The nuisance and misery of dry eyes

THE tear film is a very important layer on the eye surface which 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 all 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 with age. Conditions of a modern lifestyle (including working on computer screens, driving cars, artificial lights, air pollution and wearing contact lenses make Dry Eye Syndrome a more frequent nuisance. Generally speaking, it is a result of the tear film tissue, either caused by insufficient tears or excessive evaporation.

It is recognised that a large majority of cases are caused by the evaporation form, mainly due to an insufficiency of the external lipid layer of the tear film secreted by the glands in the eyelids called the 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 and most will end up feeling exasperated. Mild conditions can lead to frequent visits to eye care practitioners whereas moderate to severe cases is 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 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 the eye care practitioner. Usually this 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 the dry eyes, treatment will include other eye drops like Cyclosporine, sterold eyedrops, lipidbased drops, manual expression, Melbomian 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, sculpted light pulses. The energy, spectrum and time period are precisely set to stimulate the Meibomian glands to cause them to return to their normal function.

Each treatment session takes only a few minutes, during which the patient is seated comfortably. The Ophthalmologist will adjust a protective eyeware to protect the eyes from the light. A hydrogel will be applied onto the skin beneath the eyes for protection. A series of live flashes will be applied under the lower eyelid. The same procedure will then be repeated under the lower eyelid of the other eye.

IPL doesn’t affect the Meibomian glands directly. It is through the stimulation of the nerves supplying the glands via a series of chemical reactions taking place after the procedure, that stimulates the secretion and contraction of the glands and improves microcirculation.

The treatment effect is cumulative. It generally lasts for one week after the first session, two to three weeks after the second session, and six months to two years after the third to fourth sessions. It is a promising mode of treatment to help alleviate or negate the misery of dry eyes.

For details, visit www.kpjcfs.com or contact KPJ Pusat Pakar Mata Centre for Sight at: 034022 6222 (KL); 03-7880 8222 (PJ); 03-6093 1051 (Rawang).