Dry Eye
Dry eye is a very common disease related to many of the pathologies that present eye problems. It has been shown that 40% of consultations with the ophthalmologist are directly or indirectly related to dry eyes.
To give us an idea of the magnitude of the population affected by this disease, dry eye syndrome is one of the most common diseases in medicine.
Dry Eye
Dry eye is a very common disease related to many of the pathologies that present eye problems. It has been shown that 40% of consultations with the ophthalmologist are directly or indirectly related to dry eyes.
To give us an idea of the magnitude of the population affected by this disease, dry eye syndrome is one of the most common diseases in medicine.
What is dry eye?
Syndrome Dry Eye is a eye disorder which occurs when our eyes are not able to lubricate properly. This is due, in almost all cases, to one or both of these reasons:
- Insufficient tear production.
- The tear is of poor quality.
This produces great inconvenience that ends with affect the quality of life who suffers it, and can also lead to vision problems. For this reason it is vital to conduct an in-depth study of the symptoms that are causing dry eyes and propose a individualized and effective treatment for each person.
La tear is in charge of protect, nourish, humidify y lubricate the surface of the eye. It provides nutrients for the cells of the ocular surface and contributes to the defense system of our eyes. Thanks to this hydration the flickering is done smoothly, but when lubrication fails, discomfort quickly sets in.
This syndrome is one of the ophthalmic pathologies that most patients bring to our office. In Área Oftalmológica Avanzada We are specialist ophthalmologists in dry eye and we explain more about this condition, its symptoms, causes and treatment of dry eye.
How to know if I have a dry eye?
To know if we are suffering from dry eye, we simply have to look at some discomforts characteristics of this disease on the table:
- gritty feeling In the eyes.
- Irritation eyepiece.
- Stinging.
- Redness and feeling of strange body on the ocular surface.
- Fatigue or heaviness in the eyelids.
- Increased tearing due to poor eye lubrication, because the body, as a protective measure, increases the production of tears to counteract the symptoms, but they do not have sufficient quality.
- In some cases, dry eye can cause blurred vision.
Before any of these signs it is recommended go to a specialist for an ophthalmological examination Determine if it is this syndrome.
Causes of dry eye
¿Why do I have dry eyes??, This is a frequent question among patients. Let us remember that in most cases, as we said at the beginning, it is caused by insufficient tear production or it is of poor quality. But what does this mean?
The syndrome of Dry Eye, so called because it describes the dry mucous membranes in the eyes, is produced by a decrease in basal tear secretion, which the body creates on a regular basis - like a micro-rubber - to “bathe”, humidify and lubricate the surface of the eye. It is placed under the upper eyelid, in the outer edge and works like oil in a machine, so that the flickering pass smoothly over the eye without "scratching" and without damaging it.
When basal secretion is reduced, the eyelid rubs against the cornea and the conjunctiva causing continuous micro-erosion that ends up making cells jump, expose sensitive nerve endings of the eye and causes discomfort or pain like the one you feel when you have something in your eye.
This microerosion is responsible for activate the mechanisms of reflex tear secretion, a mechanism that causes the formation and production of a lot of tear to abundantly bathe the eye and try remove anything on its surface, giving rise to that excessive tearing which Dry Eye patients complain about.
Together with the tear deficit, the syndrome of Dry Eye is also explained by the rapid tear evaporation, caused by a alteration in the meibomian glands. The glands of the eyelids that secrete lipids (fats), necessary so that the tear from the eye does not evaporate quickly and thus avoid exposing the ocular surface to the air, an aggression that causes the typical discomfort of this syndrome. 80% of dry eye cases are due to a condition known as meibomian gland dysfunction..
Some of the risk factor's What can lead to this condition are:
Hormonal changes that can lead to dry eyes, such as menopause or pregnancy.
- Live in very dry environments, windy or overuse the air conditioner.
- wear contact lenses frequently or for long periods of time.
- Frequent exposure to cigarette smoke.
- medication intake for conditions such as diabetes, arterial problems, allergies or anxiety, as well as frequent consumption of sleeping pills. It is important to inform the ophthalmologist of any medical treatment that is ingested periodically.
- In some patients, dry eye syndrome may present as a side effect of laser surgery to correct vision problems.
All the dry eye causes are varied and are often related to aspects that go beyond ophthalmology like a incorrect feeding, the arrival of the menopause, skin diseases, certain paintings allergic, anxiety, Stress y environmental factors. Therefore, in our center, in addition to the advice of an ophthalmologist, we also have the possibility to consult directly with specialists from each of the identified areas related to the factors that cause this condition, such as: the gynecologist, the dermatologist, the Psychologist and nutritionist.
Dry eye symptoms
The dry eye symptoms they can be very varied. Among the most outstanding we find:
- The administration of others drugs: antiglaucomatous (drops for the treatment of glaucoma) and antiallergic.
- Alterations in flickering dynamics: flaccidity of the eyelids, excess skin in blepharochalasia, eyelid retraction and exophthalmos in the hyperthyroid
- Malposition of the eyelid edge: entropion y ectropion.
- Folds of the conjunctiva (Conjutivochalasia).
- be carrier of contact lenses.
- Presence of systemic diseases which can affect the tissues of the ocular surface such as Acnes, Rosacea, Rheumatic disorders, Diabetes, hormonal changes, antidepressant treatments.
In this list we must add the disorders that cause the presence of stress-anxiety and alterations in eating habits and nutritional as well as the be a smoker.
Deserve special mention environmental factorsas presence of wind, dry environments y with dust (fans and air conditioners) and an excess of ultraviolet radiation for living the places with high level of heat stroke y poor protection from glasses with UV filters.
Transmission
In recent years we have encountered the limitation of therapeutic options. Basically we only had artificial tears and when the inflammatory process was very evident, we associated corticoids to try to reduce it, with the inconveniences that this type of drug entails.
In Advanced Ophthalmology Area we not only offer the dry eye treatment with a traditional approach, made up of options such as artificial tears, lacrimal plugs to keep the little tear that is produced in the eye area, ointments o plasma of the patient's own blood to regenerate the affected tissue. In addition, we have a global approach that includes the first comprehensive treatment of dry eye syndrome with personalized and emotional accompaniment, carried out with the the most advanced technologies and techniques.
The situation has changed in recent years and we now have new alternatives for dry eye treatment in a joint way, trying to control all the factors that come into play. We currently do a multifactorial approach, from the systemic state from the patients, nutritional aspects, level of stress-anxiety, to the modern systems of stimulation of the meibomian glandslike the platforms IPL de Pulsed light.
To make the treatment more understandable, we divide it into 3 sections:
- Treatment of palpebral free edge.
- Treatment of Meibomian glands.
- Treatment of ocular surface and nerve endings.
Palpebral free margin
For the treatment of the palpebral free edge we highlight:
- Heat application for dry eye.
- Exfoliation of the palpebral free edge.
- Elimination of parasites such as Demodex.
In our experience, the heat application for dry eye treatment, both in compresses and in thermal pulses (radiofrequence), it has not given us good results in an individualized way.
On the contrary, the free edge cleaning with Blephex systems and hyperkeratosis exfoliation which is observed in this area, they have been very effective. In most cases, it must be completed with the opening of the exit hinges of the Meibomian glands, by means of gland probing with the Maskinn system or similar.
If the Demodex presence, we perform the root cleaning of the eyelashes with the Blephex and a tea tree oil cream in concentrations of 30%-50%.
Meibomian gland treatment
This is the gland responsible for lubricating the eye y the objective of the treatment of the meibomian glands is to recover its functionality.
To stimulate the activity of the Meibomian glands we have the new systems of IPL pulsed light, very effective and safe, with a very high success rate.
El IPL for dry eye has also shown an antimicrobial effect that helps balance conjunctival flora and Meibomian glands, contributing to symptomatic improvement. We can complete this effect with the Doxycycline administration oral or similar, which help normalize microbial flora and to improve the lipid metabolism of the Meibomian glands.
Eye surface and nerve endings
In the third group of treatment, at the level of the ocular surface and nerve endings, it is important to assess.
- El state of tissue deterioration.
- The presence of inflammation.
These two factors are usually associated, since in most cases of dry eye there is a inflammatory answer with activation of immune systems mediated by T lymphocytes. Tissue-damaging cytokines are released, contributing to the tear film instability that, when breaking early and exposing the ocular surface to ambient air, produces desiccation y more inflammation, closing a negative vicious circle.
For try this double component we use substances that help regenerate the tissues of the ocular surface, such as the autologous serum and enriched platelet derivatives.
La inflammation is treated with local corticosteroids or, modernly with the Cyclosporine A in concentrations of 0.05%, very effective and without the side effects of corticosteroids. In this line there is also the lifegrast, a new inhibitor of integrins and the action of T lymphocytes, which has just been approved by the FDA and has shown very good results in clinical studies.
Technology for dry eye treatment
Some of these solutions include the use and application of the following technologies:
Keratograph
The Keratograph allows us to make a in-depth study of the state of the eye Dry in each person. Based on the information extracted we perform the diagnosis and we propose an adapted treatment for each patient based on individual needs. These are some of the data we will work with:
- Break time of the tear film (BUT).
- Height of tear meniscus.
- Interferometry.
- Meibography.
Thermaeye Plus
El IPL for dry eye It serves for stimulate the meibomian glands painlessly and without entering the operating room. It stimulates circulation and acts on the nerve endings that control the production and secretion of fats. These, through blinking, move to the ocular surface improving the patient's condition.
Meibomian gland probing
It's a surgical procedure non-invasive to open the outlet duct of the meibomian glands, extract the fat content inside and apply an antibiotic to normalize the microbial flora. It is painless and is performed with superficial sedation.
Exfoliation of the free edge of the eyelids and glandular drainage
Consists in remove the membrane that plugs the meibomian glands through exfoliation, then perform a massage to empty the contents of the glands, applying cold and antioxidants to reduce eyelid inflammation and irritation.
Endoret: Plasma drops rich in growth factors
El Endoret in ophthalmology is applied in the form of drops that we create from the patient's own blood to treat dry eye. These stimulate the tissue regeneration of the eye from plasma extraction rich in growth factors y cytokines found in the patient's own blood.
Changes in diet to improve dry eye
Recent studies allow us to state that a poor diet is also a risk factor for the appearance of dry eye. Diets low in omega 3 and in Antioxidants, and those rich in omega 6, produce oxidative stress that generates inflammatory effects on the meibomian glands, the cornea and the conjunctiva.
Aware of this, we have incorporated nutrition experts among our ranks to help patients in a more personalized way, advising them with appropriate diets that allow for better ocular lubrication.
Dry eye treatment requires the intervention of specialists to reduce symptoms and guarantee a better quality of life, which is why we invite you to consult an ophthalmologist if you have discomfort that may indicate the existence of this condition.
