Why not find out a little bit more about Dry Eye Disease?
Dry eye disease is one of the most common ocular surface problems seen by ophthalmologists today, with over 4 million people in the UK alone estimated to suffer from this condition.
It happens when an individual does not produce enough tears or the composition of the tears is abnormal and cannot adequately cover the surface of the eye.
The tear film is an essential part of ensuring the overall health of the ocular surface. It cleanses, lubricates, and nourishes the surface of the eye as well as protecting it against infection.
Common causes of dry eye
• Adverse Environmental Conditions: Air conditioning, low humidity in airplanes, central heating, car heaters, windy weather and smoky environments can all cause tears to evaporate more quickly.
• Looking at screens: Watching TV and looking at a computer screen for long periods of time.
• Contact Lenses: Wearing contact lenses dries out the eye.
• Hormones: Many women find that they experience dry eye symptoms on reaching the menopause.
• Medications: Such as anti-depressants and anti-histamines.
• Age: The incidence of dry eye increases with age due to the natural aging process.
• Blepharitis: Bacteria and inflammation of the lids can restrict the proper functioning of the meibomian glands that are involved in producing lipids essential for a healthy tear film.
• Sjögren’s Syndrome :This is an autoimmune disorder that affects the lacrimal gland that is responsible for normal tear production.
• Other causes of dry eye include chronic allergies and conditions such as rheumatoid arthritis and lupus.
What are Meibomian Oil Glands?
Meibomian Oil Glands are glands that are arranged vertically within the eyelid near the lashes. The force of an eyelid blink causes oil (meibum) to be secreted onto the eye which helps prevent rapid tear evaporation and therefore a dryness on the eye.
What is Meibomian Gland Disease (MGD)?
MGD, also known as posterior blepharitis, is a chronic, diffuse abnormality of the meibomian glands. It is commonly characterised by terminal obstruction of the gland duct and/or qualitative/quantitative changes in the glandular secretion. The outcome is alteration of the tear film resulting in symptoms of eye irritation, inflammation, and ocular surface disease.
This is illustrated in the pictures below.
Symptoms of dry eye
There are many symptoms associated with dry eye, the most common being:
•Grittiness or Sandy Feeling in the eyes
•Burning or Stinging sensation
•Itching and Scratchiness
•Soreness or Painful
•Foreign body sensation
•A feeling of Dryness
•Sensitivity to light
Diagnosis of dry eye
Accurate diagnosis of dry eye can be complicated and is often controversial amongst clinicians and researchers due to there being a wide variety of ocular surface assessments and clinical diagnostic tests available.
Some of the most common tests are:
• Dry Eye Questionnaire: This helps the ophthalmologist to assess patient symptoms and correlate them with signs of tear film disorders. Use a free online dry eye questionnaire to find out immediately if you may have dry eye.
• Physical Examination: The ophthalmologist will perform an assessment of the whole surface of the eye looking for signs of inflammation and meibomian gland disorders, which are often connected to tear film abnormalities.
• Phenol Red Thread Test: A small thread which changes colour from yellow to red when wet is placed into the lower conjunctival sac for 15 seconds to measure tear volume.
• Schirmer Test: This is a simple test to measure tear production and is performed by placing a filter paper strip over lower eyelid for 5 minutes. The amount of tears absorbed into the paper in this time indicates whether there are enough or too little tears being produced.
• Assessment of Tear Film Stability: Evaluation of the stability of the tear film is considered to be one of the most useful tools for the diagnosis of dry eye, as an unstable and unrefreshed tear film is one of the most indicative signs of dry eye. The measurement of tear stability can be carried out by measuring the time in seconds between one complete blink and the first appearance of a discontinuity or dry spot in the fluorescein stained tear film. Many ophthalmologists consider the assessment of tear film stability by use of fluorescein to be the most important clinical diagnostic test available today.
• Impression cytology to look at goblet cell numbers in the conjunctiva: The ophthalmologist takes a small sample of cells from the surface of the eye using a small piece of specialised filter paper. These cells that are collected on the paper can stained so the number of goblet cells can be counted. People with only a small number or even none of these cells usually have Dry Eye.
Treatments of dry eye
Management of dry eye is usually a combination of treatments and lifestyle changes that are tailored to the needs of an individual patient. Professor Moore believes that there are two main goals when addressing the treatment of his dry eye patients. “My primary aim is to alleviate symptomatic discomfort and then secondary to prevent or reverse complications and further ocular surface damage that may cause a deterioration of their vision.”
• Artificial Tears: While many find rapid relief using artificial tears, often this reprieve short-lived with the patient having to use them up to eight to ten times per day. Indeed some artificial tears contain preservatives that may in fact exacerbate the problem and therefore it is often recommended that non-preservative tear supplements should be the first choice.
• Warm Compresses: Some patients’ symptoms can be alleviated by applying warm moist compresses to the skin of closed eyelids which allows easier release of lipids from the meibomian glands.
• Surgery: blocking of the tear duct with a permanent or semi-permanent plug (usually silicone, collagen or plastic) often helps those with severe dry eye by preventing the drainage of the tears.
• Massaging: For maximum effectiveness this should be used in conjunction with warm compresses. Eyepeace is designed to take supporting research into consideration and create a massaging device which stimulates the Meibomian Gland to create tears.
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