What is Dry Eye Disease or MGD ?
Our eyes are kept moist by the tears produced by the glands around and on the surface of the eyes. Of the many functions that these tears perform , the most important function is to provide lubrication to our eyes. This lubrication keeps the surface of the eye moist , keeps the cornea shining and clear and allows the lids to slide across the surface of the cornea without any friction. Under normal circumstances , we do not feel the movement of the lids at all.
When the tears reduce in quantity or deteriorate in quality due to any reason , it results in Dry Eye . Patients of dry eye have chronically red eyes which irritate prepetually with every blink of the eyelid. The eyes become over sensitive to light , cannot tolerate even a mild flow of air across the face , cannot tolerate hot , dry or dusty weather . In short , patients of Dry Eye Disease are miserable.
Some patients of dry eye may seem to suffer from excessive watering . This excess watering is a reflex action of the glands to produce tears as a response to the irritation felt in the eyes.
86 % of patients of dry eye disease suffer from "Evaporative Dry Eye".
What is "Evaporative Dry Eye ?
The tears in our eyes are made of 3 layers.
1. Mucin Layer ( This layer sticks to the surgace of the eye and is like glue )
2. Aqueous layer ( This layer is like water and floats on the mucin layer)
3. Lipid layer ( This layer is oil like and floats on the surface of the tear layer , much like oil flots on water )
It is this Lipid layer which floats on the surface of the tears and prevents their evaporation . This oil is secreted by "Meibomian Glands" glands situated in our eyelids . Any condition which causes reduction in the production of oil makes the tear film unstable because of fast evaporation. The result is -- DRY EYE.
What is the commonest cause of Evaporative Dry Eye ?
Any disease of the Meibomian Glands , leads to reduced production of the oil in the tear film and results in Dry Eye. This is also known as MGD ( Meibomian Gland Dysfunction ).
How to diagnose Dry Eye Disease ?
Your doctor can conduct a series of evaluations and determine whether or not Meibomian Gland Dysfunction and Evaporative Dry Eye are contributing to your chronic dry eye.
What is the basis of treating Dry Eye Disease ?
Typically , patients of Dry Eye Disease need to use a variety of Lubricant Artificial Tears many times in the day for years and years. With new diagnostic tools like LIPIVIEW , we are in a much better position to understand and diagnose the functioning of the Meibomian Glands . This information guides us in planning the treatment of Dry Eye Disease by improving the functioning of the Meibomian Glands .
What are the different ways to improve oil production from the Meibomian Glands ?
1. Improve the hygiene of the lids . This is done by daily cleaning of the eyes with mild soap and warm water.
2. Hot Fomentation ( Garam Paani Kee Takore ) : This can be done by dipping cotton ball in warm water and then keeping it over the closed eyes . This helps in improving the blood supply to the lids and also helps in melting the thick oily secretion in the lids thus helping it to flow easily. Hot fomentation can also be done with "Evolve"or "Bruder" masks which can be conveniently heated by keeping in the microwave oven for 20 seconds and then tying over the eyes for 15 minutes , twice a day.
3. Massage of the eyelids with your own finger also helps in expressing out the oil from the lids. Upper lids are massaged by sliding the finger from top to bottom and the lower lids are massaged by moving the fingers from bottom to the top.
4. Punctum Plugs can be used to block the tear drainage channels so that whatever tears are produced in the eyes should stay longer on the surface of the eye . These also help in fewer instillations of the artificial tears. Press here to know about Punctum Plugs
5. Bleph-Ex treatment : This is a treatment which aims to mechanically clean and remove any debris from the edge of the eyelid which may be blocking the openings of the Meibomian glands. Press here to view animation about BlephEx
6. Probing of Meibomian Glands : This procedure needs to be done if we find that the edge of the lid is scarred badly and openings of the glands are blocked . A fine probe actiavted by a Plasma Knife is used to probe these glands.
7. Mechanical queezing of the glands with a pair of forceps can help express out the oil from the Glands.
8. LIPIFLOW Treatment : Lipiflow treatment is the most elegant method of treatment of Meibomian Gland Disease. This is a microprocessor controlled computerized device which surrounds the eyelids , heats them to 42.5 degrees Celcius and then gently massages them to make the oil flow from the lids.
How is Lipiflow Treatment performed ?
How long does Lipiflow treatment take ?
Prepare to be at the physician’s office for about an hour. The treatment is roughly 12 minutes, per eye, but both eyes are usually done at the same time.
Will Lipiflow treatment provide permanent relief ?
Evaporative Dry Eye is a chronic disease and no known treatment is completely permanent. Sustained relief from LipiFlow is a function of numerous factors including: how long you have had the disease, your age, physiology and general health, and whether you continue to engage in activities that exacerbate the problem (such as staring at a computer screen for long periods of time).
What can happen if the problem is left untreated ?
Evaporative Dry Eye is a chronic disease. Without effective treatment, symptoms are likely to worsen, including:
Permanent loss of gland function
What begins as minor alterations to the tear film can turn into long-term pain and injury. Some patients with severe symptoms eventually report a drop-off in discomfort, which can mean that the nerves in the eye have stopped responding.