dry eye – what you need to know · the middle layer of the tear film is the aqueous layer. its...

Dry Eye

WHAT YOU NEED TO KNOW

Dr Jim Kokkinakis

http://www.theeyepractice.com.au/

www.theeyepractice.com.au 1

Contents

Introduction ................................................................................................................ 2

What is dry eye? ........................................................................................................ 3

What causes dry eye?................................................................................................ 4

What are the symptoms of dry eye? .......................................................................... 5

Assessment and Diagnosis ........................................................................................ 6

What are the goals of treatment? ............................................................................... 6

What is the treatment for dry eye? ............................................................................. 7

When can I expect results? .................................................................................... 8

Case Study 1 ............................................................................................................. 9

Dry Eye and pregnancy – what you need to know ................................................... 11

What are the effects of pregnancy and breast-feeding on your eyes? .................. 11

Does pregnancy cause dry eyes? ......................................................................... 11

What can I do if I have dry eye during pregnancy? ............................................... 12

The link between computer eye strain and dry eye .................................................. 13

How do we protect our eyes from the harmful effects of computers? ................... 13

The 5 things you should know about your dry eye treatment… ............................... 15

1. Dry eye is managed, rather than cured… ......................................................... 15

2. Dry eye is often a skin problem, rather than an eye problem… ........................ 16

3. Omega 3s are good for dry eyes ...................................................................... 16

4. Not all blinking is equal ..................................................................................... 16

5. Dry eye drops could be making your problem worse ........................................ 17

Case Study 2 ........................................................................................................... 18

3 Great Home Remedies for Dry Eye ...................................................................... 20

1. Add a nutritional supplement ............................................................................ 20

2. Warm compresses and lid massage ................................................................. 21

3. Lid scrubs ......................................................................................................... 22

Why artificial tears could be making your dry eyes worse… .................................... 23

Flushing out the good tears… ............................................................................... 24

What else can I do for my dry eye? ...................................................................... 24

About the author ................................................................................................... 25

Career Highlights .................................................................................................. 25


Introduction Dry Eye - It's an epidemic

When I first started consulting as an optometrist

thirty-five years ago, symptomatic dry eye was

almost exclusively the domain of the post-

menopausal woman. Today, dry, irritated eyes are

a very common complaint in most optometric

consultations. Depending on how you define dry

eye and where the eye clinic is located, studies

have shown that up to 80% of patient consultations

can involve some sort of dry eye investigation.

This certainly has been our experience here at The Eye Practice in Sydney CBD

where we see dry eye across the board regardless of age group or gender. From

teenagers to IT guys, pregnant mums to Uni students, no group is exempt from the

potentially debilitating effects of chronic dry eye.

READ ON TO DISCOVER THE LATEST INFORMATION ON

THE CAUSES, DIAGNOSES AND MANAGEMENT OF DRY

EYE AS WELL AS SOME OF THE EXCITING NEW

TREATMENTS AVAILABLE.

Dry Eye symptoms vary from mild to very severe and debilitating. Other than “go

and use some drops”, there is usually no productive feedback that comes out of a

consultation, as most eye care practitioners will move onto things they believe they

can help. It is commonly thought that because dry eye is not a life- or eyesight-

threatening condition, there is no risk in just ignoring it. Most eye care practitioners

believe that there is little that can be done to really help dry eye sufferers.

A visit to your local pharmacy will reveal a plethora of dry eye treatments to rival that

of the common cold. An Internet search of dry eye forums will unveil an abundant

ongoing discussion with thousands and thousands of people complaining about their

dry eye problems.

This eBook will go through the many causes of dry eyes and the many tests that

diagnose the various types. Understanding the underlying cause leads to specific,

targeted treatment, which maximises your chance of a successful outcome.

Jim Kokkinakis

http://www.theeyepractice.com.au/optometry-services/dry-eye-treatment




What is dry eye?

Dry eye is a very common condition that is characterised by a disturbance of

the tear film. It causes a variety of symptoms and signs that often interfere

with quality of life.

To keep the eyes comfortable and provide optimal vision, a thin, healthy

film of tears coats the surface of the eye.

This tear film is made up of three layers:

Lipid (oily) layer

Aqueous (watery) layer

Mucus (sticky) layer

The most superficial (top) layer is a very thin

layer of lipids (fats and oils). These lipids are

produced by the meibomian glands – a row

of specialised oil glands along the edge of

each eyelid.

The main function of this lipid layer is to prevent or reduce evaporation of the

aqueous (watery) tear layer beneath. If the meibomian glands do not

function properly, this leads to evaporative dry eye – where the exposed

watery tear layer has no protection from evaporating.

The middle layer of the tear film is the aqueous layer. Its function is to

lubricate the eye and provide clear,

consistent vision. It also has a vital role in

protecting the eye from harmful bacteria

and other pathogens. These tears are

produced in the lacrimal glands, situated

behind the eyebrows. In some people, the

lacrimal glands fail to produce enough

tears, and this is another major cause of

dry eye.

The bottom layer of the tear film is a thin

mucus layer. It acts like a sheet of Velcro

to attach the tear layer to the underlying

cornea.


What causes dry eye?

The causes of dry eye are numerous and include the following:

• Changes in oestrogen levels, e.g. menopause and pregnancy, can

cause thickening of the oils in the meibomian glands and cause them to

block

• Prolonged computer use

• Environmental – dry climates, pollution, wind, air conditioning

• Aging – often causes the eyelids to sag away from the eyeball, so the

important oils from the meibomian glands can’t enter the tear film

• Auto-immune disease (can affect aqueous tear production)

• Many systemic medications can cause meibomian glands to block or

aqueous tear production to be reduced (or both)

• Blepharitis (inflamed,

crusted eyelids)

impairs meibomian

gland function

• Poor blinking (often

associated with

computer use)

• Contact lens wear

(interferes with tear

film)

• Blocked meibomian glands are one of the most frequent causes of dry

eye

Dry eye disease is often caused by a combination of these factors, rather than

a single factor. Causes vary with age and gender. Plummeting oestrogen

levels tend to be the culprit in post-menopausal woman whereas prolonged

computer use is often at the core of dry eye in teenagers and young adults.


What are the symptoms of dry eye?

The discomfort associated with your dry eye can take many forms:

• Stinging, burning or scratchy sensation

• Stringy mucus in and around the eyes

• Increased irritation from wind and smoke

• Increased sensitivity to light

• Eye redness

• Eye fatigue

• Eye pain (can be severe)

• Foreign body sensation (feeling like there is something in the eye)

• Blurred vision (may be intermittent)

• Watery eyes

• Redness and crusting on eyelid margins (blepharitis)

Mild dry eye disease doesn’t cause serious problems to vision or health.

However, in moderate to severe cases, possible complications include:

• Long-term discomfort

• Heavy dependence on artificial tears

• Frequent eye or eyelid infections

• Scarring on the surface of the eye

• Visual impairment

• Decreased quality of life – ranging from chronic discomfort to

depression


Assessment and Diagnosis

Tests and procedures used to determine the cause of your dry eyes include:

• Comprehensive eye examination

• Dry Eye Questionnaire (e.g. OSDI)

• Measurement of the volume (quantity) of your aqueous tears

• Assessment of the quality of your tears

• Meibography – an infrared digital image of the meibomian glands

• LipiView – a series of 500 tear film images, which determine your blink

patterns and tear quality

• Manual Meibomian gland expression to determine potential flow of oil.

What are the goals of treatment?

Our dry eye practice has been specifically developed to liberate you from the

debilitating symptoms of chronic or severe dry eye. Individual goals vary,

depending on severity of disease, but usually include:

• Significant improvement in eye comfort

• Reduction or elimination of the use of artificial tears

• Improved quality of life

• Improved function of meibomian glands (in the eyelids)

• Improved appearance of your eyelid margins

• Clearer, more consistent vision

• Improved blink rate and blink completion

http://www.dryeyezone.com/documents/osdi.pdf


What is the treatment for dry eye?

There is a range of treatment options available, depending on the type and

extent of your dry eye problem. Some treatments, such as artificial tears, bring

symptomatic relief. Others improve the function of the tear glands and provide

lasting results. As meibomian gland dysfunction is essentially a skin problem

rather than an eye problem, further therapies may be recommended to

support healthy eyelids. Our treatments are tailored to each individual in order

to maximise your comfort and minimise your dependence on artificial tears.

They include:

• Ocular lubricants (dry eye drops)

• Nutritional supplements

(Omega 3 oils and

micronutrients)

• Punctal plugs (which retain your

tears in your eye for longer)

• Lid hygiene regimes (lid-scrubs,

warm compresses etc) to clear

blepharitis

• Protective eyewear (to reduce evaporation from wind, air-conditioning

etc)

• Cortico-steroids (both eye drops and oral medication)

• Prescription medication (often from compounding pharmacy)

• LipiFlow (which combines lid massage with heat to clear meibomian

glands)

• Blink rehabilitation to retrain the ocular muscles in complete blinking

• Blephasteam for daily home use

• Intense pulsed light (IPL)

• Blephex (a professional clean of the eyelid margins)

• Scleral contact lenses (to provide a physical barrier to evaporation)

• Meibomian gland expression (to clear blockages from the oil glands)

• Lid margin debridement (to clear crusting from eyelid margins)

• Specialised skin creams and cosmetics

• Dietary recommendation


Engagement and ongoing compliance with treatment strategies is critical to

achieve a level of success that will make a positive difference to your quality

of life.

It can be very useful to compare dry eye management to dental management:

We have been educated for over a generation now that it is imperative to

brush and floss our teeth every day. Yearly or more frequently we need to

attend a professional dental appointment to have our teeth professionally

cleaned and thoroughly analysed to make sure our oral hygiene is at an

appropriate level to avoid gum disease.

At The Eye Practice, we use a similar approach with many of our dry eye

patients. Once you experience dry eye symptoms, they will usually be with

you on and off for the rest of your life. Best results are achieved by combining

an individualised dry eye treatment program at home with a yearly

appointment at our clinic. This allows for a thorough assessment of your

progress and some minor treatments to keep things on track.

When can I expect results?

There is no quick fix for severe or chronic dry eye. Most therapy programs involve a

multi-pronged approach, where the underlying causes of your dry eye are targeted.

Symptomatic relief is just that – relief – and does not address the underlying causes

of your dry eye disease. Quite often there is no definitive cure.

THE GOAL OF ALL OUR DRY EYE THERAPY IS TO

IMPROVE COMFORT WHILE SIMULTANEOUSLY

REDUCING DEPENDENCE ON ARTIFICIAL TEAR

SUPPLEMENTS.

The goal of all our dry eye therapy is to improve comfort while simultaneously

reducing dependence on artificial tear supplements.

Therapy often includes a nutritional supplement to improve the symptoms of

dry eye from the inside out. Targeted eyelid treatments, such as intense

pulsed light (IPL) and meibomian gland expression, can yield immediate and

highly beneficial results. Longer term improvement usually continues for

several months. Maintenance is often required throughout your life.


Case Study 1

History

Ben is 18 when he first comes to see us. He is accompanied by his parents

and they give us most of the history. Ben has suffered from dry eye for the

past two years and is hooked on dry eye drops. He carries a vial of artificial

tears around with him and pops one in at least every half hour. Ben is a Uni

student studying computer science. He has always been a big screen-user

since he was about eight years old. Ben has been to three specialists before

he has found us and they have all prescribed a similar regimen of artificial

tears.

Diagnosis

Ben’s blinking and tear quality are assessed by the LipiView and show that

although he blinks very frequently, his eyes never completely close. His

mother also reports that he sleeps with his eyes slightly open. Ben has acne

rosacea. A close examination of his meibomian glands reveals that they are

completely blocked with hardened oil. This makes it impossible for his oily tear

film to function properly and stop his watery tear layer from evaporating.

Examination of the surface of Ben’s eyes shows inflammation of his corneas,

particularly in the area where his lids would expose his eyes while he sleeps.

Treatment

• We put Ben on a 3-month course of doxycycline, an antibiotic that has a

side effect of improving sebaceous secretions – thus helpful in clearing

acne and, in this case, blocked meibomian glands.

• A strict program of blink training is prescribed, to try and reinstate full

eyelid-to-eyelid blinking in order to spread the oily tears fully over the

eye’s surface.


• Ben is also prescribed an ointment to use at night to lubricate the eyes

while he sleeps and protect the exposed area where his lids don’t meet.

I am hoping the blinking exercises will also help with this over time.

• We also prescribe a 4-week course of unpreserved steroid eye drops to

get rid of the ocular surface inflammation.

Results

I review Ben after a month and we taper off the steroid eye drops. He reports

his eyes feel a lot better but he still needs to use the eye drops. At his next

review, two months later, the doxycycline tablets are stopped and there is a

marked improvement in his skin although his meibomian glands are now quite

active. The oily tears are still blocking the glands to some degree so Ben is

put on a regime of warm compresses and lid scrubs for a further 3 months.

The results at that stage are impressive. Although he still has oily glands –

and will have throughout his life – his oily tear layer is now looking pretty good

and is coating his eye nicely between blinks. He is still reluctant to give up his

dry eye drops but I explain to him that at this stage they are likely to be doing

more harm than good by flushing away his vitally important oily tear layer. So

he weans himself off slowly and finds he can make do with just the oily

lubricant at night. The burning has almost disappeared except for when he

uses a computer for prolonged use. He has trained himself to take a break

from the screen and do some blinking exercises when this happens and only

occasionally does he feel the need for any artificial tears.

Comment

The goal of all dry eye treatment is to restore comfort while simultaneously

reducing dependence on artificial tears. In the case of Ben, no one had

addressed the cause of his dry eye, resulting in a dependence on artificial

tears. Luckily for him, successful treatment meant he could reclaim his life.


Dry Eye and pregnancy – what you

need to know

What are the effects of pregnancy and breast-feeding on your eyes?

Pregnancy causes several changes to your eyes. Your corneal thickness,

sensitivity and curvature change, and this, coupled with an increase in your

myopia (short-sightedness), makes it a bad time to have laser eye surgery.

The curvature changes to your cornea may mean that your contact lenses no

longer fit you comfortably, although this is less of an issue with soft lenses.

Does pregnancy cause dry eyes?

The raised oestrogen levels present in pregnancy and lactation can play

havoc with your eyes. Oestrogen has an impact on the size and production of

the sebaceous glands of your body, including the row of oil-producing glands

at the edge of each eyelid. Situated just behind your eyelashes, these glands

play an essential role in balancing your tear film. Tears are made up of three

layers. The first is a thin layer of mucus that helps anchor the tear layer onto

the surface of the eye. The bulk of your tear film consists of aqueous (watery)

tears, which are produced in your lacrimal gland, situated just under the

eyebrows. And the top layer is a thin coating of oil which prevents the watery

layer from evaporating into thin air. If this oily layer is disrupted, it doesn’t

matter how much watery tears you produce, they will evaporate leaving you

with dry eyes. Oestrogen changes the consistency of the secretions from the

oil glands and reduces oil production. And this can mean trouble!


PREGNANCY CAUSES A NUMBER OF EFFECTS ON THE

EYES. THESE INCLUDE CHANGES IN YOUR GLASSES

PERSCRIPTION, DECREASED TOLERENCE TO CONTACT

LENSES, WORSENING OF SOME SYSTEMIC CONDITIONS

(SUCH AS DIABETES), AND DRY EYE.

What can I do if I have dry eye during pregnancy?

The nausea and vomiting experienced by many women during pregnancy can

lead to dehydration, as can the medications taken to relieve this nausea.

Most doctors agree that unpreserved artificial tears are safe to use to lubricate

very dry eyes. Sometimes the simplest solution is to stop wearing your

contact lenses for the duration of the pregnancy.

My rule of thumb is to use the least amount of medication possible – even if

they are generally assumed to be safe. There are lots of natural options to

support your eyes during this time. Nutritional supplements like Omega 3 oils

can boost your tears from the inside. You can also have your tears retained in

your eyes for longer through the use of punctal plugs, which sit inside the tear

drainage ducts (and act like a bath plug)! Pregnancy is meant to be a

wonderful time in a woman’s life but it can be marred by unpleasant side

effects. Luckily dry eye is treatable and the eyes quickly return to their pre-

pregnancy state within a few months of delivery or breastfeeding.

SOMETIMES THE SIMPLEST SOLUTION IS TO STOP

WEARING YOUR CONTACT LENSES WHILE PREGNANT.


The link between computer eye

strain and dry eye

At The Eye Practice more and more patients consult with us over strategies to

reduce the impact of computers on their eyes. Sitting for hours every day in

an air-conditioned environment, staring at a bright screen, not blinking often

enough or fully enough, all can play havoc with our eyes and cause signs and

symptoms of dryness.

How do we protect our eyes from the harmful effects of computers?

Use the 20-20-20 Rule…

Stand up from your desk every 20 minutes, look into the distance for 20

seconds and blink 20 times. Set your phone to remind you every 20 minutes.

It can be a little annoying, but ultimately you will reach the end of the day with

much more comfortable eyes – not to mention back and neck…

Hit the park…

Screen-time reduces the quality of our natural tear film and leads to dry eyes.

We all do it; you’re on a roll, the emails are rolling in and sometimes it’s just

more efficient to grab a bite to eat at your desk and keep going. But this is

bad news for your back, your neck and especially your eyes. Hit the salad bar

or, if you’ve brown-bagged your lunch, find your favourite park bench and take

a proper break.




Turn down the heat…

…and not just the air-conditioning; it is also wise to turn down the contrast and

brightness of your screen. Better still, choose a low blue light emission

screen. Companies like BENQ lead the way in this arena. Choosing a low

blue light screen will not only save you from the discomfort of eyestrain, but

will also save your eyes from the harmful effects of blue light. This oxidative

stress can damage your eyes.

Wear blue-blocking glasses…

Light from the blue end of the spectrum is shorter in wavelength and better

able to penetrate the eye. Both ultra-violet light and visible blue-violet light are

believed to cause oxidative stress to your retina. But not all blue light is bad!

In fact, light from the blue-turquoise part of the spectrum is essential for

healthy biorhythms to function. This is what helps us wake up in the morning

and wind down at night. Blue blocking filters on your glasses (whether

prescription or not) will filter out harmful blue light without blocking the

important blue-turquoise light from getting through. Our patients report relief

from eyestrain from wearing these lenses and they are reassured that they are

offering their eyes the best protection against long-term damage from

exposure to blue light.


The 5 things you should know about

your dry eye treatment…

It’s official. Our eyes are getting drier. In the past ten years we have seen an

epidemic of dry eye syndrome throughout the western world. The advent of

the digital age as well as lifestyle and diet changes all contribute to the

problem. Here are some things about dry eye you may not have known.

1. Dry eye is managed, rather than cured…

Unfortunately there is no definitive once-off treatment for dry eye, although

effective management is possible with the vast majority of people we

see. Up to 70% of dry eye is evaporative; this means the tears can easily

evaporate from the surface of your eye because of deficiencies in the thin

layer of oil that sits on top of your tear film.

Your tears are made up of three distinct layers; a

thin mucus layer, a thick watery layer (or

aqueous layer) and a thin oily (or lipid) layer on

top to stop it all from evaporating. The oily tears

are secreted from a special row of glands in the

eyelids. These are called meibomian glands and

when they are working well, they squeeze oil

into the tear film on every blink. And therein lies

one of the problems: if you blink infrequently or

incompletely, the oil doesn’t make it into the tear

film and the tears are not spread over the whole

eyeball. The result? Burning, itching, red eyes.

Adding artificial tear drops can help with the

immediate symptoms of dry eye but it doesn’t get to the root of the problem.

Read on to discover what DOES work.


THE ROOT OF THE PROBLEM OFTEN LIES IN YOUR

SKIN…

2. Dry eye is often a skin problem, rather than an eye problem…

Even though the symptoms of dry eye are felt, as the name suggests, in

your eyes, the root of the problem often lies in your skin. Skin conditions

such as acne rosacea, eczema and psoriasis can all cause the meibomian

glands to malfunction and are strongly associated with dry eye syndrome.

One of the mainstays of our dry eye treatment at The Eye Practice is a

course of doxycycline pills to address the underlying skin condition. Many

of our patients find a huge improvement in symptoms after a couple of months

on the drug.

3. Omega 3s are good for dry eyes

The challenges of feeding the world’s burgeoning population has led to the

intensification of farming over the past 50 years. This in turn has led to a

change in our diet, whereby we now consume far more omega 6 oils (in

vegetable and seed oils) and less omega 3 oils (from seafood and other

sources) than we did in the past.

Where we once consumed Omega 3s and 6s in roughly even quantities, these

days we consume far (up to 20 times) more omega 6s at the expense of

omega 3s.

This shift is thought to be responsible for

changes in the makeup of our cells, resulting

in an epidemic of health problems – including

dry eye. Addressing the balance by

increasing omega 3s in your diet, or

taking an omega 3 supplement, can make

a difference to your dry eye symptoms from

the inside out.

4. Not all blinking is equal

We’re not doing it like we used to. The digital age has led to a huge upsurge in

screen time, resulting in poor blink rates and incomplete blinking – both of

which cause dry eye problems.




The oil from the meibomian glands doesn’t make it into the eye if the lids don’t

completely close and even if they do, it is likely to be at a greatly reduced rate

compared to pre-digital times.

Use the 20-20-20 rule to guide you: Stand up from your computer every 20

minutes, look into the distance for 20 seconds and blink firmly 20 times.

Blinking is performed by muscles in the eyelids. Just like any other muscle, if

you don’t use it you lose it. So get blinking!

5. Dry eye drops could be making your problem worse

Artificial tears are often the first line treatment for dry eye symptoms and, for

mild cases of dry eye, especially if due to environmental factors such as

airconditioning or wind, they can be quite effective.

They supplement your own natural tears in much the same way as a

moisturiser hydrates your skin. But the fact is that up to 70% of dry eye is

believed to be evaporative – i.e. caused by a lack of the thin oily layer of your

tear film (and not a shortage of aqueous tears). In the case of evaporative dry

eye, artificial tears may actually do more harm than good, by flushing away

even more of your essential oily tear layer.

At The Eye Practice dry eye clinic, we try to get to the root of the problem by

addressing the underlying causes of evaporative dry eye. Improving your

skin function will have huge benefits for your tear film and often the

combination of a course of antibiotics plus a nutritional supplement as

well as a mechanical removal of the hardened oil blocking the

meibomian glands, can have spectacular success where other treatments –

like artificial tears – have failed.






Case Study 2

History

Claire is a 59-year-old female suffering with

dry eyes for the last 6-7 years. Prior to that

she had no symptoms of dry eye.

Interestingly, she had worked on a computer

for twenty years. She had seen her GP, three

ophthalmologists and two optometrists before

she came to see us. Claire feels like her

condition is progressively getting worse.

Claire’s main symptoms are burning eyes with

some gunky discharge around the eye lid

margins in the mornings. She is finding it

uncomfortable to use her computer. Her eyes

are also bloodshot and feel dry in the

morning. The symptom of burning eyes is

what has driven Claire to a number of specialists to seek relief. She has been

taking a cocktail of artificial tears and anti-histamines and using a lid hygiene

system to clean her eyelids several times a day. All of this is symptomatic

relief and doesn’t get to the root cause of the problem.

Diagnosis

LipiView results for Claire show a major problem with her blinking. It can be

useful to think about blinking much like the wipers on your car windscreen.

When the windscreen is dirty you squirt the water onto the eye (like putting in

artificial tears) and at first everything is worse. Then on come the wipers and

the first few wipes just smear the windscreen worse than ever before finally

things start to clear up. Proper, consistent blinking is crucial and it’s not an

easy thing to correct in someone who has had poor blinking for years.

Other diagnostic tests reveal that Claire’s meibomian glands are working

reasonably okay. There isn’t a lot of oily tear discharge from them but at least

they are not blocked.

Treatment

• The first thing we did was prescribe a program of blinking exercises for

Claire to get that back on track.

• Preservative-free steroid eye drops were prescribed for 4 weeks

(monitoring her intraocular pressure as some people respond to

steroids with an increase in intra-ocular pressure which can put them at


risk of damage to their optic nerve). In Claire’s case, the steroids were

essential to break the cycle of inflammation.

• We also prescribed an oily ointment at night as Claire had been waking

in the morning with very dry eyes.

• We recommended that Claire wear blue-blocking reading glasses,

which not only protect against harmful blue light but the frame chosen

was curved to help humidify the air around her eyes and protect her

against the drying effects of air-conditioning.

• I suspect the lid hygiene regime is far too extreme, considering her

meibomian glands are produce quite nice-quality oil. I ask Claire to

drop the lid hygiene and just gently express a little of the oil from the

glands once or twice each day. Her current regimen is stripping her

eyes of much needed oil for her tear film.

Results

Two days later, Claire sent me an email to say that her eyes were already

much better – although still looked a bit bloodshot. Four weeks later we are

able to taper off the steroid eye drops and the redness had completely

disappeared.

Claire’s eyes felt comfortable most of the time although she chose to continue

with the oily ointment at night so that her eyes felt good on waking. The quality

and rate of her blinking had improved significantly and she was now

comfortable using her computer for hours at a time. This is a typical scenario;

a patient with dry eye impacting her life for years and no one getting to the

heart of the problem. Unfortunately, we see this all too often. Patients often

come to us devoid of hope and lacking in trust, having been so many places

before. Thankfully, most of them achieve lasting results.


3 Great Home Remedies for Dry Eye

The Eye Practice specialises in diagnosing and treating all forms of dry eye –

even stubborn cases that haven’t responded to treatment in the past.

Many of our dry eye treatments are done in-house and involve some very

high-tech pieces of equipment. But not all dry eye treatment needs to be as

sophisticated. Sometimes, simple, relatively inexpensive remedies can be

effective in reducing symptoms. It’s never as good as the professional

treatment but certainly a lot better than nothing. The use of dry eye drops

alone is often insufficient to manage dry eye and there is even cause to think

they may actually worsen your condition.

The following are some dry eye remedies that you can try at home. How

much relief they give will depend on the root cause of your dry eye.

1. Add a nutritional supplement

Don’t have time to eat as well as

you would like to? Add a

nutritional supplement. You’re

probably aware that Omega 3s are

good for your health, but did you

know they are also good for your

dry eyes? These supplements

combine omega 3s with

micronutrients such as zinc to

boost the body’s ability to produce

good tears from within.


2. Warm compresses and lid massage

As much as 70% of dry eye is

believed to be evaporative in

nature. What this means is that the

underlying cause is not caused by

a lack of watery tears (the ones that

run when you cry or cut an onion)

but a lack of oily tears. These oily

tears are produced in a row of

glands along the edge of each

eyelid and the glands are prone to

blocking in many people. The reasons for the oil glands becoming blocked

are varied and can include hormonal changes (such as in pregnancy or

menopause) and certain skin conditions (such as acne rosacea). The

glands can become blocked as the oils become thicker and waxier and the

trick is to clear out the blockages and allow the oil to flow again.

Nothing beats an in-house treatment such as LipiFlow, which uses heat and

movement to gently and effectively express the glands. But a good home

remedy is to apply a warm compress to the eyes for 10 minutes before you go

to bed. A gentle heated gel pack or wheat back is ideal, with a clean tissue

placed across the closed eyes before applying. Lie back in your favourite

armchair, crank up the sounds and enjoy!

The whole ritual is very relaxing...

For a more effective treatment, add a lid massage after the heat pack. Using

your fingertips, gently massage your eyelids towards the eyelashes. You are

aiming to gently squeeze the thickened oil out through the openings of the

glands, right at the margins of your eyelids. This treatment is very effective if

repeated daily for several weeks. Once symptoms have improved, you can

then drop back to weekly maintenance sessions.


3. Lid scrubs

Keeping the eye lid margins

scrupulously clean is very important

for dry eye sufferers. It is common

to get itchy, red and flaky lid

margins and any residue collecting

on the lash-line can harbour the

bacteria that cause redness and

irritation. We always recommend

using a purpose designed product

to gently

and safely dissolve away the

material that crusts along the edges of your lids. The Eye Practice stocks

Sterilid and Blephadex for home use. The foamy solution is applied either

with the fingertips or with the provided wipes (depending on the product). Like

the warm compresses above, it is recommended to use lid scrubs daily for

several weeks to get the problem

under control and then ease back into

a maintenance regime of once or

twice a week.


Why artificial tears could be making

your dry eyes worse…

DRY EYE DROPS ARE ONE OF THE MOST FREQUENTLY

USED OVER-THE-COUNTER REMEDIES. BUT ARE THEY

REALLY HELPING YOUR DRY EYES? TO UNDERSTAND

HOW THIS COULD BE SO, LET’S HAVE A LOOK AT THE

UNDERLYING CAUSES OF DRY EYE:

Your tear film is made up of three distinct layers; a thin mucus layer, which

helps attach the tear film to the surface of your eye, an aqueous (watery)

layer, which hydrates the eye, and a lipid (oily) layer which prevents the

watery layer from evaporating immediately.

The watery tears are produced in our lacrimal gland, situated close to the

eyebrow. If your eye feels dry or irritated (for example from cutting an onion

etc.), the tears will flow.

The oily tears are produced in a different set of glands, this time in the eye

lids. These tiny glands squeeze droplets of oil into the tear film each time you

blink. These tears play a crucial role in preventing the watery tears from

drying up. These oil-producing glands can block up, resulting in a shortage of

oil in the tear film. Studies show that up to 70% of dry eye is actually


evaporative – in other words, it is not caused by a lack of watery tears but by a

lack of oily tears. So, how could artificial tears be making it worse?

Flushing out the good tears…

As you add copious amount of tear supplements to your eyes, you may

actually be flushing away the essential, oily layer of your tear film. The more

you put in, the more diluted the oil becomes, aggravating the problem. It is

important to remember that artificial tear supplements (dry eye drops) only

provide temporary relief from the symptoms of dry eye and do not address the

underlying cause. However, artificial tears can be very effective in milder

cases of dry eye, or in temporary dry eye such as after eye surgery or during

pregnancy.

Preservative-free or bust…

Any dry eye drops that come in

a bottle will contain a preservative. This preservative works by killing cells of

any micro-organisms that are introduced to the bottle – through the air or

through touching your hands or eyelashes. But the preservative also kills

healthy cells and can be damaging to

the delicate surface of your

eye. We recommend

preservative-free drops for all our patients.

These are readily available in unit-dose so you

can relax in the knowledge that you are not

causing a toxic effect on your eyes.

What else can I do for my dry eye?

Dry eye is present in Australia in epidemic proportions. Artificial tears can

help with the symptoms but will do nothing to address the underlying causes

of the condition. A thorough dry eye assessment at The Eye Practice will

establish what treatment will be most effective for you. We try to get to the

root cause of your dry eye, rather than just treating the symptoms. Nutritional

supplements can help address the problem from the inside, and often a

course of prescribed medication can make a big difference to the quality of

your tear film.

Getting the oil glands in the eyelids back on track and functioning properly is

often key to successful long-term management of your dry eye. At-home

treatments can only go so far to improve your tear film. Professional, in-house

treatments such as LipiFlow can make the world of difference. It’s a bit like

comparing the way you clean your teeth at home to the professional clean you

get at the dentist once or twice a year. There’s just no comparison. In-house

treatments will always deliver far better results than home remedies.


About the author

Dr Jim Kokkinakis is one of Australia’s most experienced optometrists and is well

known amongst his peers as an expert in dry eye diagnosis and treatment. Many

colleagues from far and wide refer their patients to Jim’s practice in the Sydney CBD.

Over the past three decades he has worked alongside world-famous contact lens

fitters and ophthalmic surgeons.

Over the years, Jim has seen how prevalent dry eye has become, especially in the

wake of the digital age. At The Eye Practice, Jim now has one of the best-equipped

dry eye clinics in the world for the diagnosis and treatment of all kinds of dry eye

condition. Even the most severe symptoms of dry eye can be alleviated with his

techniques. Jim realised that to succeed in treating dry eye, one must have a

thorough medical knowledge of the eye, a good understanding of the patient’s

lifestyle, environment and expectations, and an up-to-date approach to dry eye

diagnosis and treatment. In addition, you have to invest in the latest technological

instruments so that even the most stubborn dry eye can be tackled. Most importantly,

you and your team must have empathy for the dry eye sufferers who have endured

their condition, often for years, with little success in treatment. Jim will NOT stop until

he has a workable solution.

HIS COMMITMENT TO EXCELLENCE SETS HIM APART

Career Highlights

Senior lecturer and clinical supervisor at the Optometry School (UNSW)

Co-author of Keratoconus – A User’s Manual

One of only 40 full members of The International Society of Contact Lens Specialists

Lectured internationally on advanced contact lens fitting, dry eye treatment and

computer vision syndrome.

One of Australia's first optometrists to be qualified in Ocular Therapeutics

Call today on (02) 9290 1899 for an appointment with Dr Jim Kokkinakis

http://www.theeyepractice.com.au/Jim-Kokkinakis

http://www.theeyepractice.com.au/Jim-Kokkinakis



http://www.theeyepractice.com.au/optometrist-sydney/tag/Dry_Eyes/

http://www.theeyepractice.com.au/optometrist-sydney/tag/Dry_Eyes/



dry eye – what you need to know · the middle layer of the tear film is the aqueous layer. its...

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