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Dry Eye - What Can Be Done?

Written by Optometrist Karyn Zhao


If you or anyone you know is affected by dry eye, there are treatment options available which can be tailored to address the underlying causes. A dry eye assessment takes up to 45 minutes and investigates the extent of any existing dryness, the health of the meibomian glands, the quality of your tear film and any underlying risk factors for dry eye which allow us to design a custom treatment plan for you and your eyes.


Continue reading to discover more about what causes dry eye and the treatment options available to help with symptoms.


Evaporative dry eye disease is the most common type of dry eye, and is usually caused by meibomian gland dysfunction (MGD).


Meibomian Gland Dysfunction


Meibomian gland dysfunction, also known as MGD, is a very common condition where the oil glands in our eyelids get blocked up and fail to release oil into the tear film. This leads to increased evaporation of the tears, dryness and inflammation. People who have MGD may be asymptomatic, or they may experience dry eye and changes to the lid margins.


MGD is very common, and is thought to be the leading cause of dry eye disease with up to 50% of patients seen in optometric practice showing signs or symptoms of MGD.


MGD is typically treated with warm compresses for 5-15 minutes followed by lid massage. We recommend using a wheat bag as it maintains adequate heat for a longer period of time, although a face towel dipped in hot water can also have a similar effect (although you will have to re-wet the towel throughout to keep it warm enough). This can be repeated up to four times daily depending on the severity of the MGD.


There are a number of further treatments or lifestyle changes that can help treat MGD if heat and massage aren’t quite enough. These can include:

  • Lid hygiene: keeping the eye and lid area clean

  • Diet: Omega-3 supplements or omega-3 rich foods such as salmon have anti-inflammatory properties which can help to improve signs and symptoms of dry eye disease

  • Environment: improving ambient humidity (such as with a humidifier) and being aware of dry conditions from air conditioning or heaters

  • Healthy blinking habits: remembering to take full blinks regularly - especially when performing intensive tasks

  • Tear supplements: the eye’s tear film can be supplemented with artificial tears which help to keep the eye comfortable. Lubricating eye drops can also act to dilute toxins and pro-inflammatory molecules found in tears. Lubricating eye drops that increase the oil layer of the tear film can also be helpful for relieving symptoms of MGD by increasing the stability of the tear film.


Blepharitis


Blepharitis is a common infection of the eyelashes. It typically leads to dandruff-like crusting/flakes on the lashes, which may sometimes cause the lashes to stick together. The eyelids may become red, itchy or stingy. They may also become watery and sensitive to light. Although blepharitis can be treated fairly easily, treatment needs to be consistent and ongoing in order to be effective.


The main treatment for blepharitis is through lid hygiene - keeping the area clean aims to reduce the bacterial load on the eye that is causing the infection. A dedicated lid cleanser is recommended, or a weak baking soda solution may be effective as well. Even with improvement to symptoms, it is important to continue keeping the area clean to remain symptom free. Stopping the treatment can result in the condition returning, as the bacteria that cause the condition are very common on the skin and eyelids


In-Clinic Treatment Options


Blephasteam


Blephasteam can be thought of as a more intensive in-house heat & massage treatment for MGD-related dry eye. It involves a goggle-like device which combines moisture and heat therapy in order to unblock the meibomian glands, improving tear film quality.


The device is electronically controlled to provide a stable source of heat for 10 minutes, and saline rings provide a moist environment within the goggles. The moist heat acts to soften up the oils inside the meibomian glands, making them easier to express.


At Milburn and Neill, a Blephasteam session is followed by an in-house gland expression in order to get the most out of the heat therapy that Bephasteam provides.This involves using special gland expression tools which allow us to individually apply pressure to unblock each gland, allowing for free-flowing oils and a reduction in MGD symptoms. In some cases, you may also be prescribed a short course of antibiotics prior to your Blephasteam session to reduce inflammation and aid in the softening and expression of stubbornly blocked glands.


IPL


Intense pulsed light (IPL) therapy is a novel treatment for dry eye which has traditionally been used in the cosmetic industry for treatment of a range of dermatological conditions.


IPL devices such as the E>Eye release high-intensity polychromatic light, ranging from infrared to visible spectrum, and the intensity can be adjusted to target selected structures.For dry eye, IPL stimulates the meibomian glands in order to return them to their normal function, and is one of the longest lasting treatment options for MGD.


In a study published by the University of Auckland, significant improvements in clinical signs and symptoms of dry eye were observed during the treatment period with IPL. The treatment was seen to enhance the quality of the oil layer in the tear film and reduced blockage of the meibomian glands. Five flashes per side were seen to have more effective results than four flashes per side, with earlier improvements being seen in dry eye symptom scores on day 15 in participants receiving five flashes.


IPL allows for a sustained cumulative effect following multiple treatments. Research suggests an initial course of 4 treatments of 5 flashes per side, with continued “top up” treatments spaced out thereafter to maintain the cumulative effects.


Medical Therapy


Although not usually used as standalone treatments, in certain cases the addition of medicated eye drops or oral antibiotics can help reduce symptoms of dry eye disease and improve the efficacy of other treatments.


Topical antibiotics can sometimes be prescribed to reduce the amount of bacteria on or around the eyes.


Low-dose topical corticosteroid eye drops can sometimes be prescribed for a short period to help to reduce inflammation and its associated symptoms resulting from dry eye, or in cases of flare-ups.It does not necessarily treat the underlying cause (dry eye) directly, but can help manage the symptoms until further treatment kicks in.


Oral antibiotics such as doxycycline or azithromycin may be prescribed to assist in the treatment of dry eye. Doxycycline and azithromycin both act to reduce the secretion of bacterial enzymes which break down the oils in the tears, leading to a more stable tear film. They also act to reduce inflammation associated with MGD, which aids in reducing dry eye symptoms. A short course of oral antibiotic can also be prescribed prior to gland expression (such as with Blephasteam) to help soften up the blockages in the oil glands which allows them to be removed more easily.


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