Dry eye

Dry eye syndrome or dry eye disease, is a very common condition that occurs when the eyes do not produce enough tears or the tears evaporate too quickly. This leads to the surface of the eyes drying out and becoming irritated and possibly inflamed.

Although there is no cure for dry eye syndrome, targeted treatments are available to help control the symptoms. These depend on whether the symptoms are caused by the decreased production of tears, tears that evaporate too quickly, or an underlying condition. We have recently invested in the Oculus Keratograph 5M, which incorporates the latest technology for tear film assessment. This allows us to investigate the cause and provide an individualised treatment plan.

An insufficient or poor tear film can cause a range of uncomfortable symptoms which can often be managed very simply. Please ask about a dry eye and tear film assessment.

I have just completed my follow-up consultation with Graham Coates
of Morgan-Owen & Coates and wanted to express my gratitude to
him for helping to manage my ‘runny watery eyes’…
Since my consultation and diligently sticking to my day-to-day
management of the condition (which is not onerous at all) my eyes
have felt hugely more comfortable almost to the point that I am not
‘conscious’ of my eyes and it’s all thanks to Graham and his interest
and research into ‘Dry eye Syndrome’.
I would recommend anyone travel a distance to visit him if it meant
getting relief for this tiring and annoying eye condition.
–Sue Sheppard, Jul 14–Sue Sheppard, Jul 14

Click on the image to the left to play a video clip produced by the Oculus 5M and showing a dry eye.

  • The Tear Film

    Tears are important as they form a layer on the very front of the eye. Called the tear film, this layer does a number of things. The tear film takes a part in the focusing of light into the eye but it mainly lubricates the eye keeping it moist and smooth. The tear film is actually made up of three layers each with a different function.

    • The layer closest to the eye is called the mucin layer. It coats the cornea which is the clear window at the front of the eye; it forms a foundation for the other layers of the tear film.
    • The middle layer is called the aqueous layer. This is the watery layer that most people think of when they think of tears. This layer is produced by the lacrimal gland which is underneath the upper eyelid. This layer provides moisture and supplies oxygen and other important nutrients to the cornea. This layer is mainly water.
    • The outer layer is called the lipid layer. This is an oily film which seals the tear film to the eye and helps to prevent any evaporation.

    The mucin and lipid layers are produced by small glands around the eye. Each time we blink the tears are spread onto the front of the eye. Excess tears are drained away by tiny drainage holes on the inner margin of the eyelids, these holes channel the excess tears into the nose. This is why crying sometimes makes your nose run.

  • Symptoms of Dry Eye

    You are probably experiencing dry eye if your eyes:

    • feel irritated
    • feel scratchy
    • feel dry and uncomfortable
    • feel a burning sensation
    • feel gritty 
    • are red
    • experience periods of blurred vision
    • have periods of watering too much

  • Causes of Dry Eye

    Dry eye has a number of causes. It happens mostly as a part of the natural ageing process but can also be caused by problems with blinking or problems with the glands which produce the tears. Some drugs can cause dry eye, like antihistamines and oral contraceptives. Contact lenses carry an increased risk if you have dry eye.

    Sometimes dry eye is also a symptom of other conditions affecting other parts of the body particularly arthritis or a condition called Sjogrens syndrome. This is where, as well as dry eyes, people can also have a dry mouth and may involve a type of arthritis.

  • Sue's full testimonial

    Meibomian Gland Dysfunction

    I have just completed my follow-up consultation with Graham Coates of Morgan-Owen & Coates and wanted to express my gratitude to him for helping me manage my ‘runny watery eyes’.

    Over the years I had found that my eyes were increasingly ‘scratchy’ and tired-feeling and often it felt like I had an eyelash trapped in my eye. That coupled with even the merest hint of a breeze outside and my eyes would be streaming – particularly annoying on the golf course!

    I tried all sorts of OTC eye-drops, in fact I must have spent a fortune trying to find the one that would cure the problem – did I have an infection in both eyes? Am I allergic to my eye make-up? All sorts of questions were pinging away in my head. In the end I decided to visit my GP who, I hoped, would stop the guesswork and amateur diagnosis!

    The GP diagnosed Dry-Eye Syndrome and recommended I go see an Optometrist. Fortunately there is a specialist in my local town of Petersfield – Graham Coates who, he said, had a particular interest in ‘dry-eye syndrome’.

    I was able to get a consultation quickly and after a thorough examination of the eyes using specialist equipment not ordinarily available from high street opticians, Graham diagnosed that I
    had Meibomian Gland Dysfunction* in both eyes but it was definitely worse in one eye, the one I had particular problems with! Using the equipment (pain-free and non-invasive!), he was able to prescribe the right type of eye drops that would help my specific problem and he also provided other management techniques to help prevent further deterioration in the function of my MG.

    Since my consultation and diligently sticking to my day-to-day management of the condition (which is not onerous at all) my eyes have felt hugely more comfortable almost to the point that I am not ‘conscious’ of my eyes and it’s all thanks to Graham and his interest and research into ‘Dry-Eye Syndrome’ who has helped me with this condition.

    I am fortunate to live in Petersfield where Graham practises but I would recommend anyone travel a distance to visit him if it meant getting relief for this tiring and annoying eye condition.

    *there are other glands in the eye which can also cause dry-eye syndrome so this is why it is best to get proper advice

    Sue Sheppard
    July 2014

Tear Substitutes

Eye drops are the mainstay of treatment for many forms of dry eye.  A drop of normal saline immediately soothes the dry eye, but its relief is fleeting.  Attempts have therefore been made to improve the composition of artificial tears and prolong their duration of action.

As a general rule, tear substitutes of low viscosity, such as Tears Naturale, are prescribed for those patients who have very mild symptoms and for day time use.

Others, e.g. Systane, are slightly more viscous and enhance the stability of tears.  These products can generally be used as often as required.  Many of the formulations are now available in single use, preservative–free options for convenience and for those requiring long term use. The latest formulations include lipid enhancing components for those with evaporative dry eye.

The more viscous products, including gel formulations such as Viscotears, may be more suitable for those with severe dry eye and for night time use.  They are not recommended for use when driving as they can blur the vision.

Eye logic is an eye spray which restores deficiencies in the tear film’s lipid layer and hence protects the tears from evaporation.   It is easy to use as it is simply sprayed onto the closed eyelid.

Practical advice

  • Environment – Air conditioning, central heating or smoke filled rooms are dry environments. These are best avoided or improved with the use of effective humidifiers.  Extra plants and a bowl of water can help to add moisture into the atmosphere.  One simple piece of advice which may help computer users is to lower the screen height.  The down gaze narrows the aperture between the eyelids which reduces the evaporative area.
  • Blinking – Incomplete lid closure is a recognised cause of dry eye.  This can be exacerbated in environments where we blink less such as with computer use.  Full blinks should therefore be encouraged by closing the eyelids without squeezing them tightly.
  • Nutrition –  Good nutrition plays a part in reducing the effects of dry eye. Caffeine and alcohol act as diuretics and therefore reducing consumption may help to alleviate symptoms. Multivitamin supplements may be beneficial as vitamins A, C and E have been shown to influence watery and mucous gland secretions. Omega 3 essential fatty acids, found in oily cold water fish like salmon, herring and tuna, have been shown to reduce dry eye symptoms.

  • Hygiene –  A dry eye is commonly associated with inflammation of the eyelid margins, a condition known as ‘blepharitis’.  In such cases the glands that secrete the lipid layer of the tears can become blocked so the tears are prone to faster evaporation. Treatment begins with applying heat to the eyelid margins to loosen any debris around the base of the lashes. The heat also helps to open up any blocked glands. We recommend the EyeBag (see below), as the best method to achieve this. Massaging the glands can help to establish a more normal flow of oils. Lid scrubs are then wiped across the eyelid margin to clean them. This reduces the number of attendant bacteria. We supply a range of products that can help. Initially this needs to be repeated twice a day and only reduced as the condition becomes controlled.

The EyeBag

Convenient, simple and extremely easy to use, the EyeBag is a re-usable warm compress which treats a variety of eyelid and eye problems. It provides an effective alternative  to the use of hot wet face flannels.

The EyeBag was devised in 2004 by Mr Teifi James, a Consultant Ophthalmic Surgeon who works in West Yorkshire.  We have had very positive feedback from those who have tried it.

Simply microwave for 30 seconds and lay the warm EyeBag across the closed eyes. The warmth softens and releases the natural oils in the eyelid glands which are then able to ‘lubricate the blink’.

Use the EyeBag for ten minutes twice every day for a fortnight to rapidly relieve the symptoms of dry eye syndrome, blepharitis, stye and eyelid cysts.

    A Video about how to use the EyeBag

Conditions which usually benefit from regular EyeBag treatment include:

  • Meibomian Gland Dysfunction (MGD)
  • Blepharitis
  • Dry Eye Syndrome
  • Styes
  • Eyelid Cysts (Meibomian cysts know as chalazion)
  • Contact Lens Dry Eye
  • Corneal Laser Dry Eye