Jonathan Joffe and Simone Klose shed light on the cause and effect of the ocular disorder, Dry Eye disease, and advises on the treatment modalities thereof.
While the term ‘good eye health’ usually conjures up images of annual visits to the optometrist or ophthalmologist, wearing sunglasses, following a diet loaded with superfoods and using computer caution (to name but a few), many of us unaware that tear function also plays a major role in eye health. This is because poor tears or poor tear function can lead to “dry eye” or “dry eye disease” – an ocular surface disorder with symptoms ranging from minor (with the occasional irritated eye), to extremely severe (leading to loss of vision/eye damage). Healthy tears are therefore essential for normal vision and comfortable eyes.
Tears consist of a complex combination of an oily (lipid) layer, a watery (aqueous) layer, and a sticky (mucin) layer.
These 3 layers of the tear must all be present in balanced quantities to be effective. The innermost layer that sits against the cornea is the mucin layer. Next is the aqueous layer, which is made of water and is secreted by the lacrimal gland. It is very rare for this gland to function abnormally.
The last layer is the outermost layer, which is made of oil and is secreted by the meibomian glands. These glands are located in the upper and lower eyelids, secreting meibum which contributes to the lipid layer of the tear film.
If these meibomian glands function inadequately (termed Meibomian Gland Dysfunction), it leads to a poor lipid layer, which in turn can lead to evaporative dry eye (see diagram below). While there are many causes of dry eye, Vision Science has taught us that Meibomian Gland Dysfunction (MGD) is the most common regular underlying factor in dry eye disease (DED).
Symptoms of dry eye can include one or more of the following:
- A sandy or gritty feeling
- Short-term or intermittent blurred vision
- Uncomfortable and sometimes painful eyes
- Persistent eye “fatigue”
- A pressure feeling behind the eyes
- An itching or burning sensation
- When more severe – red eyes with possible corneal infections or erosions
- Watering eyes – having watery eyes can mean you are producing poor-quality tears, thereby causing dry eyes. The body then attempts to make more tears, but these tears remain of poor quality, where they are lubricating the eye but not reducing the dry eye symptoms.
While dry eye tends to be more prevalent over the age of 50, more and more people are presenting dry eye symptoms at much younger ages. This is largely because of the ‘information age’ we are living in – an age where we prefer trading information with online communication over meeting socially, thereby evoking an increased visual demand. And with this heightened visual activity, even mild tear dysfunction may cause dry eye symptoms.
Treatments of dry eye are aimed at reducing symptoms and breaking the dry eye cycle. This can be acheived in a number of ways, including the use of lubricating eye drops, improving nutritional factors to help the body improve tear formation, treating infective or inflammatory conditions that hamper proper tear formation, or by altering the environment to reduce tear evaporation.
Examples of current treatment include the following:
- Adjust your environment for humidity if possible (avoid air-conditioning, which increases evaporation)
- Make an “Oasis” with specific plant types in your office or room that increase humidity
- Avoid smoking or smoky environments
- Outdoors – using wraparound sunglasses can reduce evaporation
- Keep well hydrated – drink enough water
- Instilling tear replacement/lubricating drops to break the cycle (there are various types available)
- Blink more frequently
- Taking a rest from concentrated visual tasks.
- Oral supplements – Omega 3 or Flaxseed capsules.
- Treatment of blepharitis, which is commonly associated with the Demodex mite (eyelid infection). These mites appear to be a significant factor in impairing meibomian gland function.
The IPL option
A recent option for improving tear function is by applying Intense Pulsed Light (IPL) to the eyeleids. This is specifically aimed at improving meibomian gland function, which then helps restore the balance of the tear film layers. This leads to a healthier eye and reduction or elimination of dry eye symptoms.
The following diagrams shows the openings of the meibomian glands, as well as the position of the meibomian glands where IPL treatment is aimed at.
IPL at work
IPL stimulates the meibomian glands to create a healthier and thicker oil layer for the tears, which often leads to a significant reduction in dryness and an improvement in redness, pain and vision.
There are a number of IPL units available worldwide which are optimised for meibomian gland IPL treatments, yet – the Lumenis 22 specifically – is a versatile unit that not only treats meibomian glands, but is also designed to treat numerous other skin conditions elsewhere in the body.
There are additionally a number of publications that show the value of IPL as a modality in improving and maintaining meibomian gland function.
The meibomian glands
A2 Disclaimer: This article is published for information purposes only, and should therefore not be taken as an endorsement or advertisement for any product or medical treatment – nor should it be regarded as a replacement for sound medical advice.
This article was written by Dr Jonathan Joffe and Simone Klose and edited by the A2 team EXCLUSIVELY for the A2 Aesthetic & Anti-Ageing Magazine December 2017 Edition (Issue 24).
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