Keratoconus and dry eye – symptoms causes and treatments

No more tears

Dry eye syndrome – which affects nearly five million Britons over the age of 45 and, despite its name, leads to more tears. Dry eye can be at best annoying and at worst, painful and irritating. Dry eye syndrome has several varied underlying causes. But, in many cases there is no one cause that’s easy to pinpoint. You’re not alone as Dry eye syndrome is common. It tends to affect people above 60 years of age, but it can affect younger people. It is also more common in women than men.

Dry eye symptoms

The symptoms of dry eye syndrome can be mild or severe. They include:

• dry or sore irritated eyes
• blurred vision, vision changes
• the feeling of something in your eye
• burning, itchiness, stinging
• watering- sounds funny but it’s the wrong sort of tears!

• contact lenses for keratoconus, which can make you more at risk; you should follow the advice for wearing and looking after them very carefully

 Dry eye syndrome can be caused by:

• environment, particularly dry heat or a windy climate- so central heating and air con should be avoided
• disease – keratoconus, Sjogren’s syndrome
• side effects of some medicines
• hormonal changes- pregnancy, teenage growth spurts, being on the Pill, HRT
• ageing –  (up to a third of people aged 65 or older may have dry eye syndrome)
• over use of dry eye drops and ointments, or inappropriate use

About 20% of people in the UK suffer from dry eye syndrome, rising to 50% in those over  65. Rosie Gavzey, an optometrist and trustee of The Eyecare Trust, explains: ‘As we get older the constitution of tears is just not quite as strong so the eyes become dry.’

Tears dry on their own

The tear film is a complex structure which consists of three key layers:

• a sticky mucous layer
• a watery layer containing nutrients and essential proteins which protect the eye
• an oily layer which prevents evaporation

Each part is made by special glands, including:

• the lacrimal gland (the main gland which produces the water layer)
• mucous glands (distributed across the surface of the eye)
• meibomian glands (oil-secreting glands running vertically in the upper and lower eyelids, opening just behind the roots of the lashes)

The tear film is spread across the surface of the eye by the eyelids when you blink, and drains into the tear ducts (situated in the corner of the upper and lower lids) and then into the nose.

Stop Your Sobbing

You probably only notice your tears when you laugh or cry. However, the surface of your eye is always covered by a thin layer of liquid known as the tear film.

Tears have several important functions. They lubricate your eyes, keeping them clean and free of dust, protect your eyes against infection, and aid sight by helping to stabilise your vision.

Tears are produced and regulated by a system known as the lacrimal functional unit.

• The lacrimal functional unit is made up of a number of different parts that work together. This is described below:
• lacrimal gland – found in the upper corner of the eye socket behind the bone and produces the watery liquid that makes up the majority of your tears
• goblet cells – found in the lining of the eye (conjunctiva) and produce a sticky mucin which allows the watery liquid part of the tear film to stick to the surface of the eye
• meibomian glands – found along the entire length of the upper and lower eyelids and produce a specialised oil that forms the outer layer of the tear film, preventing evaporation
• eyelid – spreads tears across the surface of your eye when you blink
• cornea – the clear window at the front of your eye which is vital for sight
• conjunctiva – a clear membrane that lines the back surface of the eyelid and forms a natural gutter between the eyelid and the eyeball
• tear ducts – two small drainage channels at the inner ends of the eyelids (next to the nose) that allow tears to drain into the nose through the tear duct openings

If any part of the lacrimal functional unit is affected, the whole system can break down, resulting in one of two outcomes, or possibly both:

• the quantity of tears is affected – either the lacrimal gland does not produce enough tears due to diseases damaging the glands, or the tears evaporate before the body has a chance to replace them
• the quality of the tears is affected – the tears contain abnormal proteins and other molecules that irritate or damage the surface of the eye

Either outcome can cause dry eye syndrome. As the eyes are no longer adequately protected by the tear film, special signals are sent to the immune system (the body’s defence system) to try to compensate and correct this deficiency. It is this process that causes the inflammation (redness and swelling) of the eye, which is frequently associated with more serious forms of dry eye syndrome.

Dry your Eyes –  Quick tips for healthy eyes

You can help ease or prevent dry eyes by:

• keeping your eyes and eyelids clean and protecting them from the environment
• If your dry eye is caused by wearing contact lenses then having a break from your lenses may help the dry eye to improve
• using your computer or laptop correctly to avoid eye strain

A study published in the journal Optometry And Vision Science found that reading from a Smartphone can cause eye strain because the eyes have to point in the right direction as well as focus on the small text, meaning they have to work harder.

When using a computer, Smartphone or tablet for long periods, remember the 20-20-20 rule:

Every 20 minutes, look up for 20 seconds at something at least 20ft away

Or here’s a tip from Ali Mearza, consultant ophthalmologist at Imperial NHS Trust: ‘Think of the Enter or Return key as a “blink’’ key. Every time you hit it, remember to blink.’

•  using a humidifier to moisten the air
• avoid air conditioning or sitting directly in front of a fire
• eating a healthy diet that includes flaxseed oil and omega-3 fats, oily fish
• drink lots of fresh water
• not smoking or being in a smoky environment
• never rub your eyes

Regular blinking is crucial for healthy eyes, as every time you blink, you’re keeping your eyes refreshed and clearing the cornea, the transparent front part of the eye.’

The problem is that when we’re concentrating on something, particularly a screen, we tend to forget to blink – meaning the eyes become dry. Studies have shown that on average, we blink about 22 times a minute, but when we concentrate on a computer screen or Smartphone, or even while driving, the rate goes down to between five and seven blinks per minute.

Treat the problem don’t mask the symptoms

The exact treatment for dry eye syndrome depends on whether symptoms are due to:

• not enough watery tears
• too much evaporation
• associated disease

Steps can be taken to relieve the symptoms, including:

• treating the underlying cause- VERY IMPORTANT
• using ocular lubricant eye drops- see your GP or doctor/ Optom/ eye specialist
• wearing specialised eyewear- polarised sunglasses are ESSENTIAL

In severe cases, dry eye syndrome may be treated with surgery to block the drainage tear ducts. This is either with temporary punctal plugs or by permanently sealing the drainage hole.

Once it is confirmed by a doctor that you have dry eye they will discuss what can be done to help you. You cannot “cure” dry eye but there are some treatments that can help your eyes feel more comfortable. If your dry eye is caused by another condition, such as an infection, then treating this infection may help with your dry eye symptoms. Often dry eye is caused by getting older, which can’t be helped, but there is treatment that can help with your symptoms.

There are three main ways to help your dry eye according to RNIB:

1. Making the most of your natural tears

There are things that you can do yourself which may help reduce the symptoms of dry eye. You can often lower the temperature in a room because high temperatures and central heating can make tears evaporate more quickly. However, you need to make sure that you keep yourself comfortable. A humidifier is a small machine that helps put more water into the air, which may help slow down the evaporation of your tears.

Many people find that their dry eye is more uncomfortable when they’re reading or using a computer. This is usually because you tend to blink less when you are doing this sort of thing, which gives the tears more chance to evaporate. You can try to blink more when you’re doing these tasks or use eye drops before you do anything, like reading, as this may help to keep your eyes comfortable.

2. Using eye drops

Most people with dry eye need to use some form of eye drops, also known as “artificial tears”. Eye drops aim to supplement and replace your natural tears and make the eye more comfortable. They can also prevent any damage to the front of your eye, which can happen if the eye is dry for a long time.

Eye drops don’t contain any drugs, they are just replacement tears. This means that they can be used frequently, or as much as you need them. However if you are having to use your drops more than 4 or 6 times a day then you should let your ophthalmologist or optometrist know as you may need a different treatment to the drops you’re using.

There are three main types of eye drops which the GP, optometrist or ophthalmologist may prescribe or recommend:

Artificial tears

Artificial tears are made by many different companies. Some people find one brand works better for them than another, although no one knows why. Your doctor may suggest a selection of different brands for you to try. It is usually best to try one type for at least a month.

Most artificial tear drops can be bought over the counter from the pharmacist. If you’re entitled to free prescriptions, or have a prepayment certificate, you can ask your doctor to prescribe them. Some people develop sensitivity to the preservative used in the drops, especially if they’re using them a lot. This can make your eyes sore. Preservative-free drops are available.

Gels

If your standard eye drops aren’t helping, your doctor may suggest thicker gel-like drops which are made from different chemicals and may last longer in the eye. They do the same thing as the ordinary drops but you don’t have to put them in as often.

Ointments

Ointments are also available to help keep your eye moist overnight. When you sleep, sometimes your eyes aren’t fully closed, so tears can evaporate and leave your eyes very dry when you wake up. Ointments help stop the eyes drying out overnight so that they feel more comfortable in the morning. Ointments tend to be used overnight because they are sticky and cause blurry vision. Ointments are usually used as well as eye drops during the day.

3. Reducing the draining away of tears

It is possible to help dry eye by blocking up the two drainage holes in your lower eyelids. Stopping the tears from draining away may help your tears to stay in your eye for longer. The medical term for blocking the tear ducts is punctal occlusion.

Usually, punctal occlusion is tried for a period of time to see if it helps. The small drainage channels are blocked by little pieces of plastic called punctal plugs. If it helps you with the symptoms of dry eye, the plugs are left in place. Sometimes blocking the ducts can cause the eye to over-water or you may experience infections. If this happens, then the plugs can be removed. If you have had your tear ducts blocked you may still need to use drops, gels or ointments to protect your eyes and keep them as comfortable as possible.

There is some debate on whether or not diet helps with reducing the symptoms. In particular, certain oils, omega 3 and 6 are thought to help with dry eye. However, there isn’t any large scale evidence that taking these supplements will help you.

http://www.rnib.org.uk/eyehealth/eyeconditions/eyeconditionsdn/Pages/dry_eye.aspx

EyeBag

Convenient, simple and easy to use, the EyeBag is a re-usable warm compress which treats a variety of eyelid and eye problems. Eye Surgeons, doctors and opticians frequently advise regular use of a warm compress but hot wet face flannels are a real hassle and less effective than the MGDRX EyeBag. Try an EyeBag for some relief for dry eye and blepharitis http://www.eyebagcompany.com/

Finally

Contact your GP or visit your nearest accident and emergency (A&E) or ER department immediately if you have any of the following symptoms, as they could be a sign of a more serious condition:

• extreme sensitivity to light (photophobia)
• very red eyes
• very painful eyes
• a rapid deterioration in your vision

Further reading:

Relieving digital eye strain http://mashable.com/2013/02/19/digital-eye-strain-tips/

Living with Dry Eye and Sjogrens Syndrome http://www.sjogrens.org/home/about-sjogrens-syndrome/living-with-sjogrens/dry-eye-tips

Dry eye info http://www.systane.com/Dry-Eye-Information.aspx