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Dry Eye

Dry eye is a term frequently used when people complain of sore gritty eyes. More often than not the eyes actually water as well and being given the diagnosis of dry eye can be confusing. Whilst there are many different conditions that can be associated with it, in most cases no diagnosis is possible other than the term “dry eye”. Unfortunately in most cases there is no treatment that will completely resolve all the symptoms. This lack of diagnosis and relatively ineffective treatment can be very frustrating for both patient and doctor alike.
In simple terms the causes may be thought of as a genuine reduction in tear production (true dry eye); poor quality of tears and inflammation. They can occur in combination.

True dry eye

Dry Eyes - Details from Derby Eye Surgery

The tears are produced by a gland (lacrimal gland) that lies just underneath the upper lid. Other small glands (accessory glands) around the eye and lids also produce components for the tears. Tears are in fact a complex mixture of salt water, fats and mucous as well as many other chemicals such as natural antibiotics. Tears perform many functions such as lubricating the eyelids as they move over the eye. They also keep the front of the eye clean. There is a constant flow of tears from the glands over the front of the eye then draining through small channels in the lids to the nose.

In true dry eye some or all of these glands stop working and tear production falls. The resulting dryness causes problems with the front of the eye and results in severe pain and grittiness. Several conditions can cause this but the most common is severe rheumatoid arthritis. Very often the salivary glands are also affected resulting in a permanently dry mouth. Fortunately, true dry eye is rare.

Poor quality tears

Dry Eyes - Details from Derby Eye Surgery
For some reason the fine balance of the different tear components is upset and the tears can no longer keep the front of the eye healthy and comfortable. On looking at the eye there is nothing specific to find. There are a few tests that can show the tears are not working well (such as tear osmolarity) but they are not widely available. The diagnosis is usually made from listening to the symptoms and seeing an otherwise healthy looking eye. 

Inflammation

Dry Eyes - Details from Derby Eye SurgeryLow grade longstanding inflammation of the eyelids (blepharitis) is a common cause of sore gritty eyes. It’s thought that this inflammation can also affect the quality of the tears making the symptoms worse. It’s thought that the normal bugs that live on al our eyelid skin (so called friendly bacteria) produce by-products that over a period of time set off an inflammatory reaction.  The whole front of the eye can become inflamed as well and in severe cases this is called blepharo-kerato-conjunctivitis (BKC).

Some experts actually think that most cases of dry eye syndrome have at least some degree of inflammation underlying them.

Inflamed eyelids

Treatment

Treatment of dry eyes in Derby is the same as in other major centres. Firstly the eyes are examined to see if there is an obvious cause for the problem. This may include tests for tear volume (Schirmers) though they are not always helpful. Staining the tears on the eye is a useful test.

If true dry eye is suspected then problems such as rheumatoid arthritis will be checked for. Eyestrain may exacerbate the discomfort, so it’s well worth seeing your optician for an up to date pair of glasses.

In true dry eye the treatment consists of substitute tears (drops or cream) and methods to keep the normal tears on the eye as long as possible. Putting plugs into the drainage channels of the lids is an effective method of keeping tears in the eye. Goggles can reduce the evaporation of tears from the surface of the eye.   This combination, whilst not perfect, does help true dry eye considerably.

Treating people with poor quality tears can be more difficult. None of the artificial tears available are as good as the real thing. It’s a matter of finding the drop or cream that suits a particular person most. The biggest mistake most people make is not using the drops/cream enough. Some people need to use them six times a day or more. It may vary from day to day as well.

It’s worth remembering that the lubricants are not actually a drug and there is no risk of becoming dependant on them. It’s important to appreciate that it’s unlikely that the lubricants will completely eradicate the discomfort; the aim is to make it more tolerable. It’s also important to remember that, whilst a nuisance, this problem will not damage your vision.

Where there is inflammation associated with dry eyes, there are a number of other treatments that can be used in conjunction with lubricants. One of the simplest is called lid hygiene. Here the aim is to reduce the by-products of the friendly bacteria causing the inflammation. Half a teaspoon of bicarbonate of soda into half a pint of warm water is an effective cleansing solution. Clean the eyelid margins with cotton wool soaked in the solution, like a woman taking off make-up. Some people do this every day, others find twice a week is enough.

For more serious cases a short course of antibiotic cream may help, but prolonged use rarely does and can make things worse if the lids react to the antibiotic. Antibiotic tablets or syrup can be very helpful where there is associated blepharitis (lid inflammation). The most common is doxycyclin, or erythromycin in children. They are thought to work not by killing the friendly bacteria but altering their metabolism so they do not produce the irritant by-products. These do have to be used for prolonged periods to be effective.

It has been shown that regular use of omega 3 supplements can reduce eyelid inflammation and alleviate the discomfort.

For severe cases there are other options as well. A course of steroid drops can settle down a severe inflammation. Long term use of steroids is best avoided as the drops themselves can have serious side effect. Cyclosporine A is a very powerful anti-inflammatory which has been shown to be helpful. It has less damaging side effects than steroids and may be better for long term use. Its main drawback is that it stings. Unfortunately it is not readily available in the UK. Using the patients own blood serum as drops has also been beneficial in some cases. As in most conditions, it’s sensible to start with the simple options first and work up to the more complicated treatments if and when required.

Useful link: www.dryeyezone.com

 

 

 

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