Dry eye (also known as Dry Eye Disease or Dry Eye Syndrome) is a very common eye condition affecting people of all ages. People with dry eye either do not make enough (lubricating) tears or their tear film is of poor quality, causing the tears to dry up too quickly and the front of the eye to become dry and irritated.
The glands above your eyes make tears that cover the surface of your eye, often called the tear film. The tear film keeps your eyes wet and also has several other functions: it washes, protects, nourishes and lubricates the eye.
The normal tear film is made up of 3 layers:
1- Oily (lipid) layer
2- Watery (aqueous) layer
3- Sticky (mucous) layer
Any disturbance in the balance between the layers of the tear will cause it to break up quickly and cause dry eyes.
People with dry eye may get a wide range of symptoms that may vary from mild to severe.
- Feel your eyes are gritty or sore or uncomfortable.
- Feel your eyes are itchy or burning
- Short-term blurred vision.
- Watery eyes, as if you are crying (having watery eyes can mean you are producing poor-quality tears and actually have dry eyes).
Dry eye can be caused or aggravated by multiple factors including:
- Hormonal changes
- Environmental conditions such as air conditioning in cars or offices
- Poor diet
- Increased computer work or mobile phones or tablets, leading to reduced blinking
- Contact lens wear
- Certain eye surgeries as LASIK surgery
- Prolonged use of some medications as anti-histamines
- Some medical conditions are associated with dry eyes as Sjögren’s Syndrome. Fortunately, this is rare.
Dry eye tends to be a chronic condition, meaning that your symptoms may reoccur or worsen over time. Dry Eye can have a significant impact on your quality of life, affecting daily activities such as reading or computer work or driving.
The main treatment for dry eyes is lubricating drops. There are many types of lubricating drops or gels. Most of these drops can be bought over the counter. It is important to use the correct type of drops. The wrong drops are unlikely to cause any harm, but they won’t help as much.
Preservative-free drops are preferred for dry eyes as preservatives in the eye drops can themselves cause eye irritation or discomfort. If your drops aren’t working or you’re not sure which drops to use, you can ask Mr Ellabban for advice.
Regular eyelid hygiene is recommended for all dry eyes patients as this will help to relieve the discomfort.
Some conditions as Blepharitis or Meibomian Gland Dysfunction (MGD) can make your dry eye symptoms worse. These conditions should be treated well.
Blepharitis is the inflammation of the glands of the eyelids and along the eyelashes and margins of the eyelids. It is a very common eye condition. It usually affects both eyes and tends to be a chronic condition with ups and downs. Blepharitis can be also caused by bacterial infections.
Signs and symptoms
Blepharitis can cause a wide range of eye symptoms as:
- Eye discomfort
- Feeling like there is “something” in your eye
- Sore or painful eyelids
- Watery eyes
- Excessive blinking
- Sensitivity to light
- Sticky eyelashes when waking on a morning
If Blepharitis is left untreated, it can cause other complications such as conjunctivitis, Meibomian cysts (small abscess in the eyelid), and eyelashes that turn in and irritate the eye or intolerance to contact lenses.
Treatment for blepharitis can be ongoing as in some cases treatment is unsuccessful and the condition cannot be completely cured.
Regular routine of eyelid hygiene is essential in the treatment of blepharitis. It is important that you clean your eyelids every day, whether or not you are experiencing symptoms. You should consider it part of your daily routine. Effective eyelid hygiene will reduce both the severity and frequency of symptoms.
Warm compresses and eyelid scrubs may help in selected cases.
-Dry eye (lubricant) drops
Blepharitis is commonly associated with some dry eye symptoms. You may be advised to use some lubricant drops. Most dry eye drops are available from a pharmacist over-the-counter (OTC) without a prescription.
-Treatment of eyelid infections
If blepharitis is associated with an eye infection, your ophthalmologist will initially attempt to treat it with eye drops or ointment and then advise a proper cleaning regime of the eyelid.
Mr Ellabban will assess you and advise you about the management plan for your particular condition.
Conjunctivitis is an inflammation of the conjunctiva (a very thin layer that covers the white part of the eyes). Conjunctivitis is a very common condition in which one or both eyes become red or sore and may be watery or sticky with discharge.
Conjunctivitis can be caused by:
- Infection by germs as bacteria, viruses or other organisms.
- Allergy: many people with hay fever (pollen allergy) can get red and inflamed conjunctiva.
- Inflammation: by some irritants (for example, shampoo in your eyes or chlorine in swimming pools ..etc) can cause conjunctivitis.
Symptoms and signs
The main sign of conjunctivitis is “red eye”. If you have conjunctivitis, you may feel your eyes:
- Sore or gritty
- Swollen eyelids or stuck together with discharge after a sleep. This is particularly common in bacterial conjunctivitis. Bacterial conjunctivitis often begins most obviously in one eye but quickly spreads to both eyes.
Vision is not normally affected in conjunctivitis. You may develop some blurring of vision, due to discharge at the front of the eye. However, this clears with blinking.
Prevent the spread of infection
If you have an infection of the conjunctiva, you should wash your hands regularly and avoid sharing towels with other individuals. this is important to prevent the spread of infection to other family members or work colleagues. Also, you should avoid using contact lenses.
Mild cases of simple conjunctivitis may need no treatment and usually settles within a week.
Conjunctivitis can usually be treated with eye drops or eye ointment, depending on the type of conjunctivitis as determined by your eye doctor.
Choroidal Naevus (Freckle)
Choroidal Naevus is a pigmented (darkly coloured) patches seen in the retina (back of the eye). It is similar to skin naevi (moles) that may be found in other parts of the body. The eyes contain cells that can produce pigment, similar to the skin, and these cells can cause these “moles” to develop inside the eye.
Choroidal Naevi are probably present at birth. They are often stable but may slightly grow in childhood and rarely beyond puberty.
Choroidal naevi are present in about 5 in 100 of the general population. They are often discovered by chance during an eye examination at the opticians or at the eye clinic.
Choroidal naevi (freckles) are often left alone, as they are harmless and they do not cause any problem. Occasionally, some naevi (freckle) may have suspicious features that will require monitoring as a very small percentage of naevi can develop into a malignant (cancerous) lesion known as Choroidal Malignant Melanoma.
Monitoring is done by taking pictures of the back of the eye and sometimes ultrasound of the eye to monitor if any changes over time. It is often done once a year but occasionally you may need to be reviewed more frequently at the first few appointments.
If you develop any of the suspicious features, which increase the suspicion that melanoma could develop, Mr Ellabban may advise a referral to a regional centre for further assessment and to consider treatment. This is a very rare event.
Otherwise, choroidal naevi are mostly harmless although very rarely they can affect vision in other ways for which treatment may or may not be possible.
Large naevus with suspicious features