What is it?
The surface of the eye needs to be kept lubricated in order to provide clear vision and maximum comfort. The body does this naturally. Dry eye is a very common ocular complaint where the surface of the eye is not sufficiently lubricated.
The tear film is composed of three different layers:
- A lipid layer. This is an oily layer on the outer-most surface of the tears. This layer helps to prevent your tears from evaporating off the surface too quickly. The lipid layer is secreted by meibomian glands which are located along both the upper and lower eyelid margin.
- An aqueous (or water) layer. This is the largest component of the tear film and makes up the bulk of the tears. Aqueous is produced by the lacrimal gland.
- A mucin layer. This is the inner most layer of the tear film. It is in contact with the surface cells of the cornea and is responsible for binding the tears to the surface of the eye.
Dry eye has a wide variety of symptoms. Oftentimes, people don’t realise their eyes are dry but dryness can present upon examination without someone experiencing symptoms.
- painful, sore, gritty or burning eyes
- eyes feeling tired or fatigued
- blurred vision
- eye watering/ tearing
What causes it?
Dry Eye Disease (DED) can be a result of one of the two following conditions, or a combination of both:
- Lack of water in the tear film.
- Lack of oil on the surface of the tear film protecting the water layer from evaporating. In 86% of DED cases, the lack of the protective oil is the biggest issue.
How is it treated?
Treatment options will vary depending on the type of dry eye that you have. If there is a shortage of water production, it is necessary to increase the supply of water in the tear layer. If there is sufficient water present, but there is excessive evaporation, then it is necessary to improve the oil/ lipid layer to reduce evaporation.
If the problem is due to lack of aqueous/water:
- Make sure to drink enough water during the day. Two litres per day is recommended to keep the body properly hydrated, which in turn will help to ensure the surface of the eye is also hydrated.
- Avoid consuming too much coffee and tea. Caffeine is a diuretic, and excessive amounts of it can affect the water component of the tear film layer.
- Avoid/reduce use of medications that reduce the water component. Or, if possible, find an alternative medication that does not reduce the water layer of the tear film. For example, antihistamine tablets for allergies, cold and flu medications/decongestants, and some blood pressure medications. *Please do not stop any medications prescribed by your G.P. without checking that it is acceptable to do so.*
- Use lubricating eye drops that assist the water layer. These can include, but are not limited to: Hylo-Tear, Hylo-Forte, Thealoz Duo, Artelac, Blink, or Systane. We strongly recommend that you use a drop that is preservative-free, and to use these drops 4 times per day as a general guideline. However, they can be used as often as required, as there is no limit to the number of lubrication drops that can be used daily.
If the problem is due to lack of oil:
- Perform blinking exercises throughout the day. The Meibomian Glands will only release oil during a “complete blink” (when the eyelids touch one another during the blinking action). When the lids touch, the glands express a drop of oil much like a toothpaste tube would express toothpaste. We recommend using the diagram to the right as a guideline on how to perform the blinking exercises. Try to train yourself to blink properly, especially when spending time on screens. Here are two good rules to follow:
- While on a computer, squeeze the eyelids tightly every time you press the Enter Key. This creates an association, and over time your blinking will become more effective.
- Follow the 20-20-20 Rule: every 20 minutes you are on a screen, look 20 feet into the distance, and perform the blinking exercises for 20 seconds.
- Use lubricating gels and/or ointments at night. Examples of these include Hylo-Night, Thealoz Duo Gel, Vidisic, or Liposic. These contain oils that help add to the oil component of the tear film overnight.
- Use an eyedrop with an oil component. A good example of this is Hylo-Dual, and this can be used during the day, as opposed to the thicker gels and ointments which are typically reserved for night-time use only as they can cause a temporary blur while coating the surface of the eye.
- Do warm compresses. this softens the oil, opens the glands, and when you squeeze them, the thicker, older oil can be expressed and newer, fresher oil can be loaded into the gland from the blood stream. Warm compresses may be done one of two ways, either by using a thermal mask or a hot cloth. Using a hot cloth is hard work, and most times people tend to give up on this method of hot compresses within a couple of weeks. By using a thermal mask with bags that heat in a microwave or oven, better outcomes are achieved thanks to improved compliance. We recommend two brands of microwaveable masks: Opti-Therm and Optase.
- Ensure that you get enough omega-3 oils in your diet. We recommend Omega-Eye capsules manufactured by Scope. The appropriate dosing for this is 4 capsules per day: 2 in the morning and 2 at night. This particular supplement is the only Omega 3 to our knowledge that has shown in published results to have a beneficial effect on the tear film. There are alternatives to Omega Eye, such as flaxseed oil and krill oil but they need to contain the same amount of EPA and DHA (1680mg and 560mg respectively) as Omega Eye to be as effective at improving tear film. Taking 4 Omega Eye capsules daily is equal to eating 37 cans of tuna per week!
Visit our patient resources page to learn more about treating dry eye at home
Warm compresses and meibomian gland expression
Alternative treatment options
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Total cost for course of 3 treatments
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If you, your G.P. or local Optometrist suspect that you may have dry eye, follow our at home management advice or book your initial consultation to be screened.