Dry eye treatment
The official definition:
“Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface”.
Dry eyes and blepharitis are common complaints affecting the quality of life of millions of people in the UK. Dry eye syndrome is five to six times more common in women than in men. As well as feeling gritty and sore, dry eye often causes fluctuating vision and watery eyes.
It is one of those conditions that really affects one’s quality of life and can be very miserable.
Often the cause is hormonal – its incidence significantly increases with menopause and pregnancy. HRT also increases the likelihood of Dry Eye.
Refractive laser surgery is another common cause of dry eyes.
Before preparing a treatment plan, an assessment is required to determine the severity of the symptoms and, most importantly, the type and cause of the issue, as different causes require different treatments.
We’ll perform various tests, including slit-lamp examination, tear quality analysis, tear osmolarity (saltiness) and meibomian gland imaging to assess gland dropout, which is the definitive proof of meibomian gland dysfunction.
We can then plan a treatment program using in-practice procedures such as Blephex, IPL, punctal plugs, as well as nutritional advice, supplements, recommended eye drops and accessories such as heat masks and hyaluronic acid-rich lid wipes.
Blepharitis is a chronic inflammation of the lids and lashes. The symptoms are typically itchiness, grittiness and sore eyelids but can also include dryness, stinging, redness and difficulty wearing contact lenses.
It usually affects both eyes rather than just the one and is often accompanied by styes. One can have blepharitis without dry eye, but they often go hand-in-hand.
Historically, people were advised to use a ‘hot compress’. The problem with this advice is that no one seems to agree what a hot compress is. To help clear up styes and blepharitis, one needs heat applied for ten minutes at 40°C. This can only be achieved using a proper heat mask. We supply a few varieties – those that work with a microwave are best.
Styes might need local antibiotics to clear if they’re persistent.
All four eyelids contain the meibomian glands, of which there are roughly thirty in each lid. The glands are responsible for creating an oily secretion called meibum, that forms the outer lipid layer of the tears. Its primary function is to bind the tears between blinks and prevent evaporation.
Meibomian gland dysfunction (MGD) occurs when the glands become blocked, inflamed or atrophied and therefore unable to secrete sufficient oil (meibum) to seal the outer layer of the tears, or the oil is of poor quality which results in the tears evaporating quickly.
The majority of dry eye cases are of the evaporative form. Sufferers can be treated using a combination of Blephex, IPL and LLLT (see below), which when combined, leads to a high success rate.
Intense Pulsed Light (IPL) is a non-invasive, completely painless treatment whereby flashes of light are converted into energy within the cells of the meibomian glands photo-rejuvenating them to open up and express the oil more effectively.
IPL stimulates the nerves supplying the meibomian glands by creating a temperature gradient, which causes the secretion and contraction of the glands to produce the all-important oil.
IPL has been shown to improve tear quality, minimise dry eye symptoms and slow the progression of chronic dry eye. In addition, it can help to improve patient outcomes of procedures such as laser and cataract eye surgeries.
Four sessions separated by two to three weeks are required and benefits are usually seen after the second session, but often immediately. The positive effects last well over a year – usually two to three.
The protocol is to perform both IPL and Low-Level LED Light Therapy (LLLT) during the same session. For best results, I use Blephex to open the pores on alternate visits.
The eyes are covered with goggles and gel is applied to the face whilst five flashes of light pulses are applied below each eye.
This is a device that spins a medical grade microsponge along the edge of your eyelids and lashes, removing scurf and debris whilst exfoliating the lids.
In almost all cases of dry eye, this would be recommended as a first step.
This is by far the best treatment for blepharitis, and provides almost immediate relief. It also unblocks years of makeup clogging the eyelid pores.
Developed and patented for medical use the technology originally employed by NASA biological level, generating endogenous heat through powerful LEDs stimulating ATP production in cells.
The mask is worn for fifteen minutes and is very pleasant for the user. The lids are warmed and the results are usually felt immediately. The mask contains medical-grade LEDs that are considerably more effective than the home-use LED masks that have become popular of late. Best to bring along some earphones to keep yourself occupied.
LLLT works by triggering endogenous heating of both eyelids, which means that the heat is created within the cells themselves rather than externally. This improves cell metabolism due to increased ATP (adenosine triphosphate) production within the mitochondria, the engine of the cells within the meibomian glands.
It’s recommended that you bring AirPods or headphones to keep occupied during the fifteen minute session, unless you’re good at meditation!