dry eye syndrome - glaucoma association dry eye syndrome and glaucoma dry eye syndrome and glaucoma...
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Dry Eye SyndromeA Guide
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This free booklet is brought to you by the InternationalGlaucoma Association (IGA). Contact the IGA for furtherinformation or advice:
International Glaucoma AssociationWoodcote House, 15 Highpoint Business VillageHenwood, Ashford, Kent TN24 8DH
Sightline: 01233 64 81 70Monday-Friday 9.30am-5.00pm
Email: [email protected]
Charity registered in England and Wales No. 274681 and Scotland No. SC041550
Author: Valerie Saw MB BS (Hons I) FRANZCO FRCOphth PhD
Medical Editor: John Brookes B.Sc MB BS FRCOphthConsultant Eye Surgeon
© International Glaucoma Association 2017
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Welcome
The International Glaucoma Association is the charity forpeople with glaucoma. This booklet has been producedfollowing requests from patients who can be affected by dry eye syndrome. It is estimated that 50-60 per cent ofglaucoma patients also have dry eye syndrome.
This booklet has been provided to you free of charge becausewe believe that it is very important for a person to receivethe information they need. However, we should be mostgrateful for any donation you may be able to make in orderto help us maintain this free service in the long-term.
Karen OsbornChief Executive
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Contents Page
What is dry eye syndrome? 3
Dry eye syndrome and glaucoma 4
Structure of the eye and eye surface 5
What makes tears? 6
Why are tears important? 7
What are the symptoms of dry eye syndrome? 7
Who is at risk of dry eye syndrome? 8
How is dry eye syndrome managed? 9
What can I do about dry eye syndrome? 9
What are the treatments for dry eye syndrome? 10
What is meibomian gland dysfunction and 12how is it treated?
Summary 15
Glossary 16
Further help and information 18
All words in bold can be found in the glossary at the end of this booklet. Funding for this leaflet was provided by Santen,but Santen have had no influence over its content.
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What is dry eye syndrome?
Dry eye syndrome, also known as dry eye disease, is acommon eye disorder where the eyes don’t make enoughtears or the tears evaporate too quickly. It can make youreyes feel dry, scratchy and irritated or watery, and feel heavyand tired at the end of the day. Usually, it does not causelong-term problems with your sight, but can causefluctuating blurriness.
Dry eye is more common as we get older, and is exacerbatedby time spent in front of computer screens and in air-conditioned environments. One in every three people overthe age of 65 experience problems with dry eyes.
Dry eye syndrome is a chronic, long-term condition and youmay need to try several different treatments before you find the right one for you. Treating and managing your dryeye syndrome early can prevent permanent damage to thesurface of the eye and therefore stop future vision loss. If you experience any of the symptoms of dry eye syndromeyou should speak with your GP or optometrist, who mayrefer you to an eye specialist, known as an ophthalmologist.
The image on the retina is converted into electrical impulses by a series of nerve cells. These impulses pass alongnerve fibres in the optic nerve to the back of the brain, where the final image is processed. Keeping the eye surfaceand tear film healthy is also important for successfulmanagement of glaucoma.
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Dry eye syndrome and glaucoma
Dry eye syndrome and glaucoma commonly appear together.Studies suggest that 50–60 per cent of people who are beingtreated for glaucoma also have dry eye syndrome.
Managing both conditions effectively is important but can bechallenging. Glaucoma is usually treated as a priority as itcan cause vision loss, but dry eye symptoms are oftenreported as more troublesome for the individual. Eye dropsused to treat glaucoma can cause dry eye symptoms.Switching to preservative-free glaucoma drops helps inpatients who have dry eye and glaucoma.
If your glaucoma eye drops seem to be causing redness andstinging of your eyes, talk to your glaucoma specialist. Theremay be alternative eye drops, or alternative ways to reducethe eye pressure, including laser treatment or other options.Alternative eye drops include preservative-free eye drops andeye drop solutions rather than suspensions.
Maintaining good oily tear production by gentle daily hoteyelid compresses, addressing lifestyle factors and usingartificial tear supplements are the best ways to manage dry eye associated with glaucoma. Both conditions are long-term but manageable.
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Structure of the eye and eye surface
The eye is shaped like a ball, and has a tough white outerlayer called the sclera. The surface of the sclera is covered bya thin translucent layer called the conjunctiva. The sclera hasa clear section at the front of the eye called the cornea,which is protected by the tear film.
Several glands containing cells that produce differentsubstances, in the eyelids and within and under theconjunctiva, help produce the tear film, including thelacrimal glands and meibomian glands.
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What makes tears?
Each time we blink, our eyelids create a new layer of tearsover the front of the eye.
Tears have three main components:
1. Mucous inner layerProduced by mucous cells in the conjunctiva. This is healthy in most people.
2. Watery (aqueous) middle layerThis is produced by lacrimal glands, also known as tearglands, through openings in the upper eyelid. As we getolder, particularly in women after menopause, thelacrimal gland produces less watery tears.
3. Oily outer layerProduced by the meibomian oil glands in the eyelids,which have openings just behind the eyelashes on boththe upper and lower eyelids. Problems with these glandsare the most common cause of dry eye syndrome. Thissmooth layer of tears acts like a waterproof barrier. Itstops the watery tears from evaporating.
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Why are tears important?
A smooth layer of tears is essential for sharp vision. If thetear film has patchy areas where it has dried out, the lightthat hits the eye is scattered and does not focus clearly. A patchy, poor quality tear film also leads to discomfort and irritation.
What are the symptoms of dry eye syndrome?
In most cases dry eyes cause mild discomfort, but in somecases it can become painful and the dryness can causepermanent damage to the eye surface.
The most common symptoms are:
l Heavy, tired feeling of the eyesl Difficulty reading or working on the computer l Blurriness of visionl Excessive watering of the eyes (when they are
very dry a reflex reaction in the brain causes more tear production)
l Discomfort when wearing contact lensesl Stinging or burning of the eyesl A sandy or gritty feeling, as if something is in the eyel Pain and redness of the eyes
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If you experience any of these symptoms you should discussthese with your GP or optometrist, who may then refer youto an ophthalmologist.
Who is at risk of dry eye syndrome?
Dry eye syndrome can affect anyone, but is more common in women and people aged 65 and over. As we get older wegenerally produce less tears, and the eyelids also become less effective at spreading the tears each time we blink.
People who frequently use computer or video screens arealso more at risk of developing dry eyes. Using screens for a long period of time can lead to reduced blinking, meaningthe tears are not spread across the eye surface as well.
Lack of sleep and excessive stress can lead to dry eye due to oily tear gland dysfunction. The use of some medicines,including anti-depressants, anti-histamines and oralcontraceptives, can also affect the amount of tears produced.Dry eye syndrome is also more common in people withautoimmune diseases like Sjögren’s syndrome, rheumatoidarthritis and lupus.
Other risk factors for dry eye include long-term contact lens wear, laser or cosmetic surgery, long-term use ofglaucoma eye drops and large blebs from glaucoma surgery.
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How is dry eye syndrome managed?
There are two main types of dry eye syndrome:
A. Lack of watery tears
B. Rapid tear evaporation due to lack of oily tears
The first step is to evaluate which type of dry eye is present;both types can be present at the same time.
The second step is to identify and treat or remove anyunderlying causes. You may be asked to stop certainmedications, use a different type of glaucoma eye drop, use a different type of contact lens or reduce the number of hours you wear contact lenses.
The next step is to treat each type of dry eye in turn.
What can I do about dry eye syndrome?
There are several things you can do yourself to help improvetear production, reduce evaporation and reduce thesymptoms of dry eye.
l Drink lots of water, as this helps improve tear production
l Get enough sleep each night
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l Avoid alcohol or spicy foods, as these can causemeibomian oil gland blockage
l Avoid smoking or smoky areas as this makes the eyes drier
l Wear glasses or sunglasses on windy days to protectyour eyes from the wind
l Avoid air-conditioned environments and draughts near your face, and consider using a humidifier to put more water into the air
l Remember to blink more frequently when using acomputer screen or reading, and close your eyes or
look away from the screen for a break every 30 minutes
What are the treatments for dry eye syndrome?
There are several different options your optometrist orophthalmologist may suggest for treatment of your dry eye syndrome, depending on the type and severity of your condition.
Tear replacementArtificial tears are eye drops used as a replacement forwatery tears. Gels and ointments are also available, and arethicker than eye drops. They usually last longer in the eyeand need to be put in less frequently, but can blur the vision.
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There are many different types of artificial tears availablewithout prescription. Preservative-free eye drops arerecommended for use with contact lenses, or if they areneeded more than four times a day.
Expressing natural oily tears to the ocular surface by dailyhot eyelid massage can reduce the frequency of artificial teardrops required (see diagram on page 14).
Switching to preservative-free glaucoma eye drops isrecommended for patients with glaucoma who also have dry eye syndrome.
Reduction of inflammationSteroid eye drops or topical ciclosporin eye drops may beprescribed by an ophthalmologist if the dry eye conditionhas led to inflammation of the surface of the eye.
Prevention of tear drainageWhen there is lack of watery (aqueous) tears, punctal plugscan be inserted into the tear duct (puncta) to stop tearsfrom draining away and keep them on the surface of the eyefor longer. They should be inserted by an optometrist orophthalmologist. If the plugs help your dry eye but fall out,then punctal cautery can be considered. This is a simpleprocedure where the opening of the tear drainage tube ispermanently sealed.
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What is meibomian gland dysfunction
and how is it treated?
Blockage of meibomian oil glands in the eyelids, known asmeibomian gland dysfunction, is the most common cause ofdry eye syndrome. This causes rapid tear evaporation due tolack of oily tears.
Inflammation of the eyelids associated with waxy debris onthe eyelashes is known as blepharitis. In blepharitis, ratherthan producing clear oily tears, the meibomian oil glands areblocked with waxy solidified oil. The blockage of the oilglands leads to them becoming inflamed, causing a burningfeeling in the eyelids, which is worse in the morning. Thewaxy material collects on the eyelashes, causing grittiness,stickiness and itching of the eyelids. There is also rapid tearevaporation due to lack of oily tears.
What causes oil gland dysfunction is not well understoodand likely to be multifactorial. It is thought that
Eyelid swollenand reddened
Waxy material
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microbiological changes lead to an increased meltingtemperature of the oily tears, leading to blockage of themeibomian glands.
Lifestyle factors associated with meibomian glanddysfunction include lack of sleep, excessive stress, and insome people, drinking alcohol and eating spicy foods. Omega three fatty acids, available as tablet supplements,and eating oily fish such as salmon and sardines are thoughtto help improve meibomian gland dysfunction. Long-termuse of certain types of glaucoma eye drops seem to be morelikely associated with oil gland blockage than others.
A simple way to help restore meibomian oil gland function isto carry out hot eyelid compresses and gentle massage daily.This will help to unblock the meibomian oil glands andexpress natural oily tears onto the surface of the eye. As analternative to a hot towel, commercially available eye maskscan also be used, but may not work for everyone.
The waxy debris on the eyelashes can be removed usingeyelash-cleaning wipes. Avoid using baby shampoo as thisremoves natural oils from the surface of the eyes. Once theoil glands are expressing clear oil every day, rather thanbeing blocked with thick wax, there should no longer be any need to continue with eyelash-cleaning wipes. Clean eye make-up away carefully and have at least one or twomake-up free days per week.
If meibomian gland dysfunction is severe and has causeddamage to the eyelids it may be necessary to take a course
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of oral antibiotics. Artificial tear supplements, topicalantibiotics and topical steroids may also be prescribed.
Heat a small, thin, folded towel with hot running water (as hot as you can tolerate) and place over the closed eyelids. This will melt the thick wax which is blocking the oil glands.
Push gently backwards on the upper eyelidsfor 10 seconds, nearwhere the eyelashescome out. Try tosqueeze the oil glandsopen gently, to express natural oily tears onto the eyeball.
Reheat the towel in hot water and repeat the same movement onthe lower eyelid for 10 seconds, towardswhere the eyelashescome out, to express oily tears on the surface of the eye.
Repeat again,making sure toreheat thetowel every 10 seconds.
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Summary
Dry eye and glaucoma frequently coexist and meibomian oilgland blockage, leading to rapid tear evaporation, is the mostcommon type of dry eye associated with glaucoma. Bothconditions are long-term but can be managed successfully.
Daily hot eyelid massage and regular use of artificial tearsupplements, combined with optimising glaucomamanagement, can ensure successful management of both conditions.
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Glossary
Autoimmune A disease where your immune disease system, which normally defends your body against disease, decides that healthy cells are foreign. As a result your immune system attacks healthy body cells.
Blepharitis Inflammation of the eyelids, which usually affects the part of the eyelid where eyelashes grow.
Conjunctiva The thin layer that covers the surface of the white of the eye and lines the inside of the eyelids.
Cornea Transparent layer forming the front window of the eye.
Inflammation The body’s response to an injury or infection. Symptoms include pain, heat, redness and swelling.
Lacrimal gland Glands under the upper eyelids that secrete the watery (aqueous) layer of the tear film.
Meibomian gland Glands in the rims of the eyelids (near the eyelashes), which secrete the oily layer of the tear film.
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Puncta An opening in the corner of the eye that collect tears. Also known as tear duct opening.
Punctal cautery Local procedure to burn the puncta (tear duct openings) to close the opening with scar tissue.
Reflex reaction An involuntary response to an external action (stimulus).
Sclera The white, protective, outer layer of the eye.
Tear film Thin layer of tears across the surface of the eye, made up of three layers; oily, watery and mucus.
Topical Applied directly to a part of the body, e.g. topical eye drops applied directly to the eye surface.
Glossary
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Further help and information
Telephone usThe IGA operates a telephone advice line,called Sightline.
If you would like to find out more about any of theinformation contained in this booklet, or you would liketo discuss any concerns you may have about glaucoma,you can call the IGA’s Sightline. Out of office hours there isan answer phone service where you can leave a messageand you will be called back.
Sightline: 01233 64 81 70Monday - Friday 9.30am - 5.00pm
Visit our website: www.glaucoma-association.comfor a wide range of information, to order other booklets orleaflets, or to participate in our on-line discussion forum.
Email us at: [email protected]
A full list of references and information sources used in thecompilation of this leaflet is available on request by phone:01233 64 81 70 (Sightline) or byemail: [email protected]
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Other IGA booklets and leaflets
The IGA produces a range of informational bookletsand leaflets. These are constantly being reprinted,reviewed and updated so call Sightline, or visit thewebsite, to find out what is currently available.
How to contact us
Telephone: 01233 64 81 64(donations and general enquiries)
Sightline (help and advice): 01233 64 81 70Monday - Friday 9.30am - 5.00pm
Email: [email protected]
We value your feedback. Please help us improve ourinformation by sending us your comments about the contentand format of this publication to [email protected] orby writing to us at the address below.
International Glaucoma AssociationWoodcote House, 15 Highpoint Business VillageHenwood, Ashford, Kent TN24 8DH
Charity registered in England and Wales No. 274681and in Scotland No. SC041550
© International Glaucoma Association 2017
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Patient support group
We have many patient support groups around thecountry run by hospital staff for the benefit of people with glaucoma. A list of these, along with contact details,can be found in our newsletter or on our website atwww.glaucoma-association.com
Buddies
If you are due to have surgery or laser treatment for your glaucoma, you may feel that you would benefit from speaking to someone else who has already had that experience.
We have a list of people who are willing to do this. You may find that after your own experience that youdecide that you too would like to become a buddy.
For further information on either of the above, please contact Sightline on 01233 64 81 70or [email protected]
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Additional information
NHS Choices – Dry eye syndrome
www.nhs.uk/conditions/dry-eye-syndrome/Pages/Introduction.aspx
Tear Film and Ocular Surface Society:
www.tearfilm.org
The Dry Eye Zone: Resource centre for people with severe or chronic dry eye.
www.dryeyezone.com
British Sjögren’s Syndrome Association
www.bssa.uk.net
Funding for this leaflet was provided by Santen, but Santen have had no influence over its content.
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NOTES
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Making a Will is essential to ensure your wishes are carried out
but is also an opportunity to do something amazing. Glaucoma is
the most common cause of preventable blindness in the UK and ever year over 11,000 people
are newly diagnosed with the condition.
By leaving a gift in your Will to the IGA, you will be continuing the fight against
preventable blindness. You will ensure that everyone with glaucoma will have access to advice, care and treatment enabling them to retain useful sight for life. Your gift will also help to fund vital research;reducing the time it takes to find a cure.
For more information please call01233 64 81 64.
Help us see well into the future
International Glaucoma AssociationWoodcote House, 15 Highpoint Business Village, Henwood, Ashford, Kent TN24 8DH
Telephone: 01233 64 81 64 • Sightline: 01233 64 81 70Administration: 01233 64 81 71
Email: [email protected] •Website: www.glaucoma-association.comCharity registered in England & Wales No. 274681 and in Scotland No. SC041550
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The International Glaucoma Association is the charity for people with glaucoma
Core valuesl Compassion – We will treat everyone who needs ourhelp and assistance with empathy, sincerity and care
l Honesty – We will conduct ourselves and our activitieswith trust and integrity
l Excellence – we are passionate about everything wedo, and committed to “going the extra mile” individuallyand collectively
l Equality – We respect each other and value diversity
l Relevance – We will evolve to serve the needs of our audience so that we are relevant both today and tomorrow.
Vision statementOur vision is that all people with glaucoma and those atrisk should have the knowledge and access to the carethey need to avoid preventable sight loss.
MissionThe International Glaucoma Association is the charity forpeople with glaucoma, an eye condition that may lead toloss of sight. Our mission is to raise awareness of glaucoma, promote research related to early diagnosisand treatment and to provide support to patients and allthose that care for them.
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Don’t Forget!
• Use your eye drops as prescribed by your consultantto avoid further sight loss in most cases.
• Tell your close relatives that you have glaucoma. Theyare at higher risk than average so should be testedregularly, and first degree relatives over the age of 40are entitled to free eye tests.
• Contact the IGA Sightline if you have any questions.We are here to help.
• Join us! A membership form is enclosed in the middle ofthis booklet. If you are a member already, please pass itto a relative or friend. You may save someone’s sight:
• Support leaflets for other patients!
• Support research into the causes and treatmentof glaucoma
• Receive the quarterly IGA News
The information contained in this booklet was correct at the time of printing.
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The International Glaucoma Association is registeredunder the Data Protection Act 1998 of the UnitedKingdom. Any information you provide will be heldon a database within the UK. The database willbe administered and controlled by the InternationalGlaucoma Association, Woodcote House, 15 HighpointBusiness Village, Henwood, Ashford, Kent TN24 8DH.You agree that we may use any information you supplyin the following way:
• To maintain records of donations and requestsfor information
• To use for future requests for support
Only the IGA will have access to your information. Itwill not be disclosed to other third parties except to theextent required by the laws of the United Kingdom. Ifyou do not wish us to use your information in this way,please state when calling that you do not consent foryour information to be used for this purpose.
Printed: May 2017 Review: May 2020
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