Dry Eye
Dry eye, also known as dry eye disease (DED) is one of the most common eye conditions worldwide. According to a review published in the Journal of Global Health, a study reported that the global prevalence of dry eye can be as high as 50%. Causes of dry eye include long screen time, wearing of contact lenses, external environment, etc. If you notice symptoms such as persistent dry eyes and itchy eyes, You can have an examination and receive customized dry eye treatment plan from our ophthalmologists at Vivid Eye Dry Eye Centre.
Source: 1. Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
Source: 1. Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
Dry eyes are caused when the eye does not produce enough tears or when the tears evaporate excessively, resulting in the surface of the eye not remaining moist and hence feeling dry.
The tear film on the surface of the eye has three layers:
If one of the layers decrease in production, it may cause dry eyes. Eyes may feel dry, have a gritty sensation or stinging.
Types of Dry Eyes
If the lacrimal gland is damaged, degraded or becomes abnormal, the secretion of tear will decrease. Aqueous-deficient dry eye may be caused by ageing, e.g. the elderly and menopausal women (hormonally influenced) produce fewer tears or those with autoimmune diseases.
The dysfunction of the meibomian glands near the eyelashes is the main cause of evaporative dry eye. These glands secrete lipid of the tear film onto the ocular surface, slowing down the evaporation of the aqueous layer of the tear film. When there is an abnormal secretion of the meibomian glands, the tears will lack a lipid layer and water will evaporate rapidly, causing the evaporative dry eye.
Most patients have mixed dry eyes, including both symptoms of insufficient tear secretion and increased tear evaporation rates.
Causes
Ageing
Tear production decreases with age.
Hormonal influences
Post-menopausal women are more likely to have dry eyes than men of the same age.
Patients with immune system diseases
Examples include diabetes, thyroid-related diseases, lupus, rheumatoid arthritis and Sjogren’s syndrome.
Prolonged use of electronic products
Blinking less frequently, resulting in tear evaporation.
Long-term contact lens wear
Reduces sensitivity of the corneal surface and deprives the cornea of oxygen, leading to reduced tear secretion and, most likely, dry eyes.
External environment
Dry weather or windy outdoors, indoor air conditioning and heating can reduce humidity and accelerate the evaporation of tears.
On medication
For example, antihistamines, antidepressants, certain antihypertensive drugs and contraceptives all increase the risk of dry eye.
Eyelid issues
Severe dry eyes can be caused by abnormal or insufficient blinking reflex or incomplete eyelid closure during sleep.
Cataract surgery / laser vision correction surgery
The wound is made by cutting through the cornea or cutting the nerve of the cornea, resulting in change of sensitivity of the corneal surface and tear film stability.
Symptoms
Persistent dry eye
Red eye
Itchy eye
Gritty eye
Stinging & aching
Burning sensation
Stringy mucus in or around eyes
Sensitivity to light
Eye fatigue
In serious cases, patients will experience eye redness, hyperaemia, keratinisation, corneal abrasion, etc.
Diagnostic Tests
A variety of tests and measurements with international standards are used to analyse the ocular surface and diagnose dry eye, from the analysis of tear quality to the meibomian gland.
- Testing for the lipid layer of the tear film
- Test for measuring the lipid layer
- Break-up time test for aqueous layer
- Blepharitis
- Tear volume assessment
Treatment
Intense Pulsed Light
It is a direct treatment for dry-eye patients suffering from "meibomian gland dysfunction".
Intense pulsed light therapy uses pulsed light to induce thermal effect and help to open blocked eyelids, restoring oil production to normal and reducing tear evaporation.
Moreover, the ophthalmologist applies pressure to the patient's eyelids to remove the blocked oil and make the treatment more effective.
During treatment, patients must wear eye protection and the ophthalmologist will carefully adjust the energy to reduce the risk. A minimum of 3-4 sessions is required for the treatment to obtain the most effective results.
Post-treatment Care
Driving is not recommended on the day of treatment, but otherwise you can return to your normal routine. You need to as well cleanse your eyelids and apply hot compresses, avoid irritating foods, and take extra protection from the sun for a week after treatment. IPL is a painless and non-invasive treatment that is suitable for all.
Dry eye is a chronic disease that requires long-term treatment while patients’ living habits are also crucial for relieving the symptoms.
Artificial Tears
Relieve dry eye symptoms, prevent corneal damage and maintain a smooth eye surface.
There are 3 major types:
Eye drops: they provide moisture to the eye for a short time and are usually applied 4 times a day. The artificial tears may come in little vials for special needs or for use more than 4-6 times a day, as recommended by your doctor. As the medication is preservative-free, it is best to use the opened vial for not longer than 24 hours.
Gel: it can be used to give a thicker moisturizing coating of tears at any time. The thicker consistency of the gel drop may blur your vision a bit. It can be applied before bed if you are worried that it will affect your work, but the blurred vision is less of a problem than with ointment.
Ointment: this type of tear has the longest effect. After applying the ointment, close your eyes for 5 minutes and rotate your eyeballs to distribute it evenly. Recommended for use at bedtime as it can cause temporary blurred vision.
Hot Compress
Hot compresses can help prevent dry eyes and relieve discomfort. Apply a hot pack or hot towel at about 40°C to the eyes for about 10-20 minutes, at least once or twice a day, or up to 4 times a day if you have time.
The 20-20-20 Rule
Basically, every 20 minutes spent using a screen, you should try to look away at something that is 20 feet away from you for 20 seconds. You can also close your eyes and let the tears moisten the eye surface.
Eyelash Mites (Blepharitis)
Eyelash mites are tiny parasites that live in or near the eyelash follicles. Their secretions and excretions can easily cause eyelid inflammation. People of all ages are susceptible to infection, especially those over 70, as older people have a weakened immune system and are more vulnerable to blepharitis. Girls who use cosmetics frequently are more likely to be infected as mites can be transmitted through the make-up. If you develop eyelid infections, the quality of your tears will change and you will not be able to keep your eye surface moist, resulting in dry eyes and discomfort such as excess discharge, redness and gritty eyes.
Treatments
♦ Tea tree oil
Apply diluted tea tree oil to your eyelids. It takes at least one month of treatment to ensure that all bugs and eggs are killed. However, be aware that tea tree oil can irritate the eyes and excessive use can dry out your eyes and surrounding skin.
♦ Intense pulsed light (IPL)
It is a rather advanced treatment that penetrates deep into the pores to kill the mites and has fewer side effects than tea tree oil.
Dry Eye FAQs
What should do if I have dry eyes?
Manage your screen time properly and follow the 20:20:20 rule: Take a 20s break after 20 min of using electronic devices and view from 20ft away. Close your eyes and let the tears moisten the eye surface.
If you wear contact lenses, it is advisable to reduce the amount of time you wear them, for example by removing them immediately after returning home. If the symptoms become severe, you should consult an ophthalmologist.
How can I relieve the discomfort of dry eyes?
- In case of eye discomfort, artificial tears (in preservative-free or contact lens formulations) can be used to temporarily relieve the condition.
- Blink more often to evenly distribute the tears and moisten the eye surface.
- Hot compresses can help prevent dry eyes and relieve discomfort. Apply a hot pack or hot towel at about 40°C to the eyes for about 10-20 min at least 1 or 2 times a day, or up to 4 times a day if you have time.
Can I treat dry eyes on my own?
Artificial tears, blinking and hot compresses are only meant to relieve dry eye symptoms and prevent further damage to the cornea, but they do not cure dry eyes on their own. To treat dry eyes, you should seek treatment from your ophthalmologist, such as IPL therapy, medicated eye drops, tear duct plugs, etc.
How long does it take for dry eye to heal?
IPL treatments require at least 3 to 4 sessions to be most effective. Dry eye is a chronic disease that requires long-term treatment while patients’ living habits are also crucial for relieving the symptoms.