Dry eye disease affects more than 4 million Australians and it’s on the rise.

Dry eye is a big issue with Australians and is increasing with our ageing population. In January 2020, Optometry Australia reported 77% of Australians have suffered dry eye, yet only 26% have seen an optometrist about the plethora of new treatment options available.

It’s about the quality and quantity of your tears.

Dry eye begins with a lessening in the quality or quantity of tears. Your tear film keeps your eyes moist and protected. The top oily layer helps to prevent evaporation of tears. The middle, watery layer is the thickest layer and the sticky bottom layer helps the tear film to adhere to the eye. If the tear film is disturbed or altered, it can evaporate or become unstable. This results in dryness and inflammation of the front of the eye. The resulting symptoms may be sore, itchy, blurry or watery eyes.

Chronic dry eye is a condition that persists for a long time or is constantly recurring.

Because chronic dry eye occurs over a long period of time and is experienced regardless of environment or activities, it often has an underlying cause that can be difficult to identify. Each tear component is produced by different glands on or near the eye. A problem with any of these sources of tear film components can result in tear instability and dry eyes. More than 80% of dry eye disease comes from these meibomian glands not functioning the way that they should be. In some cases they can stop functioning altogether.

What causes dry eye disease?

Dry eye disease is caused by an imbalance in the different components of the tear layer that coat and protect the eye surface. An adequate and consistent layer of tears on the surface of the eye is essential to keep your eyes healthy, comfortable and seeing well.

No two dry eye cases are exactly the same or respond the same way to treatments, or present in exactly the same way. Dry eye disease is not something that happens overnight. It is a chronic issue that may have been in existence for some time before the symptoms actually started.

A normal tear film consists of three important components and each component has a critical purpose.

  • An oily component – is produced by meibomian glands in the eyelids
  • A watery component – is produced by lacrimal glands in the upper eyelids
  • A mucus component – is produced in the cells that cover the white of the eye

Dry eye disease is a multi-factorial disease. Often people have more than one influence that is producing their concern for dry eye. In years gone past it was considered an age-related condition but we are now seeing people come in much younger than they used to with dry eye disease and so we think there are a lot of environmental factors such as:

  • Working in air-conditioned offices
  • Using digital devices for extended periods of time
  • Pollution
  • Smoke, the bush-fires lately have been a provoker of dry eye disease

A number of factors can increase your risk of dry eye:

  • Contact lens wear
  • Ageing
  • Autoimmune disease
  • Smoking
  • Health conditions such as diabetes, thyroid diseases, arthritis and lupus contribute to dry eye problems
  • Medications
  • Aeroplane travel
  • Eyelid problems
  • Menopause

Many of the dry eye issues come from the meibomian gland dysfunction. Meibomian gland dysfunction involves the meibomian glands and these are what are described as finger shaped glands we have in our upper and lower eyelid. We have about 30 in our bottom eyelid and about 60 in our top eyelid. They produce an oil that is a very principled part of our tears. A problem with any of these sources of tear film components can result in tear instability and dry eyes.

What symptoms do optometrists see in dry eye patients?

Often there a number of people out there who already have an element of clinical dry eye but they haven’t experienced the symptoms yet. Then, environmental changes or workplace changes will push them over the edge from being asymptomatic to becoming symptomatic.

The tear layer is quite a protective layer to the eye, it protects the eye from microbes, it protects the eye from physical things irritating their eye. It protects the eye from chemicals and pollution that’s in the air. So if we don’t have an efficient tear layer on the eye then we are far more susceptible to getting irritation, the grittiness, the soreness, and the redness, from the dry eye disease.

People who may have dry eye disease will describe a burning or a grittiness in the eyes, or a pain in their eyes, almost like a foreign body sensation that they get during the course of the day.

Dry eye patients may discuss even getting some pain or having inflamed or red eyelids. They may say they feel like they have sand or grit in their eyes.

Many people get confused when they come in talking about their eyes watering a lot, as that can be another principal symptom that can lead us towards the desire to look for dry eye disease, which people don’t realise can also be a watery eye problem.

There are a lot more allergic conjunctivitis cases now too in conjunction with dry eye disease and in most cases we try to suppress the allergic conjunctivitis before we start treating the dry eye disease.

Certainly, with all the different seasons there can be different presentations, but with this bush fire season, particularly this catastrophic one that we have had, where there has been smoke lingering around for days and weeks at a time and people become more symptomatic presenting with blurry vision. Even blurry vision is a symptom of dry eye.

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Optometrists spend time examining the meibomian glands and looking at the quantity and the quality of the secretions of those glands produced.

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How is dry eye treated?

Optometrists offer a comprehensive assessment of your dry eyes and have a wide range of management options to provide you with the most effective solution.

Dry eye is a chronic and progressive condition, and correctly diagnosing the cause is essential to a successful management plan so that both greater eye comfort and sharper vision can be achieved. When we are looking specifically at dry eye disease, it will involve considerable examination of the eye lids, the eye lashes, exploring for inflammation, and factors that would contribute towards inflammation. We we will look at the tear stability, and tear quality closely. Treatment depends on the type and severity of the condition. Treatment can include ocular lubricants to relieve the symptoms of dry eye .We may also prescribe eye drops or recommend omega-3 supplements to help reduce inflammation of the cornea. Tiny plugs can also be inserted into the tear ducts to increase the amount of tears at the eye surface.

There is considerable variety in the causes and ways that dry eye presents, so the investigative pathway is not always the same. The diagnosis and management of dry eye disease is complex, and requires specialised equipment and clear protocols for assessment and management.

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