Dry eyes and their symptoms occur when the ocular surface tear film is insufficient. Paradoxically, watering may also occur because of a protective reflex which triggers a sudden “emergency” flood of tears from the lacrimal (tear) gland when the level of dryness threatens to damage the ocular surface.
The tear film is composed of 3 layers:
Mucus – this allows water to stick to the ocular surface
Water – washes away foreign particles and contains dissolved oxygen and anti-bacterial agents.
Oil – produced by Meibomian glands in the eyelid margins, it slows down evaporation of tears.
Dry eye can result from deficiency of any of the three layers.
Age – Tear production and blink rate slow down over time.
Meibomian Gland Disease – often associated with rosacea
Central heating/air conditioning – Reduced humidity causes worse symptoms in the Winter.
Leaky CPAP masks worn overnight to treat Obstructive Sleep Apnoea
Medications – e.g. certain antidepressants, antihistamines
Autoimmune diseases – e.g. Rheumatoid arthritis, Sjogren’s syndrome
Reduced blink – Neurological disorders e.g. Parkinsons disease, Bells palsy
Visual attention – Reading and computer work reduce blink rate and increase tear evaporation
Radiotherapy near the eye, Chemical injury, Eyelid malposition (Ectropion)
Unfortunately, it’s not usually possible to cure dry eyes, but management or elimination of as many of the modifiable risk factors listed above may help.
The good news is that for the vast majority of sufferers relief can be found with simple measures.
Lubricants – Lubricant drops are widely available over the counter and are effective and safe to use. There are hundreds of different brands with differing ingredients and textures, some being more watery; others more gel-like and prices vary significantly. I recommend starting with the cheapest and working your way up, if required to the more expensive and sophisticated. Lubricant ointments have a thicker consistency so blur the vision and are best used last thing at night. For contact lens wearers if using drops more than 4 times daily, a non-preserved drop is recommended, as the preservative, Benzalkonium Chloride, is not compatible with contact lenses and can be toxic to the ocular surface when instilled more frequently than this.
Warm compresses– Using a warm, damp flannel or cosmetic pads and massaging in firm circular movements around the eyelids at least once daily helps to express the Meibomian gland oil onto the surface of the eye, helping to improve the staying power of the tear film. Don’t add baby shampoo, bicarbonate of soda or use blepharitis wipes or anything containing alcohol as these strip away the oil layer, worsening the dryness. If removing cosmetics, use a gentle cleanser to remove every last trace, prior to massage. I recommend iS Clinical’s Cleansing Complex, iS Clinical Cream Cleanser or Codage Micellar Water, depending on the your preference of gel, cream or aqueous cleanser.
Activity and Environment awareness -We live in centrally heated and air-conditioned environments and stare at screens for hours. These contribute to more rapid drying of the eyes. Keep your central heating off at night if possible and ensure there is good ventilation to your bedroom. You can also increase the ambient humidity with an air humidifier or damp towels over radiators. Use lubricant drops before engaging in prolonged computer work or driving long distance. Switching off your car’s aircon is also helpful.
Inflammation – When eyes are severely dry it can cause inflammation which can sometimes require medical treatment. This will involve examination by an Ophthalmologist using a slit-lamp biomicroscope and you may be prescribed additional drops, creams or tablets. Sometimes tiny plugs are inserted into the tear drainage ducts to reduce the flow of tears off the eyes, which can be helpful in some cases.
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