Dry Eye, Blepharitis & Meibomian Gland Dysfunction (MGD)

Dry Eye, Blepharitis & Meibomian Gland Dysfunction (MGD)

What is dry eye?

Dry eye is a common eye surface problem that occurs when the eye does not produce tears properly, or when the tears are not of the correct consistency and evaporate too quickly from the surface of the eye. If the tears do not adequately protect the eye's surface, dry spots form, and over time, inflammation and damage to the eye's surface may occur. This leads to irritation, discomfort and eventually redness and blurred vision.

View Video

What are the symptoms of dry eye?

  • Stinging and/or burning eyes
  • A sandy, scratchy or gritty feeling as if something is in the eye
  • Irritated eyes
  • Eye fatigue: Sore and tired eyes
  • Episodes of excess tearing
  • A mucous or sticky discharge from the eye
  • Pain and redness of the eye
  • Blurred vision or fluctuating vision
  • Heavy eyelids
  • Eyes that are difficult, sore or painful to open in the morning
  • Inability to cry when emotionally stressed
  • Reduced comfort with contact lenses where these symptoms are typically worse in drying environments, such as occurs on windy days, in air conditioned spaces and during airplane travel.
  • Dry eye can make it more difficult to perform some activities, such as using a computer or reading for an extended period of time

What are risk factors for developing dry eye?

There are many causes and contributing factors to a dry eye condition. Dry eye can be a temporary or chronic condition depending on the underlying cause or causes.

View Video

General risk factors for dry eye include:

  • Older age and female gender. Hormonal changes that occur with age are associated with dry eye symptoms.
  • Dry eye can be a side effect of some medications and eye drops. Including, eye drop medications to treat glaucoma with the preservatives in these medications frequently lead to symptoms and signs of dry eye.
  • Dry eye can be associated with immune system disorders such as Sjögren’s syndrome.
  • Diabetes is associated with dry eye symptoms, an unstable tear film, poorer eye surface sensation, and eye surface damage.

Blepharitis, Meibomian Gland Dysfunction and dry eye

Blepharitis is a common condition, which involves in inflammation affecting the eyelids, and eyelashes. Symptoms of blepharitis include eyelid redness, flaky skin on the eyelids, crusty or greasy eyelids and lashes, and itchy eyelids.
Blepharitis occurs in two forms: Anterior blepharitis affects the outside front of the eyelid, where the eyelashes are attached. The two most common causes of anterior blepharitis are over growth of normal Staphylococcal skin bacteria and seborrhoeic dermatitis (scalp dandruff).

Picture of Staphylococcal blepharitis Picture of Demodex Blepharitis
 Staphylococcal blepharitis
 Demodex Blepharitis

Demodex is a mite that lives in the lash follicles and Meibomian glands of our eyes. An overgrowth of Demodex can produce chronic anterior and posterior blepharitis. A cuff or collar of debris seen at the base of the eyelashes is suggestive of Demodex.

Picture of Meibomian gland dysfunction
Meibomian gland dysfunction

Posterior blepharitis affects the inner eyelid (the moist part that makes contact with the eye) and is caused by problems with the oil producing (Meibomian) glands in this part of the eyelid. Meibomian gland dysfunction (also known as MGD) is associated with a number of skin (dermatological) conditions. In MGD, the eyelid margin is red due to dilated blood vessels (telangiectasia) and the openings to the Meibomian glands can become swollen and blocked.

Dry eye and conjunctivitis

Picture of Conjunctivitis
Conjunctivitis

Dry eye can occur following of chronic inflammation (redness, swelling and possibly discharge) of the conjunctiva. The conjunctiva is the thin translucent (semi-clear) membrane lining the inner eyelids and covering the sclera (white tissue lining of the eye). Conjunctivitis can be caused by eye allergies, contact lens wear, viral or bacterial eye infections, eye drops and their preservatives, contact lens solutions, exposure to irritants such as chemical fumes and tobacco smoke.

View Video

 

Are there different types of dry eye?

Yes. Any condition or disease process that alters the components of tears and/or increases tear evaporation can result in dry eye.  There are two main types of dry eye:

1) Aqueous tear-deficient

This is a condition in which the lacrimal glands, through age, hormonal changes, inflammation, infection, medication influences, surgery or trauma fail to produce enough of the watery component of tears to maintain a healthy eye surface.

2) Evaporative dry eye

The main cause of evaporative dry eye is Meibomian gland dysfunction (MGD). 9 out of 10 patients diagnosed with dry eye have MGD.  These glands are located in the eyelid and create the oil that stabilises our tears.  If the Meibomian glands do not produce the proper quantity and quality of oil in the outer layer of the tear film, the tears evaporate more rapidly and dry eye symptoms arise. The oil produced by the Meibomian glands becomes increasingly cloudy and thickens further to a paste-like consistency.  Plugging of gland opening may occur.  As the condition worsens, the eyelids shows signs of inflammation (red, thickened lids) and dilated blood vessels. Tear evaporation is also increased when blink is less frequent or incomplete.

View Video

How is dry eye detected and assessed?

At OKKO our clinical team will comprehensively assess your dry eye symptoms are signs. Using the latest techniques and technology, the volume and composition of your tears and the status of the tear producing glands of your eyes will be assessed. Your eye surface health, eyelids and blinking patterns will be evaluated.

Our dry eye assessment will include:

  • Meibography which is an imaging technique that allows us to see whether Meibomian gland are still structurally normal or if they have become dilated with thickened oil secretions or if they have atrophied (loss of Meibomian gland tissue) from chronic obstruction (blockage).
  • The Schirmer test for aqueous deficiency (lack of production of the watery part of the tears). The test records how much tear fluid is produced in 5 minutes when a small piece of paper is inserted in between the lower lid and the eye.

 

Schirmer Test Tear Osmolarity Test
Schirmer Test
Tear Osmolarity Test

 

Meibomian gland dysfunction 01 Meibomian gland dysfunction 02
Meibomian gland dysfunction (abnormal thickened oil secretion from the oil glands in a dry eye patient before and after treatment. 

How can I prepare for my dry eye assessment?

Picture of the Clinic 01At your appointment we will ask you about the history of your dry eye, your current symptoms and treatment regimen and also about any treatment you have had in the past. We will also ask you about your medical history and what medications you are taking – as many medicines have effects on the eye.
Please bring with you a list of eye drops and ointments that you use and also any medicines that you take. If you wear contact lenses please bring details of your lenses and any solutions that you use to clean them.
On the day of your appointment please try not to use drops, gels or ointments as this will affect some of our measurements and we want to assess the true status of your dry eye. It is also preferable that you do not wear any eye makeup.
If you are a contact lens wearer please come wearing your glasses, having not worn your lenses that day.
As part of our comprehensive initial assessment process, and to fully assess your eye health, you may have drops instilled in your eyes that blur your vision for several hours. We recommend that you don’t drive for several hours after your assessments are complete so it is preferable that you bring a driver or make alternative transport arrangements.
You should expect to spend one to two hours at the practice.

How is dry eye treated?

After we have performed your dry eye assessment we will explain your diagnosis and formulate a dry eye treatment plan for you. You will receive your dry eye treatment plan with full instructions and we will review your progress at a follow up appointment.
Depending on the causes of a dry eye condition, there are various treatment approaches to relieve the symptoms and improve the signs of dry eye.
It is important to understand that dry eye is a chronic condition. There is no cure for dry eye. At best, dry eye can be managed as an ongoing condition.
There are three forms of dry eye treatment: Medical (Prescription and non-prescription eye drops and oral medications), Home based treatments and Clinic based treatments.
Clinical based treatments are used to augment results of medical treatments. In moderate to advanced dry eye disease, use of eye drops and medicines and home based dry eye treatments can be insufficient in relieving dry eye symptoms and signs. Clinic-based treatments include: Eyelid Lid Margin Debridement,Blephasteam, BlephEx, Punctal plugs and Intense Pulsed Light (IPL) treatment.

Intense Pulsed Light Treatment

E>Eye Intense Pulsed Light system is treatment for MGD. An IPL device generates a polychromatic pulsed light. The energy, spectrum and time period are precisely set to stimulate the innervation of the Meibomian glands in order for them to return to their normal function and to create a healthier and thicker oil layer for the tears. The heat generated by the flash of IPL can warm and unblock the glands.

What does IPL involve?

Picture of the Clinic 02The treatment is painless and no needles or injections are required. Four or five gentle applications of intense pulsed light are applied to each lower eyelid and to the temple side of your eye, you will feel a “warmth” on the cheeks and lids. Your eyes will be covered with a pair of goggles to protect them from the bright light.  Afterwards, a drop of local anaesthetic will be instilled into your eyes.  This will allow a firm squeezing of your eyelids to express some Meibomian gland fluid out of your Meibomian glands. The E>Eye IPL treatment and Meibomian gland expression takes approximately 30 minutes to treat both eyes.
Please do not wear eye or face make-up or sunscreen to your appointment when having IPL but you may put it on after the treatment.

How much does IPL cost?

The IPL treatment is priced at $500 for the recommended 4 treatments or $150 per session.

Is everyone with Meibomian Gland Dysfunction suitable for IPL?

It is important that we make sure the IPL treatment will be both safe and suitable for you and your eyes. For this reason we will need to carry out an initial assessment to establish suitability.

What can I do to help myself manage my dry eye condition?

  • Where possible avoid drying conditions, wearing wrap around glasses or sunglasses that fit close to the face or that have side shields can help slow tear evaporation from the eye surfaces.
  • Allow your eyes to rest when performing activities that require you to use your eyes for long periods of time. Instil lubricating eye drops before starting and every few hours while performing these tasks
  • Indoors, an air cleaner to filter dust and other particles helps prevent dry eyes and eye allergies.
  • A humidifier in your office or bedroom also may help by adding moisture to the air.
  • If you sleep with your eyes partially opened at night, an eye-shield night protection device may be an effective method of managing your dry eye symptoms and protecting your ocular surface.
  • Stay well hydrated.
  • Avoid smoking and smoky environments.
  • Increase your intake dietary intake of Omega 3 rich foods.
  • If your dry eye symptoms are associated with taking a prescription or over the counter medication, your general practitioner may be able to recommend switching to a medication that does not cause these dry eye side effects.
  • Avoid using eye drop preparations with chemicals that cause blood vessels to constrict (decongestant eye drops).
  • Remove your eye makeup well after use and replace it regularly as these products are a potential source of eye lid infection and inflammation

Dry eye treatment products

At OKKO Eye Specialist Centre we are able to able to supply you with an extensive range of home based treatment products including eyelid heating masks and goggles, eyelid cleansing products, lubricating eye drops and Omega 3 supplements to support your tear film and eye surface  health.  We will teach you how to use these products to achieve the best results from your home based dry eye therapy.

If you are unfamiliar with instilling eye drops into your eyes, or have had difficulty in the past, the following short video may be of assistance

View Video