Treatment for dry eyes

THE tear film is an important layer on the eye that maintains the smoothness of its surface for good vision and comfort. It is made up of three layers – mucin, water and lipid. A disturbance in the balance between the three components may lead to symptomatic dry eyes.

Dry eye disease is a common pathology affecting more than 20% of the population, and symptoms increase with age. Conditions of a modern lifestyle, including working on computer screens, driving cars, exposure to artificial light and air pollution and using contact lenses make dry eye syndrome more prevalent.

It is usually caused by an issue with the tear film, either caused by insufficient tear production or excessive evaporation. A majority of dry eye cases are caused by excessive evaporation, mainly because of insufficient lipid secreted by the eyelids’ meibomian glands.

Dry eye disease is an unpleasant sensory and emotional experience for patients. Burdened with discomfort and fear, patients often feel miserable because they don’t know how to accurately describe how they’re feeling. Most end up exasperated because no one understands their experience. Mild conditions can lead to frequent visits to eye care practitioners whereas moderate to severe cases are often associated with significant pain, limitations in performing daily activities, reduced vitality, poor general health and, in some cases, depression.

Treatment is especially frustrating for both patients and practitioners as it often interferes with the overall management and perceived patient satisfaction. There are significant symptoms, which are either not treated effectively or ignored by the eye care practitioner. This usually happens when it is perceived that the complaint is insignificant or untreatable. Although lubricating eyedrops may provide some relief, it is often not enough in more severe conditions. Depending on the cause of the dry eye, treatment can include eye drops such as cyclosporine, steroid eyedrops, lipidbased drops, manual expression, meibomian gland probing and a procedure called Blephex.

The latest addition to this armamentarium is intense pulsed light (IPL) therapy. It involves applying perfectly calibrated, homogenously sequenced, sculpted light pulses. The energy, spectrum and time period are precisely set to stimulate the meibomian glands into returning to normal function.

Each treatment session only takes a few minutes, during which the patient is seated comfortably. The ophthalmologist will fit patients with protective eyeware to protect the eyes from the light. A hydrogel is then applied to the skin under the eyes for protection, after which a series of five flashes is applied under the lower eyelid. The procedure is repeated under the lower eyelid of the other eye.

The IPL doesn’t directly affect the meibomian glands. It works through the stimulation of the nerves supplying the glands via a series of chemical reactions that take place after the procedure, which stimulate the secretion and contraction of the glands and improve microcirculation.

The effect of the treatment is cumulative. It generally lasts a week after the first session, two to three weeks after the second session and six months to two years after the third and fourth sessions. IPL therapy is a promising mode of treatment to help alleviate the ordeal of having dry eyes. –

By Dr Norazlina Bachik Ng, cataract, refractive and anterior segment surgeon

Dry eye disease is a common pathology affecting more than 20% of the population, and symptoms increase with age.

For details, call KPJ Pusat Pakar Mata Centre for Sight at 03-4022 6222 (Kuala Lumpur)/03-7880 8222 (Petaling Jaya)/03-6093 1051 (Rawang) or visit www.kpjcfs.com

KKLIU No.2720/2018