Dry Eyes
Dry Eyes
We don't just have tears in our eyes when we're crying - they're there all the time. The very thin tear layer we all have on the front of our eyes is essential. They allow our eyes to feel comfortable, they help protect from infection, they flush away dust, pollen, makeup and all the other junk that might get into our eyes, and they even allow us to see clearly.
Because our tears are very thin, and because they sit on a hot surface (our eyes being at body temperature), they are inclined to evaporate. Fortunately, we have something to stop this from happening. Unfortunately, this "seal" we have against evaporation is prone to attack.
Behind our eyelashes, there are about 90 little holes leading into oil glands. These glands are called Meibomian glands. Every time we blink, a little bit of clear oil comes out of the glands and helps to maintain a layer of oil in front of the watery part of our tears. This then stops our tears from evaporating, as long as it's working properly.
This is what messes the whole thing up: normal bacteria from our skin love to live in nice warm spots. Meibomian glands fit the bill perfectly. In many people (probably most people), the glands can at times become over-populated with bacteria, and then the oils aren't quite the same any more. The bacteria cause the oils to become either deficient, or simply wrong, and our tears start to evaporate more quickly. The bacteria sometimes cause the edges of our eyelids to look red or flaky too - this is called blepharitis and is strongly associated with dry eyes.
When we have dry eyes, the symptoms could be any or all of the following: stinging, burning, itching, dryness/scratching, redness, wateriness, a tired feeling, or intermittent blurry vision.
We recommend Lid Care by Ciba Vision. This "glorified eye makeup remover" cleans out your Meibomian glands and improves their performance. We think of it as "toothpaste for eyes" - keeping your Meibomian glands clean and functioning, in the same way that cleaning your teeth helps to prevent decay.
Lubricating drops such as Refresh & Bion Tears can also be helpful, but if Meibomian bacteria are active, lubricating drops only mask the problem.
Dry eyes can also have many other causes apart from Meibomian inflammation. Certain medications, menopause, and conditions such as some similar to arthritis, can all cause your eyes to produce fewer tears. This is when lubricating drops can be very helpful, although the high frequency of instillation may be frustrating.
Punctal occlusion is another effective form of dry eye management. In this procedure, tiny little plugs of silicone are inserted into your tear drainage holes. These are called "puncta" and are on your eyelids, behind your lashes, near your nose. When they're blocked, tears are forced to recirculate for a while, keeping your eyes moist for a longer time. A trial can be organized with temporary collagen plugs - these are cheap and easy to insert, and dissolve themselves over about 5 days. We use collagen plugs to see whether the semi-permanent silicone ones are a worthwhile option.
Some people need a combination approach. Silicone plugs and 1 daily drop of lubricant, or Lid Care and punctal plugs. Different strokes for different folks.
Drinking more water will help, as will reducing your intake of caffeine and alcohol. If you can (this is harder than it sounds), blink more often. Blinking not only resurfaces your tears, but it actually pumps tears onto your eyes, and pumps clear oil onto the surface of the tears to hinder their evaporation. People tend not to blink much when they're concentrating on close tasks (reading, computers). Lately, omega 3 fatty acids have been getting some good press, and these can improve the quality of your Meibomian oils. You can increase your omega 3 fatty acid intake through diet (eg salmon, tuna) or with supplement tablets from your pharmacy.
If your eyes are feeling dry, welcome to the club. Dry eyes seem to be an epidemic lately. If you've recently had a checkup but you have a problem with dry eyes, drop in to ask Jane or Julie about Lid Care, and how to use it to best effect. If you haven't had a checkup for a couple of years, we recommend a comprehensive examination - click here to make an appointment.
