Dry eye disease
What is Dry Eye Disease?
Dry eye disease occurs when the eyes become inflamed due to an imbalance in the tear chemistry. There are two forms of dry eyes, evaporative dry eye and aqueous deficient dry eye. Most people have evaporative dry eye.
Evaporative dry eye occurs when the meibomian glands in the eyelids aren’t functioning properly. The meibomian glands are responsible for secreting oils which prevent the tears from evaporating too quickly.
Meibomian gland dysfunction (MGD) is when these glands become blocked and inflamed reducing the quality and effectiveness of the oils
causing rapid tear evaporation.
Aqueous deficient dry eye occurs when there is an insufficiency in the Aqueous layer of the tear film produced by the lacrimal glands.
Dry Eye Causes
There can be several causes such as:
• Low blink rate
• Decreased function of the lacrimal glands (water producing glands)
• Meibomian gland dysfunction
• Incomplete lid closure (lagophthalmos)
• Contact lens abuse
• Medications
• Environment/Lifestyle
• Hormone changes
• Lasik.
Symptoms
• Burning
• Red eyes
• Contact lens intolerance
• Excessive tearing
• Gritty sensation
• Itching
• Blurred vision
• Light sensitivity.
Diagnosing Dry Eye
At Simon Falk Eyecare we have the latest-state-of-the-art equipment to
diagnose dry eyes. The IDRA has the capability to measure various components of the tear film and the structures of the eyelid.
• Fluorescein imaging
• Tear meniscus
• 3-D meibography
• Lipid layer thickness
• Blink rate
• Non invasive tear break up time.
Meibography uses infrared technology to image the meibomian glands.
Osmolarity is the measurement of the saltiness of the tear film and is
an important factor in the diagnosis of dry eye. Dry eye is defined as
hyperosmolarity of the tear film. The Scout Pro measures the osmolarity
of the tear film. The grading scale allows us determine the severity of
the dry eye.
A measurement greater than 302mOsm/L is abnormal and a value over
336mOsm/L is a severe value. It is possible to have different values
between the two eyes and a difference of 8mOsm/L is significant.
Diagnostic Dyes are used to determine the inflammation on the surface
of the eye including the cornea and the conjunctiva.
Lifestyle is another crucial part of the assessment which includes diet,
habitual screen use, general health conditions and medications. We may
also recommend you see the GP for blood tests to check vitamin levels.
We will investigate lifestyle factors and suggest modifications to help
symptoms.
Treatment Plan
A bespoke treatment plan will then be recommended this may include
in practice treatments, lifestyle changes to implement at home or a
combination.
Tixel® which is a new device that is used for dry eye treatment. It uses
Thermo-Mechanical Ablation (TMA), a non-laser treatment technology,
to transfer thermal energy to the skin around the eyes quickly and
safely to correct dry eyes by increasing lubrication and reducing tear
evaporation.
Tixel® treatment takes less than one minute and involves only a little
discomfort with little to no pain. It is non-invasive and there is no
downtime. The effects of Tixel® are longer lasting than the use of eye
drops.
In most cases, patients will need three Tixel® treatments, with an interval
of two to three weeks between each treatment. In more severe cases,
patients may require four treatments.
This machine can also offer a range of cosmetic treatments to help
improve the appearance of the skin around the eyes tightening the skin,
skin rejuvenation and improving skin texture and acne scaring.
AB MAX™ is a treatment for blepharitis which is inflammation of the
outer eyelids. It is a professional cleaning procedure to remove bacteria,
eyelash dandruff and demodex mite infestation. Treatments are usually
repeated at regular intervals depending on the severity of your case.
After a few treatments patients start producing more of their own tears
and the chronic and irritating symptoms caused by Blepharitis will be
reduced or alleviated.
ACTIVA is a painless and relaxing treatment to give immediate relief for
evaporative dry eye. A clinically proven mechanical method to de-cap
and stimulate Meibomian glands unclogging your glands and stimulating
the natural production of oils to keep your eyes lubricated. Patients
typically notice a distinct improvement in comfort and a significant
reduction in their dry eye symptoms often in the first month of use. We
suggest using Activa once a week for four weeks. At the end of this
first period, a session every two months is recommended to keep the
benefits of the relief. This would reduce the need for at home heat mask
and lid massage.
Artificial Tears may still be needed to manage symptoms and we will advise on an individual basis which will be the right ones for you. There are many types of drops available and it can be overwhelming which one to purchase. Not all drops are made equal, some contain preservatives which further irritate the ocular surface. Some are designed to enhance the aqueous layer only, which is not helpful if you are deficient in the lipid layer.
Supplements may also be recommended, especially omega 3 and vitamin D. Omega 3 has been shown to improve the quality of the tear film and reduce inflammation.
