Some eye conditions are straightforward to treat. But dry eye is a complex eye disease with a staggering number of underlying causes. Successful treatment depends on accurate diagnosis and requires combination therapy.
But for some long-term dry eye sufferers, even the best treatments fail. This series of blog posts examines why this comes about.
Dry Eye Practitioners? Too many cooks…
The average patient that comes to our Dry Eye Practice has been to at least 3 or 4 different dry eye ‘specialists’ before they come here. (Under National Law, an optometrist or ophthalmologist cannot technically use the term ‘dry eye specialist’ to describe themselves even if they have extensive experience or expertise in this area). We hear the same story over and over; “I’ve been to the specialist and nothing has worked. They tried everything.”
These patients have often reached a state of despair when we finally see them. It is not unusual for them to be on anti-depressants.
Ironically, these drugs are among many that aggravate dry eyes. The patient may have heard different things from each practitioner they have seen:
• use warm compresses / don’t use warm compresses.
• use artificial tears / stop all eye drops
• use baby shampoo to clean the eyelids / never use baby shampoo!
Many clinics use a blanket approach to dry eyes, where patients are given the same treatment, regardless of the underlying cause of their condition.
In-depth assessment and accurate diagnosis are key to getting results. It doesn’t matter how bad your symptoms are, they can be improved. The big question is how much?
Meibomian Gland Dysfunction? Too little too late…
One of the big causes of dry eyes is dysfunction of the Meibomian glands of the eyelid margins. These little glands produce the oil that makes up the oily tear layer. This layer is vital to prevent evaporation of the watery tear layer. Blocked Meibomian glands mean reduced or no oil in the tear film and this means dry eyes due to evaporation.
If Meibomian glands are dysfunctional for long enough, they can atrophy. First, individual glands start to drop out or become dormant. If they stay dormant long enough, they will eventually die off permanently.
Whenever Meibomian gland dropout is evident (on assessment) professional treatment is necessary to prevent further gland loss. There are a number of options here, ranging from at home warm compresses followed by manual finger compression of the glands, to the king of all meibomian gland dysfunction treatments – LIPIFLOW.
This treatment is vital to protect you from further damage to the remaining glands, even though the treatment may not result in a noticeable improvement in symptoms for the extremely severe patients. LIPIFLOW is preventative, and deliver incredible symptom relief for those that are in the mild to moderate category.
Unfortunately many of the patients we see have been allowed to progress (inadvertently) to the severe category. This is why some patients with severe dry eye disease may find that treatment doesn’t seem to work. What does occur though is that things do not get even worse than they are now. The earlier that appropriate treatment is instigated the better.
Let’s face it, being PROACTIVE is always better than being REACTIVE!
Poor blinking
It doesn’t matter what dry eye treatments you have, if you’re not blinking properly or often enough, your symptoms will hang around. Blink analysis is one of the most important parts of a dry eye assessment. How often and how fully you blink has a huge impact on the tear film and underlying cornea (front surface of your eye).
Blink rehabilitation is an essential component of successful dry eye management, but this is one area where we can’t do it for you. What we can do though is educate you in how to do it properly and just as importantly how to get you to be compliant with our instructions.
Take home message
Don’t wait until you have severe dry eye before seeking treatment. Results are much better for mild to moderate dry eye, so get in early when the chances of success are high.
