In my last blog I talked about the problems that dry eye can cause, and also gave some background about what the tears are made of, and how they are produced.
As I said, this problem is quite common, particularly as we all get older. Fortunately for us all it is easily controlled in the vast majority of cases. At it’s simplest all we have to do is replace the tears and that is that. Unfortunately, there is quite a bit more to it than that.
Firstly, what is causing the problem? What are the symptoms (if any)? Which type of defect has the tear film got? A simple questionnaire and observation will give a very strong indication of the cause and what treatment will help, and often the first stage is the eye test. By taking a detailed medical history, we can determine if any pre-existing medical conditions, environmental factors, or current medications could be causing the dryness. We may also perform an external examination of the eye, evaluating your eyelids, cornea, and observing your blinking patterns.
One of the more common things that we notice is a condition called Blepharitis. This is a common condition where the edges of the eyelids (eyelid margins) become red and swollen (inflamed).
Blepharitis can develop at any age, and symptoms can include:
- itchy, sore and red eyelids that stick together
- crusty or greasy eyelashes
- a burning, gritty sensation in your eyes
- increased sensitivity to light (photophobia)
- swollen eyelid margins
- finding contact lenses uncomfortable to wear
- abnormal eyelash growth or loss of eyelashes in severe cases
In most cases both eyes are affected, but one eye can be more affected than the other. The symptoms tend to be worse in the morning.
Blepharitis is usually a long-term condition. Most people experience repeated episodes, separated by periods without symptoms.
It can’t usually be cured, but a daily eyelid-cleaning routine can help control the symptoms and prevent permanent scarring of the eyelid margins.
It is common to have a combination of Meibomian gland dysfunction (MGD), as well as blepharitis, in fact it has been suggested that they are linked.
The Meibomian glands are inside the eyelids, and the openings are on the edge of the eyelids. These glands produce the oily outer layer of the tears. The outer oily layer stops the watery layer of the tears from drying out. When the glands become blocked, the oily part of the tears cannot be released. This causes the watery tears to dry up more quickly which results in the eye becoming dry and can make it feel sore. If it is not treated, the glands may stop working permanently.
There are three main steps to eyelid hygiene and well-being that should be performed once or twice a day:
- cleaning your eyelids – to wipe away any excess oil and remove any crusts, bacteria, dust or grime that might have built up
- using a warm compress – to make the oil produced by the glands around your eyes more runny
- gently massaging your eyelids – to push the oils out of the glands
There are two ways to clean and wipe the eyelids. The time-honored way is to use cotton buds pads and baby shampoo. However, I have always wondered about the wisdom of using a detergent shampoo on an eye that is dry, even if the shampoo is designed not to sting. I much prefer to use specially designed solutions or impregnated pads such as Blephasol, Blephaclean, or I-lid N Lash (although there are many other similar products available). This will help significantly with eyelid hygiene and cleanliness, allowing the tears to be produced more easily and removing causes of irritation and infection. Once the blepharitis is under control you will be able to reduce the frequency of the treatment, perhaps to every two or three days.
The warm compress will help the oily tears to be released from the Meibomian glands. What is needed is about ten minutes of gentle warmth. The conventional ways which works very well is to use a face cloth, or cotton pads, soak them in hot (not boiling) water, close your eyes, and hold the hot cloth onto your closed eye. Wet the cloth again with hot water and keep applying the compress for at least five minutes, preferably ten minutes. If the other eye needs treatment, then use a fresh cloth or pad (to avoid cross infection) and repeat the process. Massaging your eyelids will help to clear the ducts that are at the lid margin once the heat has been applied, thus improving the production of tears. The compresses will need to be repeated every day for a fortnight or so, and then the frequency can be reduced, as in the blepharitis treatment.
Many people have found that the warm flannel has helped but it is very time consuming and involved, so have found it very difficult to fit into our modern lifestyle. This is where I have found that the EyeBag (other similar products are available) is very useful. All that is needed with these is to place the bag into the microwave for a short time of around 20 to 30 seconds, place it over the closed eyes and relax for ten minutes. The EyeBag is formulated to hold the heat for that time and at the end of the period you can do the lid massage. Heating the bag in the microwave will help keep it sterile, which is a significant advantage.
More severe cases may require antibiotics that are either applied to the eye or eyelid directly, or taken as tablets, but this quite rare, normally a program of warm compresses, massage and wipes will quite quickly bring the condition under control.
This series of treatments and procedures will have a great influence on the health and cleanliness of the eyelids, and will have a beneficial effect on the production of tears, but quite often further help is needed. This is the use of creams and drops that reinforce the tear film, giving the comfort and visual clarity that we all want.
In the next blog I will go into this area in greater detail, describing how a carefully thought out, individual treatment regime can make a significant difference to the comfort of your eyes.
If, in the meantime, you want any further information please don’t hesitate to contact me by phone, email or just drop in for a chat.