Dry eye disease is very common, and occurs when your tears no longer lubricate your eyes properly and can be very uncomfortable for people with it, and it can be triggered by something as simple as sitting at a computer screen for a few hours.
However, there are several effective treatments for dry eye disease, and finding the right one for you is key to successful dry eye disease treatment.
There are several reasons why this can occur, but the consequences of long-term dry eye disease are inflammation and damage to the surface of your eyes – so it’s important to deal with dry eye sooner, rather than later, as it can severely impair your quality of life.
What’s more, ELZA is part of the TFOS committee, the entity defining the global dry eye treatment guidelines that all doctors should follow.
Need more info? The links on this page refer to ELZA pages (in English) with more detailed information on the topic.
The most common reason for dry eye disease is lipid deficiency. Tears contain two components: aqueous (mostly water), and lipid. The lipid – or oily – part slows down the evaporation of tears, and helps lubricate the surface. The lipid part gets applied to the tear film on your eye every time you blink, as it is produced by small structures in your eyelids called meibomian glands, and squeezed out each time you blink.
The meibomian glands can sometimes get blocked (sometimes the oily lipids become more solid) and this means your tears evaporate far faster, which results in dry eye.
It’s worth noting that screen use – be it your smartphone, TV, or computer screen, reduces your blinking rate, meaning your eyes become less lubricated over time and therefore drier.
The aqueous – mostly water – part of your tears is made by the lacrimal glands above your eyes. If the lacrimal gland fails to produce enough tear fluid, it results in dry eye.
Again, there are several causes, which range from aging and contact lens wear to whole-body autoimmune diseases which as Sjögren syndrome, and many types of drugs can also cause aqueous deficiency – antihistamines, anti-depressants, cancer chemotherapy drugs, and so on.
Normal tear film
Resists evaporation for over 10 seconds
Morbid tear film
Breaks down after a few seconds (black spots)
Eyedrops that lubricate the eye and control the inflammation are typically the best way of controlling this form of dry eye disease, although there are several other interventions which can help, including punctal plugs (to reduce the rate at which tears drain away from the eyes) and even dietary supplements can help.
You can experience dry eyes in an acute setting, thanks to a trigger (like entering a room with air conditioning or taking a flight on an aircraft), but if the symptoms persist for a prolonged period, then you should take action.
Tears get produced – but they also get drained into the tear duct. It’s a dynamic process, and it’s good to understand how quickly the tear film is being drained. The amount that’s being drained any given time can be determined by measuring the tear meniscus with a high-resolution camera.
We can determine the quality of the tear film with a Placido disk analysis. You look at concentric rings; a camera at the centre of the rings takes an image of what’s reflected back from the surface of the eye. The presence (or absence) of distortion in these rings provides information about the quality of the tear film.
An analysis of the meibomian glands in the lid margin allows to determine the best therapy for you.
If you have a salt solution and boil off (evaporate away) all of the water, you generate an increasingly salty solution until only the salt is left. It’s the same with evaporative dry eye: the increasing saltiness (osmolarity) indicates the severity of dry eye.
BlephEx therapy is an in-depth cleaning of the lid margin with a BlephEx device. This cleaning is done at the institute and takes about 20 minutes. In case of marked inflammation of the lid margins, this therapy should be performed twice a year.
Intense Pulsed Light (IPL) therapy has been used in dermatology for decades now, but more recently, IPL has been shown to be an effective treatment for chronic dry eyes caused by MGD.
ELZA’s IPL for Dry Eye device is the Eye-Light. It works by focusing pulses of polychromatic light with wavelengths (500-1200 nm) into the meibomian glands. The light is absorbed by oxyhemoglobin present in the blood vessels which raises the temperature of the affected cells being illuminated, which melts the solidified oil blockages that prevent the production of healthy, refreshing tears.
Most patients find that this approach brings many benefits, as it reduces the need for lubricating eye drops, makes your eyes feel more comfortable, and as a consequence, your quality of vision will improve, too. In short, IPL should bring relief from dry eyes. Scientific publications have shown that 4 IPL treatments are needed initially, then switch over to a maintenance treatment every 3 to 6 months, depending on if and how quickly MGD might return.
The IPL treatment is usually combined with LLLT, which stands for Low Level Laser Therapy. This treatment modality has been in clinical use in dentistry and dermatology for years. For treatment of the eyelids, laser light is emitted in the infrared range of the spectrum. This light gently warms the Meibomian glands in the depth of the eyelids, so that the sebum can evacuate from the clogged glands.