Dry eyes
Dry eye is a condition where the ducts within the eyelids that produce tears, dry up. Tears are very essential for the proper functioning of the eyes, because they provide lubrication for the eyelids to glide over the eye ball and help to keep it moist. This condition can lead to lower resolution of vision and in some cases can cause severe damage to the eye ball itself, not to mention the added risks of performing daily activities with bad eyesight.
If you have dry eyes, your body is telling you that you are pushing it beyond its limits, and it is a common indicator for lifestyle diseases. Dr Rohit Shetty, neuro-ophthalmologist and the Vice chairman of Narayana Netralaya says ‘something as simple as a change in posture while working on a computer for long hours could be the reason for dry eyes.’ He warns, that they are an early indicator for hyper or hypothyroidism. If you are suffering from dry eyes, getting a routine health check up might be the best thing to do.
Causes
The most common reason is our work or work culture. This means spending long hours in the day in front of the computer, without any breaks. According to Dr Rohit Shetty, ‘eyes were not really meant to see pixilated images, so a constant exposure to them can harm your eyes’. Another factor is your all-round health, if you are diabetic, hypertensive, or are on antipsychotic drugs, the possibility of suffering from dry eyes increases. Apart from this other habits like smoking, drinking, not having adequate sleep could make the symptoms of dry eyes worse.
Symptoms
Dr Shetty says,'the problem of dry eyes is very common and unique to our population, it is estimated that 25% of our population suffers from dry eyes’.
Common symptoms of dry eyes are -
- Feeling dry or itchy in the eye after a whole days work
- Having irritation throughout the day
- Fatigue in their eyes
- Redness at the end of the day
- Vision not optimal at the end of the day
While all these symptoms are true for most people, it is important to realize that symptoms change from person to person.
Diagnosis
Narayana Netralaya, is known to be a pioneer in the world of vision, Dr Rohit Shetty along with associate doctors, have set up a whole unit within the hospital to treat and diagnose dry eyes. Here are some of the advanced techniques in diagnosing dry eyes:
1. Speed Questionnaire:
This is an informal technique, where the doctor will ask you to fill out a questionnaire, so that he/she can understand your general level of discomfort.
2. Slit lamp evaluation: This is done on an outpatient basis by an ophthalmologist. A brief examination of the eye under magnification is done to determine the status of the eye and have an initial idea about the type, cause and severity of dry eye. If the doctor determines that there is a problem, he/she may prescribe further tests.
3. Lipiview ocular surface interferometer:
Lipiview is an innovative device which measures the quality and amount of lipids in your tears. Dr Shetty says that an abnormal amount of lipid in the tears is responsible for a majority of dry eye symptoms. On analysis, tears with a good amount of lipids will appear as interferometric colours on the Lipview system, whereas tears with a low amount of lipids will appear white or colourless.
4. Meibography: This test is designed to shows the morphological changes in the meibomian glands( glands present on the inner surface of the eye, they produce an oily substance that prevents the quick drying of tears) . Normal meibomian glands appear parallel, vertical and straight. Normally there are about 15 to 20 glands in each lid. If you have any deformity of this gland, you are likely to suffer from dry eyes.
5. Tear film break up time (TBUT):
To perform this test your opthamologist will first instill
fluorescein dye
into your eye. You will then be asked to blink once and keep the eyes open. The dye will mildly colour your tear film on the eye. With this the doctor will measure how much time it takes for your tears to dry up. A time lesser than six seconds is considered abnormal.
6. Schirmer’s test:
As a first step your doctor will place a Schirmer strip on your lower eyelid. A Schirmer strip is 5 mm wide and 35 mm long strip of filter paper that is calibrated to measure the amount of moisture in a person’s eyes . The strip is placed in such a manner that it does not touch the inner eye or the cornea. At the end of 5 minutes the doctor will measure the amount of moisture in your eyes.
7. Meibomian gland evaluation:
Performed with the help of a meibomian gland evaluator (a hand-held tool used for evaluating meibomian gland secretions). It is designed to deliver consistent gentle pressure, through the eyelid, to meibomian glands, to mimic the forces of a deliberate blink and to express meibomian secretions. The evaluator is placed onto the outer lid skin immediately below the lash line. It is then pressed gently so as to invert the eyelid allowing a proper evaluation of the mybomian glands. Your doctor will evaluate the health of the glands along with the number to estimate the exact cause of the problem.
Treatment
If you are diagnosed with dry eyes, your opthamologist will decide on what type of treatment you might need to better the condition. Depending on the severity of the condition, you will be given a choice between medical management techniques and surgical procedures. Here are a few remedies your doctor may prescribe:
Medical management:
1. Artificial tear substitutes: Your doctor will prescribe these drops in order to relieve your eyes of strain and help in better production of tears. Ideally you should use the drops regularly. In cases you have severe dry eyes you could use the drops once every hour. You could use the drops 4-6 times a day in moderate cases. Make sure you buy preservative free drops as they are known to cause toxicity within the eyes.
2. Anti-inflammatory agents: Since artificial tears do not stop inflammation caused within the eye due to dry eyes, your doctor will prescribe you some anti inflammatory drops to reduce the swelling in the eye.
Surgical management:
- Lateral tarsorrhaphy: This is a procedure where the surgeon aims to reduce the distance between the two eyelids. This method helps by reducing the surface area of the eye ball, reducing the chances of evaporation of tears.
- Punctal occlusion: Is a therapy where your doctor will insert small plugs into the area of the eye that drains tears. By doing this the doctor aims to maintain tears in the eye for a longer time therefore keeping it moist for longer.
- Amniotic membrane transplant: A revolutionary therapy where the surgeon will take a part of the amniotic sac and transplant it onto the eye for better tear production.
- Salivary gland transplant: This is a procedure where a small part of your salivary gland (the gland that produces saliva in the mouth) is transplanted into the eye. This procedure is usually done to increase the amount of tears produced and relieve the symptoms of dry eyes.
- Treating preexisting conditions: Certain conditions like Blepharitis, thydroidism, hypertension or diabetes etc. May lead to dry eyes. Your doctor will aim to treat these conditions first then resolve dry eyes.
- LIPIFLOW Thermal pulsation system: This is a new technique invented to relieve and reverse dry eyes. It works by applying localised heat and pressure therapy to the eyes. This system provides controlled, outward directional heat with light pressure therapy applied to the eyelids to facilitate the release of lipid from the meibomian glands.
Prevention
Tips to prevent dry eyes:
- Take regular breaks while working on the computer
- Maintain a good posture when reading, looking at the computer screen
- Use rewetting drops at the end of the day
- Get regular eye check up
- If dry eyes persist get a complete health check up, to check for any other disease conditions.
Dry eyes can be easily prevented, a good tip would be to use lubricating drops about half an hour before you leave office. This will give relief to your eye and restore vision at the end of the day.
The content has been verified by Dr Rohit Shetty, neuro-ophthalmologist and the Vice chairman of Narayana Netralaya.
91 – 22 – 2490 0302.