Tears have several important functions:
The tears consist of three layers, each produced by a different set of glands located on the conjunctiva and the eyelids. The layers need to mix in just the right balance, otherwise the tears will either not lubricate the eyes correctly or evaporate from the eye surface too quickly.
If the tears are not lubricating the eyes effectively, then the eyes will not be moist and comfortable. This will cause irritation and stimulate more tear production. These reflex tears are more watery due to the gland that secretes them, so they are much more unstable and tend to run off the eye surface very easily.
Aqueous Tear Deficiency ADDE is one of the two main categories of dry eyes related to under production of tears. Dryness results from reduced lacrimal tear secretion and volume. This causes tear hyperosmolarity (increased saltiness), because, although the water evaporates from the ocular surface at normal rates, it is from a reduced aqueous tear pool. Tear film hyperosmolarity causes hyperosmolarity of the ocular surface epithelial cells and stimulates a cascade of inflammatory events. It is uncertain whether evaporation is reduced or increased in ADDE. It is possible that this is determined by the stage of the disease.
ADDE has two major subclasses, SS dry eye (SSDE) and non-SS dry eye.
a) Sjogren Syndrome Dry Eye
Sjogren syndrome is a general disease in which the lacrimal and salivary glands are targeted by an autoimmune process; other organs are also affected. Dry eyes, mouth and other orifaces are common.
b) Non-Sjogren Syndrome Dry Eye
Non-Sjogren syndrome dry eye is a form of ADDE due to lacrimal dysfunction. There are no systemic autoimmune features characteristic of SSDE. The most common form is age-related dry eye.
Evaporative dry eyes is a result of Meibomian Gland Dysfunction(MGD): a common, chronic disorder of the meibomian glands, which are the small oil secreting glands that line the inside of the top and bottom eyelids. These glands secrete oily compounds, which are an essential component of our tear film that lubricates the surface of the eye, providing clear vision and ocular comfort. MGD is where the glands start to malfunction and not secrete appropriate amounts or consistency of these oily compounds. Most commonly they under-secrete leading to poor tear film quality, quick evaporation of tears, and “dry eyes”. They may also over-secrete leading to excessively oily tears with possible associated dermatitis conditions causing discomfort and inflammation around the eyelids. MGD is now considered to be the leading cause of dry eyes: 70-80% of cases.
MGD may be caused by obstruction of the fine meibomian gland ducts that line the interior edge of the eyelids, by skin debris blockage or hardening of the oily matter effectively forming plugs. Scarring can also cause damage to the duct openings. The process is also influenced by age, sex, and hormonal disturbances, and may be associated with skin conditions like dermatitis and acne rosacea. The end result is a reduced delivery of the meibum oils to the lid margin and tear film lipid layer; leading to tear film instability, increased evaporation, dry eyes, ocular surface inflammation and damage.
Dry eyes may affect any age group, but it is more common in females aged 30+ and increases in incidence with age. It is also more common in contact lens wearers, and with some medications.
Following are some simple preventative measures you can do every day to minimise the chances of developing dry eyes
Usually, a patient is told they have “dry eyes” after a quick look through the microscope by their eye care practitioner. At the Gold Coast Dry Eyes Center, we believe utilizing the latest technology and the latest scientifically validated assessment protocols leads to a more accurate diagnosis, and thus a more suitable treatment plan can be implemented that is customized to your personal condition. We utilize the following detailed testing procedures to fully understand the nature of your condition and ensure we start your care, knowing what we are truly dealing with.
After completing the suite of diagnostic tests, our optometrists have an accurate understanding of your current dry eye status and can formulate an appropriate customized treatment plan to start your journey back to comfortable eyes.. We thus gain a comprehensive picture of the health of your ocular surface and tear film.
IPL for dry eyes is a relatively new treatment option, developed over the last 8 years and commercially available the last 3 years or so.
E-Eye is a device that generates a polychromatic pulsed light by producing perfectly calibrated and homogenously sequenced light pulses. The energy, spectrum and time period are precisely set to stimulate the Meibomian glands in order for them to return their normal function. Many patients are familiar with IPL technology in the treatment of skin conditions and hair removal. E-Eye IPL is a dry eye specific machine that utilizes the same proven, safe technology.
The E-Eye does not directly affect the Meibomian glands. Its action is INDIRECT by stimulating nerve conduction which then activates the glands for secretion and contraction. The treatment effects is cumulative and lasts
IPL therapy is particularly applicable to patients who are suffering from evaporative dry eyes or showing signs of it developing. The initial evaluation will establish the suitability of a patient for therapy
E-Eye Therapy is available at the Gold Coast Dry Eyes Center clinics located at Envision Optical Tweed Heads South and Burleigh Heads. Step one is booking for a comprehensive dry eye evaluation to determine your suitability for therapy.
Published studies have shown an 87-90% treatment success rate. Earlier intervention will lead to greater success BEFORE permanent damage occurs leading to gland atrophy. The established treatment protocol is 3 sessions conducted at Day 1, 15 and 45. A fourth session on day 75 may be required in more severe cases.
The E-Eye IPL device has been registered at the Australian Therapeutic Goods Administration for the treatment of dry eye syndrome.
1) Blephasteam Heat Therapy and Gland Expression
This therapy forms the mainstay of our treatment programs for evaporative dry eyes caused by Meibomian Gland Dysfunction. This in office procedure involves wearing the Blephasteam goggles for 15 minutes. This creates a “heat chamber” environment that softens the solidified oils blocking the openings of the glands . You will then see your optometrist who will perform debridement of the eyelid margins, clearing debris and dead skin from the openings of the glands. This is followed by expression and massage of the eyelids to force the oil blockages out of the gland tubes. Once these blockages are fully cleared, normal function can start to occur again.
You will usually require at least 2-3 sessions of Blephasteam Therapy to clear all blockages.
2) MGDRx Eyebag Home therapy:
Traditionally we tell patients to heat a face washer, hold against your lids and maybe gently massage the lids and this will help stop the glands get blocked. This is usually ineffective for most patients as the heat does not last long enough to soften the oil blockages in the glands. Scientific studies have indicated that the MGDRX EYEBAG is the most effective heating option to give the heat levels for long enough to soften the blockages and promote good oil flow from the glands. We include an Eyebag as part of our take home treatment pack.
3) Blephadex Wipes and Demodex
Demodex mites are naturally occurring on our skin but sometimes get out of control and cause blepharitis, an irritating reaction of the skin long the eyelids, particularly around the base of the eyelashes. If signs of this exist, then treatment with daily Blephadex wipes, which contain teatree oil in concentrations known to effectively kill demodex mites can be the most effective treatment
4) Eye Drops:
Oculocin Propo eye drops are a natural based dry eye treatment with no known side effects. The key ingredients are: Propolis, Aloe Vera, and Chamomilla. They provide dry eye relief and comfort, while also providing a mild anti-septic action which helps in cases of blepharitis related dry eyes.
5) Lacrimal Lavage:
Some patient’s watery eyes are caused by narrowing of the tear draining ducts. We are able to investigate to detect any narrowing or blockages and then perform treatment to widen up and flush out the tear drainage ducts to ensure they are draining normally. If necessary we will refer to eye surgeons who sub-specialise in the correction of tear duct problems.
6) Punctal Plugs:
Some patients eye irritation is produced from aqueous deficient dry eyes or not enough tears. We are able to insert small plugs into the tear drainage ducts to help more tears stay on the ocular surface and provide more lubrication for the eyes.
7) Nutrition for Dry Eyes:
The mainstay of nutritional therapy for dry eyes is a high quality omega 3 supplement. The omega 3 has an anti-inflammatory effect and will take at least 3 months to start to reach full effect, so you must be patient. Detailed advice will be provided in your management plan