DRY EYE

As per DEWSII we use a structured treatment protocol. No one is identical and therefore treatments are customised to you. After your initial assessment, a specific plan will be designed for you. The aim is to improve the quality and/or quantity of your own tears, so that you are less reliant on tear substitutes through the day and/or night.

How can you help yourself?

Hydration – you need to keep water intake up. Coffee, Tea and alcohol will dehydrate you.

Nutrition – a balanced diet, is as important in dry eye as it is every other aspect of general health. It has been shown that the preferred ratio of Omega 3 (anti-inflammatory) to Omega 6 (pro-inflammatory) should be approximately 4:1. Unfortunately modern diets have a bias to Omega 6. That balance needs to be addressed. Omega 3 rich foods are; Oily Fish (Tuna, Salmon), Caviar, Seeds (Flax, Chia, Sunflower), Nuts (Walnuts).

Environment – Dry eyes (and skin) are more comfortable in high humidity. So raise the humidity. Humidifiers are now very easily accessible and can be compact enough to sit on a desk.

Blink – Blinking spreads the tears over the eye. Incomplete blinks will leave exposed areas, which will dry out. When people do concentrated tasks, it has been shown that their blink rates decreases.

The BASICS….

Lid hygiene – it is very important to keep your eye lids clear of bacterial build up. Colonies can accumulate along your eye lid margins, they can then release toxins and debris which cause irritation and de-stabilise the tear film. You will need to maintain cleansing at home once or twice a day.

Why don’t we advise diluted baby-shampoo?

Baby shampoo with strip the skin and eye lashes of the natural oils needed to maintain healthy function. This will exacerbate dry eye and irritate the skin around the eye. Johnson and Johnson do not advise using diluted baby shampoo for lid hygiene.

Warm compresses – the majority of dry eye patients have an element of evaporative dry eye, due to poor secretion from the meibomian glands.

To treat this, you need to soften the meibum so that it expresses more easily. Imagine olive oil and butter. To soften the meibum, we recommend warming the gland (>40’C) for 8-10 minutes, twice a day for 2 –3 weeks, then once a day every day/every other day. Warm compresses can be achieved by a variety of devices such as an EyeBag © or Blephasteam Goggles ©.

Why don’t we advise using a warm face flannel?

Warm/Hot face flannels have been shown not to get to the required temperature or stay at that temperature long enough be effective. It will just leave you with a damp face.

Artifical Tears – Lubrication. Although we aim to reduce the amount of drops/ointment you may need, it is often difficult to totally stop the need for artificial tears. If your eyes are dry, they will get irritated. This will lead to inflammation and osmolarity changes, which will cause your eyes to get drier. These elements are the basics, key and need to be on going. Try to get them into your routine, like brushing your teeth.

If there is blepharitis, one of our team will clean the lids. The cleaning products recommended will be dependent on the type of blepharitis present. Demodex blepharitis is commonly associated with dry eye (and rosacea), with the only available treatment being Terpinen-4-ol, which is found in Tea Tree oil. More recently IPL treatment has been shown to be effectice against demodex mites. Demodex mites have a life cycle of 4 week.

Anterior Blepharitis – this can be managed with regular lid hygiene modalities, such as wipes, foams or gels. Once or twice a day cleansing will be required.
Posterior Blepharitis – this is a deeper infection/inflammation and will require oral antibiotics.

Is there Inflammation? Were you Inflammadry positive?

We are proud to be one of the first practices in the country to use natural anti-inflammatory drops in our first line of treatment for dry eye.

*These medications can be prescribed in-house or via your GP.

Do you have Meibomian Gland Dysfunction?

This is a two-part question. Do they secrete and what is the secretion like? In a perfect world, all 30ish glands should meibum with olive oil-type consistency when expressed (squeezed). A common reason for them not expressing is a change in the consistency of the meibum, from olive oil (best) to toothpaste (worse). This can cause the glands to stop functioning, and then ultimately lead to gland atrophy (loss). In practice, we will make sure that the gland openings are clear.

Do you have Aqueous Deficiency?

Are you producing enough tears? Your eyes have 4 drainage points. 2 in each eye. If we need to keep the tears on the eye longer, we can plug them. Initially, we would use a temporary, 3-month dissolving plug (non-bovine/porcine). If this is beneficial, then we can install permanent plugs. We recommend that you have replacement plugs annually.

Neuropathic Dry Eye

Neuropathic dry eye, is where the eyes feel dry, but do not look dry, despite all interventions. This can be caused by long-standing dry eye, depression, post-traumatic stress disorder, and post-corneal surgery. In these cases, sometimes a referral is needed to a pain management clinic. Reports have suggested, that acupuncture, exercise and cognitive behaviour therapy can be helpful