Ways to treat dry eyes. A growing problem in this modern age, the feeling of walking around with a stone in your shoe everyday is not pleasant. Neither is the eyelash in your feels that can come with dry eye disease. Depending on the underlying cause of your dry eyes, there are a number of options available to you in treating them. Not all options are suitable for all as there are different types of dry eye.
1. 20/20/20 rule
Your eye sight might be 20/20 but are your following the 20/20/20 rule? Excessive computer work, phone browsing and reading can cause your blink rate to drop significantly. This will mean your tears evaporate, leaving the surface to become dry. Normally, you would be blinking again before your tears have a chance to evaporate, leaving patches of dry areas. So what do you do? Blinking is an unconscious act so you cant consciously blink while you are working as it would be very distracting. This is where the 20/20/20 rule come in. Set a timer on your phone for 20 minutes and work as you normally would. When the alarm goes off, stop working for 20 seconds and do 20 blinks, then reset the timer and carry on working. Do things this way means you are having a regular break from the screen and you make up for the blinking you are not doing while working.
Most people will overlook the importance of blinking or the lack there of when doing concentrated tasks. When you are busy working away on your screen or even watching a movie on your computer your blink rate comes right down. The normal blink rate is about 15 blinks a minute and you could easily go down to zero when staring at a screen intently.
3. Lubricant drops & Artificial tears
Ocular lubricant drops, also known as artificial tears are the most common form of dry eye control. They work in their simplest form by increasing the tear layer and creating a barrier between the lids and the eye surface.
There are many types of lubricating drops available. What sets them apart is in the way they work in addition to the tear volume described above.
Additional components work to mimic the natural tears in nutrient composition, lubricity, salt components. They are therefore acting as tear substitutes, continuing to do the job that our natural tears would otherwise be doing.
These additional components can mimic different parts of the tear film. The three basic layers of mucin, lacrima and meibum work together and
taking this further, manufacturers are developing drops that stay in the eyes for longer, reducing the number of times you will need to put them in your eyes over the day.
And finally there is the length of time the drops last in the bottle. Previously, most artificial tears were preserved. The preservative use, Benzalconium chloride has the long been known to actually cause dry eye itself over long term use. More and more manufacturers have been changing to either non preserved or disappearing preservative formulations.
4. Lubricant ointment
When artificial tears are just not good enough on their own. These provide maximum viscosity and will stay in the eye after one application for hours.
Sound great, but the downside is that they will make your vision all blurry while they are working. For this reason this treatment is restricted to overnight use or severe corneal surface damage.
These come in preserved and unpreserved formulations and as mentioned above, unpreserved formulas are becoming the norm.
If you are using drops during the day and need something for the night, these are what you need. Or if you find your symptoms predominantly on waking, use these before you go to bed at night.
Sterile, preservative free, vitamin A eye ointment that also contains liquid paraffin, light liquid paraffin, wool fat and white soft paraffin. It is used for moderate to severe dry eye and mostly recommended for night time use.
5. Lubricant sprays
These are aerosol based sprays that contains lipid to mimic the outer layer of the tear film. They are used if you have evaporative dry eye as the outer layer slows the evaporation of the tear film.
To use these sprays you actually spray on your closed eyelids. This results in the mixture landing on the margins of your eyelids which, when opening the eyes causes it to spread and interact with the ocular surface film.
6. Eyelid Heating/Warming
Meibomian gland dysfunction can be caused by a stagnation in the flow of meibum, the component of the outer tear layer. This is an oily secretion made of lipids. Just as oil under certain conditions can be thick and viscous, the meibum can become too viscous to travel easily through the tiny ducts that exit the eyelids. Using heat by placing a heat pad, warmed to a moderate temperature, thins the meibum. This means it can more easily pass through the ducts and perform it’s function.
Relax away the symptoms of:
MGD & Blepharitis
Grittiness & Irritation
Dry eye syndrome
Styles & Cysts
The Eye Doctor is registered as a Class 1 medical device with the MHRA
7. Eyelid Massage
Eyepeace eyelid massager
This makes a good follow on routine after the heating above. This involves gently massaging the eyelids in order to squeeze out the stagnant meibum and open the glands up. Done regularly, it can be effective for meibomian gland dysfunction. The eyepeace massager was developed by Ophthalmologists in Northern Ireland to make it easier to perform an efficient massage of the eyelids.
Introducing Eyepeace, massages the meibomian glands in the only effective way to treat meibomian gland disease and posterior blepharitis.
Developed by world-renowned eye surgeons Professor Johnny Moore and Anant Sharma, this medical massager device has the potential to offer lasting relief to millions who suffer the daily discomfort of dry eye disease.
Hints and tips for using eyepeace:
1) Once a day use only is recommended and you should squeeze on that occasion between 5-10 times.
2) This is intended to help to express the (oil producing) meibomian glands within the eyelids to improve the tear film.
3) Do not ‘over-open’ the lips of the eye massager, rather simply place onto the closed eyelids and gently but firmly squeeze the ‘eyepeace’ to vertically massage the lids and therefore the underlying meibomian glands. If you have loose eyelid skin, please lift this out of the way, prior to placing the massager onto your lids.
4) The massager is intended to glide across the skin.
5) If massaging results in the lid recurrently everting, while compressing the massager, please check that any loose skin is lifted out of the way and try to change the massager position on the lids to improve its gliding action.
6) Do not over massage or massage in a way that causes any pain. If massaging is causing pain you should reduce the strength of massage and if it again recurs cease using the massager until you seek advice from a local eye specialist.
7) You should not experience pain or see colours during use, you should not use if you have had a recent eye operation. When squeezing there should be a gliding motion over lids. You must read the caution (back of insert) before use.
8. Eyelids scrubs
These work on the eyelids and are to treat meibomian gland dysfunction and blepharitis. Since both conditions can be present together, lid scrubs help clear the debris and mildly exfoliate the lids, opening the glands.
OCuSOFT Lid Scrub PLUS Extra Strength Formula combines a low – level, proprietary preservative blend that effectively relieves irritation by removing oil, debris, and other contaminants. This clinically proven, laboratory tested formula is safe and effective for lid hygiene.
Direction for use:
1. Wash and clean hands.
2. Close eyes and gently cleanse lids using side – to – side strokes.
3. Rinse (or leave on if directed). Avoid touching eyes directly.
9. Micro-blepharo Exfoliation (Blephex) Tearfilm clinic
Used to clear the debris and exfoliate the lid margin.
This treatment targets the lids margins where you can have a buildup of dead skin cells, scurf and bacteria. As a result of these factors a localised inflammatory reaction can occur. This inflammatory condition is called blepharitis and it is very common for dry eye to follow due to the close proximity of the tear glands in the eyelids and the eye itself.
BlephEx treatment involves the use of a micro-surgical sponge spinning at high speed being used to clear the debris and exfoliate the lid margin. It is a deep clean for the eyelids similar to a visit to the dentist to have your eyes professionally cleaned.
BlephEx is performed by a qualified and experienced Optometrist in clinic.
10. Tea trea oil for dry eyes
The active component TTP is toxic in higher concentrations. But at the right concentration it can be effective against demodex mites.
Naturally fresh, healthy eyes
Advanced lid, lash and facial cleanser for alleviating the symptoms of blepharitis, demodex and other ocular diseases.
For external use only.
Water, 4-Terpineol, Glycerin, Polysorbate 20, Polysorbate 80, Carbomer, Trienthanolamine.
11. Nutritional Supplements
Nutrition plays a key role in health and the same can be said for eye health. We already know of the benefits of macula antixoidants for macular health but dry eye is also influenced by our diet.
The formula for Lagad Lacrima was developed based on the work of Ophthalmologists and Nutritionists who specialise in research on dry eye.
Lagad Lacrima Softgels are easy to swallow due to their unique shape and the natural fish gelatine coating.
Pack size 60 Softgels – 2 Softgels per day
12. Meibomian Gland Expression
Eyelid massage can be effective but sometimes you need to go further. This is where meibomian gland expressing comes in. Using numbing drops your eye care professional will use a special tool to gently express the glands and give them a good clearing. This can be good for those who have moderate to severe meibomian gland disfunction.
13. Closing the eyes.
Surprisingly simple, but effective for many.
14. Punctum Plugs
Your tears collect in the corner of your eyes near your nose in an area called the medial canthus. In this area you can sometimes see, if you look close enough, a tiny hole on the corner of your lower lid. There is actually one on the upper lid almost directly above too. These holes are called the puncta and they drain the spent tears in through the lacrimal apparatus and into the back of your nose.
15. Wind shield glasses
Although there are many ways to treat dry eyes, once thing that should not be forgotten is preventative measures. As they say, prevention is better than cure. As most dry eye is the evaporative kind, due mainly to problems with the eyelid glands, we should look at how to maintain this. Staying hydrated will mean your eyes will be more moist.Prevention
16. Moisture Chamber Goggles
These trap moisture and make it available to the eyes.
17. Honey for dry eyes
Ever heard of the guy who cured his blepharitis using honey? Honey has known antibacterial and anti-inflammatory properties. This may not be the case for all types of honey as many honeys are processed by heating which significantly reduces their antibacterial properties
Inflammation is a key factor in the cycle of dry eye disease.
Bacteria can be involved in the cycle of dry eye disease and antibiotics can be effective in reducing the bacterial load. Bacteria produce toxins and cause localised inflammation. This is most often linked to blepharitis in which dry skins cells mixed with sebum collect at the base of the lid margin, thereby attracting bacteria to feed on the dead skin cells.
These prescription only medicines are only prescribed by medical professionals or specialist Eyecare professionals.
They are used sparingly, as is the case with all types of steroids. They reduce the inflammatory response in and around the eye. These are effective at reducing the symptoms and breaking the cycle whilst waiting for other interventions to take effect.
20. Restasis / Ikervis
This anti-inflammatory is derived from a fungus. Its active ingredient ciclosporin gives a clue to its origins. Ciclosporin works by dampening the inflammatory response by suppressing the immune system.
21. Intense Pulsed Light – IPL
Intense pulsed light or IPL is used in the aesthetic industry for hair removal. However, it has also been found to be useful for meibomian gland dysfunction.
22. Blood serum for dry eyes
Your own that is. Surprisingly, blood has common ingredients with the tearfilm with the addition of haemoglobin that gives it the nice red colour.
23. Lipiflow Thermal Pulsation System
A high tech approach to dry eye therapy, Lipiflow is for meibomian gland deficiency only.
25. Autologous Serum Eye Drops (ASED)
Made by the ftse100 company Shire, this treatment is very new and was first approved for use in the USA. It is going through the approval stages for EU licencing.
xiidra’s actual name is Lifitegrast Ophthalmic solution. It inhibits T-cell inflammation by blocking the binding of 2 key cellular surface proteins (LFA-1 and ICAM-1) that mediate the chronic inflammatory cascade
If you need help and advice in managing your dry eye consider a tear Film assessment. A 50 minutes long assessment of all the glands that contribute to the tear-film.
Salman Siddiqui MCOptom is an Optometrist with 18 years on experience and has a special interest in dry eye and it’s treatment.