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DRY EYES

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DO YOUR EYES EVER FEEL

ITCHY
GRITTY
BURNING
IRRITATED OR
UNCOMFORTABLE?

IF THE ANSWER IS YES
YOU MAY BE SUFFERING FROM DRY EYES


 THE CAUSE OF A DRY EYE

The main cause of dry eyes is an underproduction of tears from the lacrimal glands or lack of secretion from the other glands in and around the eyelids that produce the watery tears. Other causes are a codition known as Herpes Zoster Ophthalmicus, diabetes, corneal surgery, a large wide open eye (large palpebral fissure) and long term contact lens wear. Unfortunately, from the age of 10 onwards the rate of tear production decreases by about 3% each decade, and at a faster rate for men than women. The tears lubricate the eyes and allow the eyelids to slide comfortably each time we blink. On average we blink between once every 3-6 seconds although people with dry eyes tend to blink considerably less. According to surveys over 70% of contact lens wearers notice dryness of the eyes and they most commonly complain of itchy or gritty eyes with just over 40% aware of a burning sensation.

Another cause of dry eye is excessive evaporation of the tears which is often the greatest factor for contact lens wearers and may be made worse in an environment that is smoky, air conditioned or centrally heated and environmental sensitivity was the second highest symptom reported with vision affecting 30% of patients.


 OVERCOMING DRY EYES

The main treatment for dry eyes is the use of a tear supplement.

A very effective product is one called "Viscotears Liquid Gel" manufactured by Ciba Vision which, because it is a viscous gel, remains in the eye much longer than conventional re-wetting liquid eye drops. It is most effective when used as a course of treatment when applied three to four times per day for up to 28 days.

If a liquid is preferred, a preparation called "Hycosan" is recommended which, in severe cases, can be applied every hour for three to four days and then to reduce the frequency of applications to a level which eliminates symptoms. Unpreserved products are also available for those with sensitive eyes or allergies such as "Systane" which is claimed to be better at wetting the eye than other similar products. For those who don't like putting drops in the eyes a product called Clarymist may be sprayed on to the closed eyelids. This is popular as the eyes can be wetted with putting anything actually into the eye.

Blephasol is recommended for the daily hygiene of sensitive eyelids, particularly the eyelid margin (especially in cases of blepharitis). Due to its micelle properties, Blephasol mechanically removes impurities, stains, dried secretions and make-up from eyelids and the base of eye lashes. Blephasol, free from alcohol, detergents and preservative, gently cleanses without irritating the eyes or damaging the outer layers of skin which helps protect from the harsh external elements (cold, allergens, pollutants etc.). Fragrance-free, preservative-free and non-greasy, Blephasol does not need to rinsed after use and can be recommended to contact lens wearers.

With all lubricating products the procedure may need to be repeated every few months.

Hyabak multi-dose eye drops contain 0.15% sodium hyaluronate for long lasting relief from eye discomfort and dry feeling eyes. Each bottle contains 300 drops and has been shown to remain contamination-free for at least 8 weeks after first opening without the use of preservatives.

Prevention is better than cure for dry eyes. Evaporation accounts for one third of total tear production and preventing the eyes from drying out will reduce both the symptoms and the amount of rewetting required. If possible avoid air-conditioned environments, draughts, central heating and car heaters. Use room humidifiers, bowls of water or a plant such as an African Violet placed strategically or just moist sponges. Use close fitting spectacle side-shields especially in dry, windy conditions. If you use a computer for long periods, try to place your monitor below eye level. Squeeze lower eyelids between thumb and forefinger a few times during the day to improve tear film formation and to reduce tear evaporation. Try to remember to blink fully, slowly and frequently all day long.

Contact lens wearers can rewet with "Sauflon Comfort Drops" and also soaking lenses for 10 minutes during the day in saline can help, if convenient.

Cosmetics can cause dry eyes. Oily make-up removers in particular may destabilise the tear film. Never place eyeliner on the inner rim of the eyelid and avoid applying moisturising creams near the eyelid area. Mascaras can melt in hot weather and cause problems. All these cosmetics can break up the tear film and increase evaporation of tears leading to dry eyes.

 PROBLEMS WITH EYELIDS

A condition called meibomian gland dysfunction is quite common and may often be the cause of blepharitis. Meibomian glands, named after Heinrich Meibom (1638-1700), line the edges of the eyelids and blepharitis is an inflammation which affects the outside front edge of the eyelids. Meibomian gland dysfunction can cause eye or eyelid soreness, grittiness, stinging, burning, stickiness, dryness and general discomfort. Your eye care practitioner should be able to examine the eyelids and confirm the diagnosis of meibomian gland dysfunction by looking for bubbles or crustiness at the lid edge, which may be red and soggy, and solidified secretions at meibomian gland orifices.

Treatment of meibomian gland dysfunction depends upon the severity of the condition. In mild meibomian gland dysfunction using hot compresses for five minutes twice daily, lid scrubs or massage and the use of lid wipes is recommended. For moderate meibomian gland dysfunction it is advisable to use hot compresses for ten minutes three times each day, lid scrubs, lid wipes and antibiotic ointment such as chloramphenicol or fucithalmic. In severe meibomian gland dysfunction use hot compresses for fifteen minutes four times each day, vigorous lid scrubs, lid wipes, antibiotic ointment such as chloramphenicol or fucithalmic, doxycycline 100 mgs once daily for three months or erythromycin 250 mgs twice per day for three months and steroids in very severe cases.

CLEARING BLOCKED EYELID GLANDS  

There are about twenty small openings from the meibomian glands at the edge of each eyelid which can become blocked or produce a thick waxy material, instead of a clear transparent oily liquid. Your optometrist can identify meibomian gland dysfunction by observing the presence of frothing of the tears at the lower eyelid, tiny solid particles of sebum in the tear film or a notched tear prism.

To remedy the situation the use of hot compresses, lid scrubs and massage is recommended.

  1. Hot Compresses:

Apply a fairly warm face cloth to the eyes for five minutes particularly in the morning and also if possible at night for a ten day period.

  2. Lid Scrubs:

Massage the bases of the upper and lower eyelashes with a clean cotton wool bud applicator dipped in a mild solution consisting of either

a) one part baby shampoo to ten parts water or

b) one heaped teaspoon of sodium bicarbonate to one pint of boiled and cooled water.

Blephaclean is recommended for the daily hygiene of eyelids and sensitive skins (especially in cases of blepharitis). Free fromdetergents and preservative, Blephaclean gently cleanses without irritating the eyes or damaging the outer layers of the skin. By virtue of its sophisticated formulation, Blephaclean not only cleanses the skin but also moisturises the outer layers. Sensitive skin is soothed and regenerated by hyaluronic acid (a natural skin moisturising agent), capryloyl glycine, Iris Florentina and Centella Asiatica.

The procedure needs to be performed daily for ten days and may need to be repeated after several months.

  3. Lid Squeezes:

Pinch the lower eyelids between thumb and forefinger to express the meibomian glands and bathe the eyes with saline solution to remove excess material. Squeezing the upper lids is not recommended.

If your eyes are dry, it is very important to try to conserve the tears you have. Try to develop a full smooth slow blink to ensure that a proper tear film is produced and that the front surface of the eye is fully wetted.

If you do not blink fully you may now click on
Correct Blinking
for full instructions on how to blink properly.


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