Dry eye is a common and often chronic condition where the eyes don’t produce enough tears or the right quality of tears to lubricate and nourish the eye. Tears are necessary for maintaining the health of the front surface of the eye and for providing crisp clear vision. 

Classification

Dry eye can be classified into two distinct groups:

  • Aqueous deficient dry eye occurs when the eyes don’t produce enough tears to keep the eyes properly lubricated and hydrated.
  • Evaporative dry eye is the most common type and occurs when the eyes do not have the right quality of tears. 

Symptoms of Dry Eye

Symptoms can vary from relatively mild or progress to cause severe damage to the ocular surface and loss of vision. It can affect everything from driving and reading to your ability to work and socialize with friends.

Symptoms of dry eye include:

  • Unstable or blurry vision
  • Environmental sensitivity
  • Burning/stinging of the eye
  • Tired/fatigued eyes
  • A gritty sensation
  • Irritation/pain
  • Redness 
  • Contact lens intolerance/reduced wearing time
  • Reduced reading/near working time

Causes of Dry Eye Syndrome

Many different things can both cause or contribute to dry eye:

  • Gender: Dry eye is more frequently seen in females.
  • Age: It is more common with increasing age.
  • Meibomian gland dysfunction: MGD is responsible for nearly 90% of all dry eyes (The meibomian glands are small oil producing glands situated in the eye lids. These glands are compressed with each blink and inject oil into the tears. This process stabilizes the tear film and prevent evaporation. With MGD, the glands become blocked and cannot make enough oil to cover the eye. As a result the tears evaporate leading to dry eye.)
  • Certain eye conditions including allergy, trauma, infection, chemical burns 
  • Systemic disorders such as rheumatoid arthritis, lupus, diabetes and thyroid disease.
  • Hormonal changes e.g. during pregnancy and menopause
  • Certain medications e.g. medications for allergy, hypertension, anxiety, depression and even birth control pills.
  • environmental conditions: e.g. smoke, wind, dry climates, high altitudes, air conditioners 
  • situational conditions: e.g. excessive screen time that reduces the blinking rate
  • Other: long-term use of contact lenses and refractive eye surgeries

Dry Eye Evaluation

Dry eye disease is diagnosed by a comprehensive eye examination with thorough medical and ocular history performed by our optometrist and dry eye expert Loulize Marais. Careful examination of the external eye is performed with a bio microscope. The eyelids are also inverted paying special attention to the integrity of the meibomian glands. A number of “dyes” with special filters are used to highlight any surface abnormality. The quality of the tears can also be assessed by observing the time it takes for the tear film to become unstable. During our Dry Eye Examination a series of special tests is done to determine the cause and extent of chronic dry eye and how best to treat the root cause. Our new Digital Slitlamp Imaging System with Infra-red camera allows for superb high resolution images and accurate analysis of dry eye.

Home Treatment

Eye drops or artificial tears have long been an accepted therapy for dry eyes.

Modern eye drops target specific dysfunction of the tears and tear structure.

Artificial eye drops can be divided into three main groups:

  • Moisture drops primarily add moisture and volume to the tear film 
  • Cushioning drops cushions the tears and action of the lids 
  • Advanced formulations mimic the function of tear components 

Other over the counter products include eye gels and ointments. The gels last longer and offer greater protection for more severe dry eye. Ointments are usually only applied at night.

Numerous studies have found that omega-3 fatty acids containing supplements decrease dry eye symptoms, positively impact meibomian gland secretion and possess anti-inflammatory effects.

Clinicians also recommend that patients consume sufficient water.

Eyelid hygiene and healthy lids are critical components to managing dry eye and ocular surface disease. The lids contain the meibomian glands which help support a healthy and stable tear structure. Ocular cleansing preparations removes ocular secretions, bacteria and debris from eye lashes and lids.

Treatment for meibomian gland dysfunction typically consists of warm compresses performed at home. One such system is the Bruder Moist Heat Eye Compress. 

Simply microwave the mask for 20 – 25 seconds and apply to the eyes for 8 – 10 minutes. The moist heat provides deeper tissue penetration, liquefying the sebum and allowing the oils to flow back onto the eye. This helps stabilize the tear film and slows tear evaporation and offer great relief from dry eye.

In-office treatment

Blephasteam is a new and effective in-office treatment for dry eye caused by meibomian gland dysfunction. It uses heat and moisture to naturally improve tear quality. The Blephasteam goggles are used to warm the meibomian glands in the eye lids. The heat helps to soften the solidified oil within the glands. Then, by applying a firm massage to the eye lid with specialized forceps, we can help express the now liquefied oil from the glands. This allows the liquid oil to flow more naturally in the future. Between 3 – 4 sessions are enough to maintain comfort for many months.

Dry eye can be disruptive and life altering, but treatment allows for dramatic improvement in comfort and quality of life.