Dry Eye Clinic

Your assessment

Dry eye is a multifactorial disease of the tears and ocular surfaces. Resulting in those feelings of discomfort, something in your eye, and loss in your visual performance.

Successful treatment hinges on the accurate diagnosis of those underlying causes. That’s why coming for an assessment is so important. Whilst you can use drops alone to manage some of the symptoms, this may be counterproductive in the long run as your eyes need the underlying cause to be treated to resolve or reduce the long term effects on your eyes and vision.

It is our view that GPs and pharmacists don’t have the diagnostic equipment to adequately magnify and illuminate your eye for an accurate diagnosis therefore are not in the best position to recommend the appropriate eye drop for you. We suggest, for long term effective care, to have an assessment.

The visit is likely to include some or all of the following, depending on your individual profile.

Please note, you may be asked to cease the use of all eye drops the day before your first consultation. This is so that your specialist optometrist can accurately assess your condition.

Questionnaire

We use a questionnaire (based on the international task force for dry eye disease which has been validated after extensive study), to classify your symptoms consistently and reliably.

Medication and Previous History

Medications and inappropriate use of eye drops can contribute to the overall dry eye picture. Underlying health conditions such as lupus, rheumatoid arthritis may indicate, when considered with your assessment results, the need to use topical anti-inflammatory drops for a period of time.

Slip Lamp bio microscopy

Enables us to observe the quality and positioning of your lids, to consider your blinking habits and a measurement of the lipid (oily) layer of your tear film.

Osmolality assessment

Recent studies have demonstrated that over 80% of dry eye suffers have some sort of Meibomian gland dysfunction, which is also known as MGD. The Meibomian glands are responsible for producing the oil in our tear film and it is this that amongst other things, enables the moisture to remain and so aid lid movement and performs of a barrier. We can assess you Meibomian gland function by measuring the evaporation of moisture from the front of your eye using the I pen.

Vital Dyes

These are used to highlight and so assess the condition of your ocular surface. Compromised areas of the front surface of your eyes can be discovered, which in turn helps your optometrist decide what treatments are most likely to improve your condition.

Treatments for dry eyes depend upon our diagnosis

Some treatments, such as artificial tears, give symptomatic relief. Others improve the function of the tear glands and provide lasting results. As Meibomian gland dysfunction is essentially a skin problem rather than an eye problem, further therapies may be recommended to support healthy eyelids.

Our treatments are tailored to each individual in order to maximise comfort and minimise dependence on artificial tears. They include:

Eye Drops

We offer the latest and most advanced over-the-counter lubricants as well as the latest in prescription eye drops, which include Restatsis, Azithromycin, Prednisolone (all preservative-free).

We also offer specialised compounded eye drops that are not available through normal pharmacies such as VisuXL.

A short course of high strength steroid eye drops is often a great way to kick-start your treatment by dealing with inflammation. Once the inflammation has settled, other treatment strategies can be applied.

Prescription medications

Sometimes, eye drops alone are not enough to control the inflammation underlying dry eyes. Special kinds of antibiotic (Doxycycline or Azithromycin) may be prescribed for a course of weeks to months. These drugs act on your dry eye from the inside, softening the secretions of the eyelids and allowing the tear film to return to normal.

Manual Expression of Meibomian Glands

Gentle pressure is applied to determine the resistance of these most important glands in our eyes. Occasionally it is a cost effective way of maintaining the function of the Meibomian glands and keeping Meibomian gland dysfunction at bay.

Eyelid treatments

Blink rehabilitation involves a program retrains eye muscles to blink fully and more regularly. This can bring a rapid improvement in symptoms. Lid hygiene regimes (lid-scrubs, warm compresses) as used to clear blepharitis and improve oily tear-gland function.

Nutrition and Supplements

Omega 3 oils and micronutrients can provide much-needed support to dry eye sufferers. We provide high quality probiotics and supplements as well as specific recipes for those who prefer to incorporate omega 3s into their diet.

Blephex

If you have anterior blepharitis which is an inflammation on the front of the eyelid in the position of the eyelashes. The bacteria that is associated with this condition produces substances which are irritating and can cause burning and irritation amongst other symptoms. Most often the debris is microscopic and is not always visible to the eye. That is why we use microscopes to diagnose these deposits.

BlephEx™ is a procedure where an antibacterial substance (as the cleaning agent), is used whilst your lids are cleaned precisely.

Treatments are typically repeated at regular intervals depending on the severity of your condition. By eliminating the inflammatory contributors of blepharitis, the overall health your eyelid is improved. You simply walk in for an eyelid clean, almost like you would have an appointment with your dental hygienist, and walk out with clean eyelids.

Meibomian gland expression

Is a diagnostic procedure or a treatment. It promotes the healthy and adequate secretion of oil to the eye surface naturally. After heating the glands and applying an anesthetic drop, pressure is applied to unplug hardened oil glands to allow them to secrete the right amount and quality of oil to keep your eyes healthy.

Punctal plugs

Aare tiny, biocompatible devices (used with different materials), that can be inserted into tear ducts to block drainage. This increases the eye’s tear film and surface moisture in order to help relieve certain forms of dry eye. Also known as punctum plugs, lacrimal plugs or occluders, these devices often are no larger than a grain of rice.

Surgery

These are last resort approaches, but can prove very beneficial for some.

  • Thermal cautery:
    Punctal plugs are the most common solution, but if you have a poor reaction to the materials used or you need a permanent solution, thermal cautery will shrink the tissues around your tear ducts, to prevent them from producing so much fluid. The surgery itself is a simple outpatient procedure with a rapid healing time. In fact it takes only a few minutes under local anesthetic. You should have normal vision within a day or two afterwards.
  • Salivary gland transplantation:
    This is a rare procedure but can be necessary to prevent damage to your cornea, sclera, and conjunctiva If your tear glands themselves are a problem and do not create enough tears. The surgeon may remove salivary glands from your lower lip and graft them into your upper eyelid.