What is dry eyes?
Dry eye syndrome occurs when there is an imbalance of oils, tears or mucus that collectively makes up the tear film which coats the surface of your eye. Over time, these imbalances leads to inflammation of the ocular surface causing you to have a dry, gritty sensation and sometimes sharp stinging pain.
The components of the tear film all play a major role in keeping the eyes moist and are secreted in different areas of the eyes.
The top oil layer is produced in the meibomian glands which is located just on the edge of the eye lids under the lashes. You have about 20-30 on the lower lid and 40-50 on the upper lid. Its role is to prevent the tears (Aqueous layer) from evaporating.
The middle is called the Aqueous layer which contains mainly water. This layer is controlled by the lacrimal and accessory glands located in the eye lids. The role of this layer is to keep lubricate the eye, wash away particles and prevent infection. This layer is held on the eye by the mucous layer.
The bottom layer is called the Mucin layer which contains mucous secreted by goblet cells located on the conjunctiva of the eye. Its role is to lubricate the eye and also helps hold the aqueous layer in place.
As each layer plays a vital role to keep the eyes hydrated, too much or too little of each will disrupt how the tear film stays on the eye. To treat dry eye, we aim to identify and tackle the cause directly to help our patients get relief from their symptoms.
How to diagnose and treat dry eyes?
We then try to investigate the root cause of why you don’t produce enough tears or oils. Once we can establish the cause, we will make a management plan to help you. Some of the treatments range from specific eye drops to in-chair therapy and procedures.
Below are a list and explanations of each the treatments available based on stages:
Stage 1
Education: Sometimes the best solution is understanding your condition and helping avoid things that can trigger your dry eye symptoms. This includes avoiding air-conditioned rooms, false lashes, certain make ups etc.
Diet and Supplements: Some supplements like fish oil with omega 3 and 6 has the potential to help with meibomian oil expression.
Ocular Lubricants: Lubricants tend not to fix the core issue of dry eyes, but it does help prevent the eye from being so dry that it causes blurry vision or an infection. We recommend specific lubricants to help relieve your symptoms while undergoing treatment. Eventually, we hope that you will no longer need to use eye drops.
Lid Hygiene & Warm Compresses: For evaporative dry eyes, we often ask you to try and massage your eye lids to help stimulate the expression of the oils. This includes a special warm mask to heat the glands up and massaging techniques to express the oils out. If you do this for 1-2 months and there is still no improvement, we will start stage 2 of management.
Stage 2
Tea Tree Oil: Occasionally dry eye can be caused from a little lash bug called Dermodex. These microscopic species cause inflammation of the eye lid and subsequently blocking the oil glands. Tea tree oils help remove them from the lashes, reducing the inflammation causing dry eye.
Punctual plugs: Mainly used to aqueous deficient dry eyes. The punctum is the area in the eye that drains the tears out of the eye into the nose. The idea is that if we block these holes, it will retain the aqueous tears on the eye and relieve you of the symptoms.
Lid Wider Debridement: The edge of your eyelids needs to be smooth so it can spread and excrete oils evenly over the eye. Occasionally this area can be blocked and fill with residual make up or debris. To treat this, our optometrist uses a thin blade to scrap all the dead cells and debris from the area to make it a clean and smooth surface.
In-Chair Meibomian Gland Expression: When your oil glands are block for a long periods of time, it will be very unlikely that they will unblock on their own. Our optometrist can help you unblock them by manually expressing them in the chair with our instruments. Sometimes the blocked oils come out as thick toothpaste like substance or gooey oils. Normal oils are clear and very fluid.
Lipiflow: This is an instrument that uses special eye lid attachments to warm up the meibomian glands and massage them automatically helping them express.
Intense Pulse Light: Dry eye can occur from inflammation of the eye lids causing a disruption of natural oil production. This inflammation can be seen as thick blood vessels appearing on the edge of the eye lids. This therapy involves us flashing a bright red light onto the eye lids with the goal of the reducing the red vessels and inflammation. As the inflammation resolves, your oil glands will produce normal functioning oils again giving you relief of dry eye.
Prescribed Medication: We can prescribe specific medication that help you secrete more tears or oils. These work better than your over the counter lubricating drops as it specifically targets the mechanism of your dry eye. There are also certain anti biotics that we can work with your GP to prescribe to help with your dry eye. These antibiotics will help reduce eye inflammation at low doses.
Stage 3
Autologous Serum: Mainly used for very severe and symptomatic dry eyes that does not respond to tradition treatment. Our optometrist can refer you to the Australian Red Cross where they will use your blood, extract the plasma from them and turn it into eye drops. The research shows that these drops can help heal the eye from severe dry eye symptoms, however, the cause of the dry eye will need to be addressed on top of this treatment.
Contact Lenses: Symptoms of dry eye occurs when corneal nerves are exposed to air causing a sharp burning sensation. To combat this, we apply special contact lenses that help protect your eye from the environment.
Stage 4
Surgery: Used for dry eyes that does not respond to any therapies and is very symptomatic. Some surgeries include salivary gland transplants where the gland will help keep the eye moisturised, Punctal occlusion to help keep the tears on the eye and many others. Our optometrist will work with you to determine what is best and will refer you to our surgeons to perform.
If you would like for us to help you with your dry eyes, please click the link to book an appointment with us today.
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