Dry eye is a complex disease of the eye surface with many factors and causes.
Symptoms include gritty, irritated, sore, dry or watery eyes and blurry or fluctuating vision. There are predominantly two types of dry eye which generally relate to which of the two layers of the tear film is incomplete.
The most common type of dry eye, evaporative dry eye, may be caused by eye structure abnormalities or contact lens wear but is most often caused by dysfunction of the glands that secrete the oily layer of the tear film. This is called Meibomian Gland Dysfunction. As these glands are located at the base of the eyelid margin this condition may also be associated with Blepharitis, where there is an overgrowth of the normal bacteria along the base of the eyelashes.
Aqueous deficient dry eye is less common, and generally caused by systemic disease or medications.
At Home Treatments
Heat Treatment involves heating the eyelid glands to improve their function and increase the production of tears. The best at home heat treatment is with microwavable heat masks.
We recommend The Eye Doctor Hot and Cold Heat Mask used 2 times a day for 5-10 minutes for at least 4-6 weeks.
Typically heat treatment is recommended long term to maintain healthy eyelid glands however treatment may only be necessary less frequently.
Omega 3s are beneficial in all types of dry eye. It is recommended to have 1000-2000mg of Omega 3 daily, especially a type high in EPA and DHA, for the anti-inflammatory properties that help dry eye disease.
We recommend: Theratears Nutrition Supplements OR Lacritec Capsules OR 2-3 serves a week of Oily Fish such as Salmon, Sardines, Anchovies or Tuna. Vegetarian options include Flaxseeds, walnuts, chia seeds soybean oil.
Studies have shown that women may benefit from a 30% reduction in their dry eye disease with every 1000mg increase in omega-3 intake daily.
Be sure to talk to your GP before adding any supplements to your diet.
Lubricating eye drops improve symptoms of dry eye but unfortunately they don’t treat the underlying causes of dry eye, such as gland dysfunction. However they can improve comfort levels and temporarily restore the tear film balance. We recommend the following brands for their balance of watery and oily tear film components: Theratears or Systane Ultra or Systane Complete or Hylo-fesh or Hylo-forte and Novatears drops.
Anti-inflammatory eye drops, gel or ointments may be necessary in some cases to calm down the eye surface and encourage and improvement in tear gland production. Over the counter options include Optimel Manuka Honey Drops or Gel, to be used 2 times a day. All other anti-inflammatory topical treatments are available by prescription only.
Medicated Lid Wipes or Foam are used to treat blepharitis. Preparations with Tea Tree Oil are the most effective. We recommend Blephadex foam or wipes or Sterilid Foam or Systane Lid Wipes used 2 times a day for at least 6 weeks.
Blinking exercises increases tear secretion. It involves completely closing the eyes without squeezing the eyelids together. If you’re unsure hold the tip of your finger at the outer edge of each eye and if your finger moves when blinking this is too much of a “squeeze” motion. Aim to blink without your fingertips moving and repeat this exercise a few times throughout the day.
Environmental factors can exacerbate dry eye. Common culprits include environments with low humidity, high airflow and activities that caused reduced blink rate. To reduce the impact of environmental factors consider the following:
- direct air conditioning or heating away from the eyes
- keep screen monitors below eye height
- wear an eye mask whilst sleeping
- keep hydrated
- take frequent breaks when reading, watching TV or on screen based tasks
Return to see us at any time for a review and re-assessment of your dry eye symptoms and concerns.
We can refer and co-manage with Ophthalmology colleagues or your GP for further interventions such as oral medications, IPL treatments or to access specially compounded medications.