The nuisance of dry eye disease
THE tear film is an extremely important layer on the eye surface. It maintains the smoothness of the surface for good vision and comfort. It is made up of three layers: mucin, water and lipid. A disturbance in the balance of the three components may lead to symptomatic dry eyes.
Dry eye disease is a common pathology affecting more than 20% of the population, with symptoms increasing in prevalence with age. Conditions of a modern lifestyle (including working on computer screens, driving cars, exposure to artificial lights and air pollution, and wearing contact lenses) make dry eye syndrome a more frequent nuisance.
Generally, it is a result of a tear film issue, either caused by insufficient tears or excessive evaporation. It is recognised that a majority of cases are caused by evaporation, mainly because of an insufficiency of the external lipid layer of the tear film secreted by glands in the eyelids, which are known as Meibomian glands.
Dry eye disease is an unpleasant sensory and emotional experience for patients. Burdened with discomfort and fear, patients often feel miserable, not knowing how to precisely describe what they are feeling. Most feel exasperated because no one understands their condition. Mild cases can lead to frequent visits to eye care practitioners while 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.
The treatment is particularly frustrating to both patient and practitioner as it often interferes with the overall management and perceived satisfaction of the patient.
There are significant symptoms, which are either not treated effectively or ignored by eye care practitioners. This usually happens when there is not much time or 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 dry eyes, treatment will include other eye drops such as cyclosporine, steroidal eyedrops and lipid-based drops. Manual expression, Meibomian gland probing and a procedure called Blephex may also need to be done.
The latest addition to these armamentarium of treatment modalities is intense pulsed light (IPL) therapy. It involves applying perfectly calibrated, homogenously sequenced and sculpted light pulses. The energy, spectrum and time period are precisely set to stimulate the Meibomian glands to return them to normal function.
Each treatment session takes only a few minutes, during which the patient is seated comfortably. An ophthalmologist will give the patient protective eyewear to put on to shield his eyes from the light. A hydrogel will be applied onto the skin beneath the eyes for further protection. Then, a series of five flashes is applied under the lower eyelid. The same procedure will then be repeated under the lower eyelid of the other eye.
IPL doesn’t directly affect the Meibomian glands. After the procedure, a series of chemical reactions take place, stimulating the nerves supplying the glands and the secretion and contraction of the glands, which improves microcirculation.
The treatment effects are cumulative. They generally last one week after the first session, two to three weeks after the second session, and six months to two years after the third or fourth sessions. It is a promising mode of treatment to help alleviate or negate all those miseries of dry eyes. – By Dr Norazlina Bachik Ng, cataract, refractive and anterior segment surgeon at KPJ Pusat Pakar Mata Centre for Sight
For details, visit www.kpjcfs.com or call KPJ Pusat Pakar Mata Centre for Sight at 03-4022 6222 (Kuala Lumpur)/03-7880 8222 (Petaling Jaya)/03-6093 1051 (Rawang). KKLIU No.2720/2018