Dry Eye Disease
What is dry eye disease?
Dry eye disease” is an umbrella term that includes many conditions that result in an unstable tear film that can’t adequately and consistently protect, nourish and hydrate the surface of the eye. It is a chronic, often progressive, condition that affects vision, the comfort of the eyes and, ultimately, quality of life. At best, dry eyes are a nuisance and, at worse, can cause significant discomfort and poor vision. People can experience dry eye symptoms in many different ways and symptoms do not always correlate with severity. Interestingly, 40% of patients with dry eye findings report no symptoms.
Root Causes of Dry Eye
Dry Eye can be caused by a lack of the aqueous (watery) layer of the tears or by a lack of the oily layer of the tears (meibum).
Dry eye can also be caused by inflammation either from the lack of tears themselves or by long term wear of contact lenses, ocular allergies, infections. blepharitis and certain systemic or ocular medication.
Dry Eye can also develop after treatments such as LASER refractive surgery.
Dry Eye is also linked to many autoimmune diseases such as Sjögrens syndrome and rheumatoid arthritis.
Dry Eye has also been linked to changes in hormone levels and is thought to be more common as we get older.
Dry Eye has also been linked to increased screen work.
Dry eyes and screens
The majority of us now use a computer, mobile phone or tablet on a regular basis.
When we perform these tasks we concentrate very hard and we tend to stare at the screen. This reduces the amount of blinking from around 10-20 times a minute to, in some cases, only once in 5 minutes. Often when using the computer the blinks that we make are not full ones.
Blinking is important as it distributes the tears over the eye lubricating the surface and also providing oxygen and nutrients to the eye. If we are not blinking enough we do not lubricate the eye leading to the symptoms such as burning that we associate with dry eyes. As there is not enough lubrication there is also an increase in friction between the lid and the eye and this can exacerbate symptoms even more.
Blinking also squeezes glands on the lid margin of the eye called meibomian glands. When they are not squeezed they do not release the oily layer of the tears – reducing tear quality and leading to Dry Eye symptoms. In addition, as we are not blinking enough the oily layer begins to block the meibomium glands. A vicious cycle begins leading to gland blockage. Once the glands are blocked they will not become unblocked without treatment, we call this meibomian gland dysfunction. Eventually without treatment the glands begin to atrophy and can no longer function again.
One of the new services we can offer as part of our dry eye clinic is meibomium gland imaging and expression. This enables us to visualise the current condition of the glands and attempt to unblock them as much as possible to prevent any further damage.
You can help yourself by setting reminders to blink fully and completely during prolonged screen use, regularly using a warm compress and lid massage to keep the glands open and taking omega three supplements to improve your tear quality and production.