Dry Eye Clinic

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 the underlying causes. That’s why it’s so important to come for an assessment. While 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.

We believe that GPs and pharmacists might not have the diagnostic equipment to make accurate diagnoses, so they are not in the best position to recommend the appropriate course of treatment for you. We suggest having an assessment for long-term effective care.

Dry eye assessment

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

Please note that you may be asked to cease using 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, 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 and rheumatoid arthritis may indicate (when considered with your assessment results) the need to use topical anti-inflammatory drops for some time.

Slip Lamp biomicroscopy

It enables us to observe the quality and positioning of your lids, consider your blinking habits, and measure the lipid (oily) layer of your tear film.

Osmolality assessment

Recent studies have demonstrated that over 80% of dry eye sufferers 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. This oil, amongst other things, enables the moisture to remain (aiding lid movement) and performs as a barrier. We can assess your Meibomian gland function by measuring moisture evaporation from the front of your eye using the Ipen instrument or the “Tear Break Up Time” method.

Meibography

Conducting a meibography scan of your glands reveals their structure and can disclose potential abnormalities such as gland dropout, shortening, or tortuosity. This painless imaging technique can also indicate your glands’ ability to produce essential oils, including cholesterol, wax esters, and phospholipids. All the ingredients work together to stabilise your tear film and protect the surface of your eye.

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 your 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 to maximise comfort and minimise dependence on artificial tears, including the following:

At home remedies

Eye Drops

We offer the latest and most advanced over-the-counter lubricants as well as the latest prescription eye drops, including the eye doctor intensive relief drops and Vizor Aloe vera drops. We also offer specialised compounded eye drops unavailable through normal pharmacies such as VisuXL. Our dedicated dry eye team can help you select the best drops.

Prescription medications

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

To control the inflammation underlying dry eyes, special kinds of antibiotics (Doxycycline or Azithromycin) may be prescribed for a course of weeks or months. These drugs act on the dry eye from the inside, softening the secretions of the eyelids and allowing the tear film to return to normal.

Blink rehabilitation involves a program that retrains eye muscles to blink fully and more regularly. This can bring a rapid improvement in symptoms. Lid hygiene regimes (lid scrubs, warm compresses) are 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 and specific recipes for those who prefer to incorporate omega 3s into their diet.

Environmental adaptations

Working out your individual triggers could result in a spike in your symptoms. Try:

Having a humidifier to introduce more O2 into the air and so prevent your tears from evaporating.

Adjust your lighting to reduce the impact of glare by using softer lighting. Position your computer below eye level, taking lots of breaks from your screen by remembering the 20/20/20 rule( 20 minutes screen time, look 20 metres away for 20 seconds, blink lots, squeeze those lids).

Wear protective eyewear sunglasses, or glasses to shield you from winds. Sunlight.

Drink more. Ensure you have plenty of omega 3 ( found in fish oil and flaxseed), vitamins A, D, E and C in your diet

Within Clinic treatments

Low-level Light therapy (LLLT) is a painless and effective way of treating Dry eye disease at its root cause: the Meibomian glands. Using custom made LED light gently warms the eyelids, causing the glands to unclog and release their oils.

LLLT treats at the cellular level also referred to as photobiomodulation therapy.

Boosts cell energy: Low-level light therapy (LLLT) increases ATP production in mitochondria, helping cells generate more energy. This can be beneficial for treating conditions where cells need a boost, such as wound healing or reducing fatigue.

Fighting inflammation: LLLT has been shown to reduce inflammation by enhancing the body’s antioxidant defences and reducing oxidative stress. This can also be helpful for conditions like arthritis or inflammatory skin conditions such as rosacea

Triggering cell activity with light: LLLT exposes tissues to specific wavelengths of light, which can activate transcription factors and signalling pathways within cells. This can lead to various cellular responses, including improved tissue repair and regeneration.

In summary, low-level light therapy utilises specific wavelengths of light to enhance cellular function, promote tissue healing, and reduce inflammation by boosting energy production, regulating antioxidant defences, and activating cellular signalling pathways.

At the level of the meibomian glands, this potentially enables repair and improvement in their function to produce better meibum quality. Additionally, photo-activation of the cells promotes heating from within the glands or ‘endogenous heating’, thereby encouraging better meibum flow.

Intense Pulsed Light

This innovative treatment is particularly effective in managing the common underlying cause of dry eyes by liquefying and releasing the oils that are essential for maintaining your healthy tear film. It also targets the abnormal blood vessels and reduces the redness around the eyelids. This targeted light reduces the release of inflammatory mediators that can worsen dry eye symptoms.

The treatment typically takes around 15 minutes and most people report significant improvement in the levels of comfort experienced after treatment. Results that can last up to a year or more and only a maintenance dose may required subsequently. At last a treatment for those who have not responded well to traditional therapies or want a more lasting solution.

Eyelid treatments

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

The medical grade device removes scurf and debris while exfoliating your eyelids, thus removing the inflammatory biofilm from the surface. The glands can then be exposed and ready for other treatments, such as expression. This procedure is typically repeated at four to six monthly intervals. 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.

Nulids is a gentler form of blephex treatment. It is good for those with more fragile skin who require a cleansing procedure. Nulids are comfortable and a preventative measure when excess biofilm is present, often before symptoms appear.

Meibomian gland expression

Is a diagnostic procedure as well as a treatment. It promotes the healthy and adequate secretion of oil to the eye surface naturally. After heating the glands and applying an anaesthetic 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 and your glands working.

Zest Treatment

This treatment uses a micellar solution to clean the eyelids and remove debris ( micellar refers to the molecules of the formula which are arranged in tiny spherical structures called micelles. Each micelle has a hydrophilic head and hydrophobic tail that faces inward, away from the water). This formation helps the capture of dirt, oil and other impurities, making them highly effective for cleaning. This okra based solution therefore addresses the issues at the eyelid, reducing the inflammation and stabilising the tear film, thus alleviating the symptoms of dry eyes. This treatment can last from several months to an entire year. Especially when used in conjunction with other complimentary products such as zocushield foam.

Punctal plugs

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

Omnigen lens

An innovation that is designed to treat persistent dry eye symptoms. Amniotic membrane tissue (that has been donated), is incorporated into a contact lens. Amniotic membrane is rich in growth factors and has natural anti-inflammatory properties. The lens therefore promotes faster healing of the corneal surface and reduces inflammation.

The lens also acts as a barrier and a therapeutic agent, shielding the cornea from abrasions while promoting regeneration. This custom-fit lens is worn for a days and gives lasting relief to those with persistent epithelial damage for up to 18 months.

Surgery

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

  • Thermal cautery:
    Punctal plugs are the most common solution. However, if you react poorly to the materials or 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. It takes only a few minutes under local anaesthetic. 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.

Book your appointment now.