Dr Julia Sen, Consultant Ophthalmic Plastic, Reconstructive & Cosmetic Surgeon
    Dr Julia Sen, Consultant Ophthalmic Plastic, Reconstructive & Cosmetic Surgeon

      DRY EYE

      What is a Dry Eye?

      Dry eye is a common condition which can cause a feeling of grittiness, burning discomfort, redness and intermittent blurring of vision. These symptoms occur when the ocular surface tear film is insufficient. Watering may also be a symptom because of the protective reflex which triggers a sudden “emergency” flood of tears from the lacrimal (tear) gland when the surface reaches a level of dryness which threatens to damage the ocular surface.

      The tear film is composed of three layers; a mucous layer which allows water to adhere to the ocular surface (which would otherwise be water-repellent) the aqueous (watery) layer which makes up the majority of the tear film and washes away foreign particles and contains dissolved oxygen and anti-bacterial agents, and the oil layer, produced by the Meibomian glands in the eyelid margins which slows evaporation and helps prevent overspill.

      Potential Causes

      Dry eye can result from deficiency of any of the three layers. Factors which can lead to dry eye symptoms:

      • Advancing age
      Tear production and blink rate slow down over time.

      • Medications
      e.g. certain antidepressants, antihistamines

      • Autoimmune diseases
      e.g. Rheumatoid arthritis, Sjogren’s syndrome

      • Meibomian Gland Disease
      often associated with rosacea

      • Central heating/air conditioning
      Reduced humidity causes sufferers to have worse symptoms in the Winter.
      Leaky CPAP masks worn overnight to treat Obstructive Sleep Apnoea

      • Reduced blink
      Neurological disorders e.g. Parkinsons disease, Bells palsy

      • Visual attention
      Reading and computer work reduce blink rate and increase tear evaporation

      Less common causes:

      • Radiotherapy near the eye
      • Chemical injury
      • Eyelid malposition (Ectropion)


      Unfortunately, it is not usually possible to cure dry eye, 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.

      Topical lubricating eye drops and/or warm massage of the eyelids can improve the quality and quantity of the tear film. It may be helpful to instil lubricant drops prior to activities which tend to trigger symptoms (e.g. before reading or working at a computer).

      Lubricant drops are widely available over the counter and are effective and safe to use. Lubricant ointments are also available for night-time use. They have a thicker consistency so blur the vision so are most suitable for instillation last thing at night. If using with other drops (e.g those prescribed for glaucoma) the ointment should be the last thing to be instilled before bed.

      For contact lens wearers and those who require drops more frequently than 4 times daily, a non-preserved drop is recommended, as Benzalkonium Chloride, a commonly used preservative is not compatible with contact lenses and is toxic to the ocular surface in doses which exceed this.


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