Eyeballs like the Desert

If you are one of the 337 million people in the world with some form of dry eye disease then you have an idea of how much this innocuous-sounding condition can affect quality of life. If you’re one of the lucky remaining 7 billion who have never experienced a dry eyeball in your life then don’t worry, I’m sure we can find something else wrong with you.

Symptoms of dry eye can manifest as  dryness (who woulda thought), also grittiness, stinging, redness, the sensation of a foreign body in the eye, blurry and fluctuating vision, and glare sensitivity. It tends to affect women more so than men and prevalence increases with age due to physical and hormonal changes, meaning that women entering into that wonderful stage of life known as menopause have a lot to look forward to.

Fear not though, there is a great deal of research going into this area. In Australia, dry eye disease contributes an estimated economic burden of $330 million, and the dry eye therapeutics market is estimated to hit $4.6 billion by 2024; it is apparent we have realised how much dry eye can impact our lives. In the meantime, while we wait for the golden elixir of a dry eye cure, several treatments have found to be helpful.

  1. Tear supplements

If you’ve ever wandered down the eye drop aisle in the supermarket or pharmacy you may have noticed a rather large number of lubricating eye drop brands on the shelves. Different drops will work better for different people. Things to consider:

  • if you are prone to sensitivities to medications/preservatives, or if you are prone to allergies, or if you intend to use the drop more than 6-8 times a day, consider buying the non preserved version (known as a minim). Because these are no longer sterile once you’ve snapped the lid off the vial, theoretically they should be discarded after a single use.
  • I once had a patient who involuntarily shied away from me whenever my hands came near his face; he literally curled up into the foetal position in the chair. If your eyelids snap shut like giant clams as soon as they see something approaching them then consider the eye mists, which are sprayed onto closed eyelids. When you finally get around to reopening your eyes the droplets will fall onto the surface of the eye.
  • if the dryness is particularly severe, or if you’re waking up with very sore dry eyes, consider a lubricant gel. It’s more goopy and will blur your vision for a bit longer than a more fluid drop but will provide longer protection and hydration for the ocular surface.
  • if you are taking medicated eye pj-bp241a_yheal_g_20130708163818drops, such as for glaucoma, you can still use tear lubricants throughout the day as well. Use the medicated drop first, then allow 5-10mins for it to absorb into the eye before using the lubricant drop (or follow the advice of your optometrist/ophthalmologist if they’ve recommended otherwise)


2. Lid wipes

Lid wipes target what we call anterior blepharitis. This is comes from dead skin cells, resident bacteria, and skin oils accumulating around the eyelashes. These irritants can fall onto the surface of the eye and cause – wait for it – irritation! Anterior blepharitis can also present as dryness, itchiness, stinging, or just as a non-specific irritation. To treat this you can use either a specific pre-moistened wipe or a foaming detergent on a face washer or cotton makeup pad. Pull down the lower eyelid and give the eyelash line a gentle scrub, then close the eye and wipe the top eyelash line. Do the same for the other eye but using the other side of the wipe/washer to avoid cross contamination. I usually tell my patients to do it daily for a week, then drop it back to every second or third day as a maintenance long-term. A visit to your local optometrist will be able to tell you whether this treatment will be useful for you.

Severe anterior blepharitis, mmmm

3. Hot compress and lid massage

This one targets posterior blepharitis. Posterior blepharitis arises from the oil glands around the eyelid margins getting a bit blocked and basically just giving up on life. This means your tear film is prone to evaporating too quickly and causing dryness of the eye. To resuscitate them we apply heat, ideally in the form of a heat pack from the microwave (handy tip: don’t burn your face), over the closed eyes for 10mins. Then gently push upwards on the bottom eyelid with your fingers, right up to the eyelash line, all along the margin, to express the glands. Push downwards on the top eyelid. It will take 3 to 4 weeks of daily therapy to notice any functional improvement of the glands and your dry eye symptoms. After about a month, you can drop it back to every second or third day for maintenance.

4. Modify your environment 

Try staring at the vent of an air conditioner and see how long you last. Environmental factors can play a big part in the evaporation of your tear film and the resultant sensation of dry eyes. If you have an air con or a heater blowing around your room or in the car, ensure that it is not blowing directly into your face. Also consider that the use of a computer screen has been shown to decrease your blink frequency by 50-60%, which means your tear film isn’t being replenished as often as your eyeballs would like. To combat this, just remember to blink more!

As I post this article now my eyeballs are feeling pretty dry (which is actually what reminded me that I needed to complete this draft I started two months ago) so I can commiserate with my kindred dry eye sufferers. There are, in fact, even more dry eye treatments than mentioned here but these are some good ones to start with for consideration!







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