In my earlier articles I discussed the increase in numbers of people suffering from discomfort of the eyes, dry eye. I explained how the tear film is made up, what can affect it and touched on some ways that we can help.
However, to develop a long lasting, satisfactory solution we have to go into the problem in greater detail, so that an individual solution can be developed.
I have found over the years that the only way to start is to get information in a structured way, by asking questions, observing and listening to you, the patient.
I now also use the I-PEN®, the world’s first, hand-held, point-of-care, solid state electronic diagnostic device to detect and indirectly measure the elevated tear film osmolarity levels associated with mild, moderate and severe Dry Eye Disease. Using all the information that this will give will allow us to determine what the cause (or causes) of the problem is and to determine a course of action to help alleviate the discomfort.
As I mentioned previously, the tear film consists of three layers, the innermost mucin layer, the middle aqueous liquid layer and the oily lipid layer, all of which are produced by different glands underneath your eyelids. When we blink, the tears are spread over the surface of the eye, so that they can lubricate, nourish and protect the front of the eye. There two types of dry eye, the aqueous tear-deficient eye where the eyes’ lacrimal glands fail to produce enough of the middle aqueous layer of tears, resulting in low tear production, and the evaporative dry eye where the eyes’ meibomian glands don’t produce a strong outer lipid layer of tears, resulting in tears that evaporate too quickly.
So basically, the eye surface is drying out. However, this can be caused by a great number of different reasons, not all of which originates from your body. Dry eye can be aggravated by the outside world. We have to decide what the cause is and develop ways of increasing your eye comfort
Often you may also be able to reduce dry eye symptoms by adjusting your environment, changing your habits a little, keeping your eye lids clean and infection free, and possibly improving your diet.
For example, make sure that you blink more, which sounds like such a simple thing to do, but reminding yourself to blink when staring at a computer screen or screen for a long period of time may help re-moisture your dry eyes. Also, make sure that you take a technology break, having dry eye sometimes requires all of us to put down our devices and take a short break. This will help give our eyes the rest they need to retain much-needed moisture. When you are outside, wear sunglasses. By wearing wraparound eye protection whenever you are outdoors, you can reduce exposure to sunlight and other elements like wind, pollen and dust, which can increase symptoms of dry eye.
It is important to keep yourself hydrated by drinking plenty of water every day, if your body has the natural hydration is needs, dry eye symptoms can become more manageable.
Treatment for dry eye syndrome helps to control the symptoms, but there’s no cure. It is not unusual to have to continue some treatment for the rest of our lives.
The first thing to consider is whether there are any obvious factors, such as a medication or an underlying medical condition is causing the symptoms.
If your dry eye is caused by this, then an initial discussion with your GP is worthwhile before going into other courses of action
My earlier article discussed the use of lid wipes to clean the eyelid margins, and perhaps use a medicated wipe if there are any signs of infection. This can also be very useful in removing make up if it is used. I also mentioned the use of warm compresses or eyebags to help free off blocked Meibomian Glands, which will improve the oily layers of the tear film, reduce evaporation of the aqueous layer and therefore improve comfort of the eye.
However, it is not uncommon to need to supplement the tear film in one way or another, depending on where the reinforcement is needed. The normal way to do this is to use drops or gels.
Not that long ago, all we had was Hypromellose, Gel Tears, Snotears and a few others. However modern research has improved the choice and effectivity immensely.
There are now many different types of eye drops and gels, and it can sometimes require time to find exactly the right combination for you
It is not unusual to have to use a mix of two or three different treatments, drops and gels to achieve the best effect.
Another consideration is the use of preservatives in some drops and creams. As you are likely to need to continue using the treatment for a long time once the correct regime has been established it is important that you are not putting any preservatives into your eye, as this can often create sensitivity and soreness, which is exactly what we are trying to prevent!
Also, if you wear soft contact lenses, you will need to use a preservative-free lubricant, as preservatives attach to the contact lens and damage the eye.
It is for these reasons that I mainly use I-DROP PUR, I-DROP PUR GEL, Hyabak and Theoloz Duo for daytime use, with Vita-pos or Clinitas Hydrate at night. If you struggle to put drops in then Eye Logic can be a very useful alternative as it is a spray that is used over your closed eyelids, however I find that this needs to be used more frequently to be fully effective.
I hope that this series of articles has been useful. If I have raised any questions or you would like any further information, please don’t hesitate to contact me or just drop in, I will be delighted to try to help.