, Fish Oil and Borage Oil. This Australian developed, patent-pending formulation works to support a healthy tear film and reduce inflammation.

Lacritec is available for purchase at In2Eyes. Contact Us to make an appointment or to speak to our friendly staff who can answer any questions or concerns you may have.

Blephex: Treatment For Blepharitis

Blepharitis is a chronic, inflammatory disease of the eyelids caused by an overgrowth of normal bacteria living along the lid and the base of the eyelashes. Anyone can get blepharitis at any age, but the prevalence increases with age since, as we get older, we make fewer natural antibodies in our tears.

Every patient who comes to In2Eyes for Blephex treatment will also receive a bottle of Blephadex foaming lid scrub for treatment at home.

BlephEx™ is a painless in-office procedure. A revolutionary new patented BlephEx™ handpiece is used to very precisely and carefully, spin a medical grade micro-sponge along the edge of your eyelids and lashes, removing scurf and debris and exfoliating your eyelids.  The patented micro-sponge is disposable and a clean one is used for each individual eyelid so bacteria is not spread between the lids.  The procedure lasts about 6 -8 minutes. Most patients simply report a tickling sensation. A numbing drop is usually placed in each eye prior to treatment for increased comfort.

Lid Wipes

Lid wipes can be used along the eyelashes to help relieve the bacterial or demodex burden on the eyelids for anterior blepharitis.

Drops and ointment

Lubricating drops and ointments may be used throughout the day or before bed at night to alleviate the symptoms of dry eye.Not all eye drops are the same. Your optometrist will recommend the right eye drops for you, depending on your requirements.

The type of eye drop and the frequency of use depends on the severity of the dry eye. Preservative-free eye drops are recommended if usage exceeds 4 times a day.

Eyelid Massage

When you visit In2Eyes for a consultation on MGD we can show you how to do this safely and effectively as over massaging can have a negative impact on your eye health and can induce astigmatism or keratoconus (similar to rubbing your eyes).

You can massage both eyelids after applying a warm compress by pinching the lower eyelids between thumb and forefinger to express the meibomian glands. Do this around 5-10 times immediately after warming.

Regular blinking

The natural pressure applied to your oil glands during complete, regular blinking encourages the flow of oils onto the ocular surface.

How We Help You Manage Dry Eyes – Infographic

Click on the below infographic to see how we help you manage your dry eyes at In2Eyes Optometry. Feel free to download the image and share it with your friends and family.

 

References:

1. Optometry Australia Association
2. Lacritec
3. Better Health: “Dry Eyes”

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. In2Eyes has used all reasonable care in compiling the information but make no warranty as to its accuracy. Please consult our optometrists, or other health care professional for diagnosis and treatment of medical conditions.