This is an overview of the treatments that you can do to improve your dry eye. The first thing to really figure out these the underlying cause of you dry are. The term dry eye is such a general catch-all.
It’s not really that helpful in coming up with the best treatment for this condition.
So let’s say you’ve got aqueous deficiency dry eye. This is the type of dry eye where you are simply not producing enough tears. The lacrimal gland which produces these tears is in slow down mode. So if you are not producing enough tears then there will be times when the few tears that you do have are just evaporating away too quickly, particularly if you’re in high evaporation situation. This could be air conditioning, it could be fans, it could be driving in the car with an A/C blowing on your face. All these types of situations make your tears evaporate much more quickly. Flying doesn’t help either, the air upon plane is very low humidity.
The second type of dry eye is due to the oily layer of your tear film not doing its job properly. So you’ve got have got this type of dry eye then there are different strategies that you need to adopt in order to treat the dryness.
The general philosophy for treatment of dry eyes is to stage the levels of treatment depending on the severity of your dry eye. So if you just got mild dry eye there in we start off with pretty simple sorts of treatments. But if things get more severe then there are a whole range of more involved activities. So let’s just say you’ve got mild dry eye and the commonest type of treatment would be to use lubricating drops. These lubricating drops will relieve the symptoms of dry eye and yes that’s good. But they will do absolutely nothing to solve the underlying problem but let’s be honest here, treating the symptoms and making your eyes feel more comfortable is a win.
So let me just clarify. If you’ve got a lack of tears then the first-line treatment is to put in lubrication drops. If you only need to use drops for three or four times a day then using preserved drops is fine. If you use drops more than four times a day then you should be using unpreserved drops. My preference, though, is to always use unpreserved drops, I just think it’s healthier and easier on your eyes.
If you’ve got evaporative dry eye, where there’s a problem with the oil glands, the glands are either not producing enough oil or the quality of the oil is poor. This means that the oily layer of the tear film is not doing its job properly and protecting the tear film.This leads to an unstable tear film which breaks down and evaporates too quickly. The first-line treatment is to try and get these glands to work better. The traditional way of doing this is to use hot packs or warm, compresses on your eyes. How this works is that you put heat on your eyelids are about five minutes every day. Some people use a hot flannel that they run under the hot water tap and hold over their eyes. I think this is helpful, but I don’t think it’s a great idea. The problem is that the flannel loses heat too quickly. My preferred method is to use a wheat bag or those blue gel bags you can buy from the pharmacist. You can pop it in the microwave and warm up, but not too hot. Then sit there for five minutes with your eyes closed just relaxing (with your beverage of choice) and this will warm up the oil glands, melt the buttery consistency and get the oil coming out better.
The other thing is very helpful to get those all glands working better, is to take omega 3. The generally recommend dose is 2000 mg per day of omega 3. That means 2000mg of the active ingredient which is EPA and DHA. Most brands of gel capsules contain between 300mg to 500mg of the active ingredient. And if you take this consistently, then over about 6 to 8 weeks this will help to improve the quality of oil in the glands, and helps to generally reduce inflammation on the surface of your eye.
“Ok,” you say “I am putting drops in and I’m using the hot packs and I am taking fish oil. What else is there?” That’s a good start, and your next steps depend on the severity of the problem.
If you have aqueous deficiency dry eye and the lubrication is not providing you with enough relief, then you need to look at putting the drops in more often and also maybe using a thicker type of lubricant which will last longer in your eye. The problem though with the thick lubricant is that it does tend to blur your vision for a few minutes after you’ve put the drops in. If your eyes are sore then it is worth the inconvenience.
If you’ve got evaporative dry eye where the meibomian glands are not working properly then the next steps you can take are aimed at improving the functioning of those glands. We might express those glands with mechanical expression. The idea being to squeeze out all the thick grungy oil that has built up and allow the thinner, better quality oil to come through. Another way of improving the functioning of those glands is to stimulate the glands through an IPL treatment. This treatment involves zapping your cheeks with intense pulsed light and this stimulates the meibomian glands to produce more oil and better quality oil.
A third thing to think about is your blinking. If you can improve the quality of your blinking then this can be enormously beneficial in giving you more comfortable vision and a better, more stable tear film.
In summary, the first thing to do is to find out what type of dry eye you’ve got. Is it an aqueous deficiency where you don’t have enough tears in your eyes? Is it evaporative dry eye where the oil glands aren’t working properly. Or maybe its a bit of both, low tear volume and poor oil. Once you know the type of dry eye then you can tailor the treatment more effectively. I think the biggest thing you have to realise that there is not one thing to fix the problem. There are many causes of dry eye and there are many solutions., For you, hot packs may improve things by 10%. Lubrication drops 10%. Taking fish oil may improve things by a 10%. Better blinking might improve things by 10%. Being more aware of your environment and making sure that you don’t have air conditioning and fans blowing into your eyes – that make 10% different as well. Guess what? After doing lots of little things, you are now 50% better.