Dry Eye Clinic

DES is a condition affecting hundreds of millions of people and is the most frequent condition seen by the doctors in outpatient settings. In DES the eyes do not produce good quality and quantity of tears, causing chronic dryness and discomfort. DES may cause vision impairment, ocular pain and significantly affect the quality of life. Many individuals diagnosed with DES have limitations in performing daily activities, poor general health, reduced vitality and often mental health issues.

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A normal tear film consists of three essential components:

1. 1. An oily component or lipid– oil keeps the tear film from evaporating. Oil is produced by meibomian glands in the eyelids.
   2. A watery component or aqueous– this is produced by lacrimal gland located behind the outer aspect of the upper eyelid.
   3. 3. A mucous-like component or mucin- the mucin is produced by the goblet cells in the conjunctiva (white part of the eye) and this helps to anchor and spread the tear across the eye surface.

When there is a disbalance of any of these tear film components, it can result in tear instability and dry eye.

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Many individuals diagnosed with dry eye syndrome claim their eyes constantly irritated, dry, gritty and sandy. Other symptoms include red, sore eyes, and difficulty wearing contact lenses. In occasions, patients may complain of watery eyes and it can be confusing for patients. The typical question I get from patients is “Why dry eye if my eyes are watery?”, it may not make sense until you realise that the body produces excessive tears in response to the dryness and irritation.

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· Age. More than 75%   of individuals over 65y of age suffer from Dry Eye Syndrome.

· Gender. Women are   more likely to experience hormonal changes, this could be physiological, pathological or drug induced. Women at any age are at increased risk of   developing dry eye.

· Computer use. Since   COVID pandemics, people of any age work and learn remotely and spend significant amount of time in front of the computer. Digital device use can cause dry eye, as viewing a computer screen for long period of time can reduce our frequency of blinking.

· External environment.   Exposure to strong winds or a dry climate, including air-conditioning, pollution, can exacerbate dry eye syndrome.

· Frequent flying. They   air in the cabins of airplanes is dry and may lead to dry eye condition.

· Mask wear. Wearing   masks is essential to helping reduce the spread of COVID but may lead to dry eye symptoms.

· Medications. Multiple   medications can worsen dry eye. For example: anti-histamines, antihypertensive agents, antidepressants, hormone replacement agents, chemotherapy, etc.

· Preservatives in eye drops. Preservatives in antiglaucomatous medications may exacerbate dry eye

· Medical conditions. Sjogren’s   syndrome, arthritis, diabetes, thyroid disease, lupus, asthma, etc

· Contact lens wear. Contact   lens is a foreign body for the eye. It can worsen dry eye syndrome and constant   irritation and discomfort can cause wearers to discontinue contact lens use.

· Meibomian Gland   Dysfunction (MGD). Meibomian glands a   located on the upper and lower lids and they are responsible to secrete oil.   In MGD, glands are inflamed and are no longer releasing enough oil, leading to dry eye disease.

· Eyelid problems. Incomplete   closure of the eyelids when sleeping or blinking can cause dry eyes.

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Not every dry eye patient is treated with the artificial tear drops. At the Gibraltar Dry Eye Clinic – Sotogrande we try to achieve the most appropriate treatment for each patient. Firstly, we dedicate time to talk to the patient to understand the severity of the problem and take thorough medical history. Secondly, we perform a comprehensive dry eye diagnostic testing to identify the cause of the dry eye disease. Lastly, we provide patients with the truly comprehensive evaluation and customised treatment and follow-up plan.

If you would like to learn more about your dry eye treatment, please do not hesitate to reach out.

Options of treatment available:

· BlephEx TM– removes bacteria and debris on the eyelids and rejuvenates the meibomian glands.

· Intense Pulsed Light (IPL) works by stimulating the meibomian glands to produce lipids

· Meibomian gland expression– opening the meibomian gland orifices and releasing the clogged oil, restoring to function properly.

· Meibomian gland probing– unblocking the meibomian gland with a sterile stainless steel wire, removing the fixed obstruction from fibrotic tissue.

· Topical medication (artificial eye drops, anti-inflammatory medications combined with antibiotics), Tablets for dry eye.

· Warm Compresses– applying warm compresses to the eyelids helps to unclog meibomian glands and relieve symptoms.

· Cool-mist vaporizer or a humidifier– May prevent or slow down the evaporation of tears.

· Lid Scrubs–  pre-moistened pads and specialized      solutions, many available over-the-counter, can be used to remove debris      and bacteria from the eyelids.

· Nutrients– increasing the amount of Omega-3 fatty      acids in the diet can improve the signs and symptoms of ocular surface      disease.

· Punctal plugs– tiny plugs inserted into the opening of the tear drainage duct

· Punctoplasty– surgical procedure to restore proper drainage of tear

· Punctal therapy with laser or thermal cautery- treating aqueous deficiency moderate to severe dry eye

· Meibomian cyst or Chalazion surgery– removal of the cyst under the local anaesthesia.

· Lid (oculoplastic) corrective surgery– when eyelids are turned in (entropion) or out (ectropion), surgery can be done to restore normal anatomic function of the lid.

If you experience red, gritty eye, the best thing to do is make an appointment with an ophthalmologist, we will thoroughly assess your condition, and discuss the treatment options with you.

Learn more:   What Is Dry Eye? Symptoms, Causes and Treatment – American Academy of Ophthalmology (aao.org)

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