Dry Eye Syndrome. A Guide

Transcription

1 Dry Eye.qxp_IGA 16/05/ :09 Page 1 Dry Eye Syndrome A Guide

2 This free booklet is brought to you by the International Glaucoma Association (IGA). Contact the IGA for further information or advice: International Glaucoma Association Woodcote House, 15 Highpoint Business Village Henwood, Ashford, Kent TN24 8DH Sightline: Monday-Friday 9.30am-5.00pm Charity registered in England and Wales No and Scotland No. SC Author: Valerie Saw MB BS (Hons I) FRANZCO FRCOphth PhD Medical Editor: John Brookes B.Sc MB BS FRCOphth Consultant Eye Surgeon International Glaucoma Association 2017

3 Welcome The International Glaucoma Association is the charity for people with glaucoma. This booklet has been produced following requests from patients who can be affected by dry eye syndrome. It is estimated that per cent of glaucoma patients also have dry eye syndrome. This booklet has been provided to you free of charge because we believe that it is very important for a person to receive the information they need. However, we should be most grateful for any donation you may be able to make in order to help us maintain this free service in the long-term. Karen Osborn Chief Executive 1

4 Contents Page What is dry eye syndrome? 3 Dry eye syndrome and glaucoma 4 Structure of the eye and eye surface 5 What makes tears? 6 Why are tears important? 7 What are the symptoms of dry eye syndrome? 7 Who is at risk of dry eye syndrome? 8 How is dry eye syndrome managed? 9 What can I do about dry eye syndrome? 9 What are the treatments for dry eye syndrome? 10 What is meibomian gland dysfunction and 12 how is it treated? Summary 15 Glossary 16 Further help and information 18 All words in bold can be found in the glossary at the end of this booklet. Funding for this leaflet was provided by Santen, but Santen have had no influence over its content. 2

5 What is dry eye syndrome? Dry eye syndrome, also known as dry eye disease, is a common eye disorder where the eyes don t make enough tears or the tears evaporate too quickly. It can make your eyes feel dry, scratchy and irritated or watery, and feel heavy and tired at the end of the day. Usually, it does not cause long-term problems with your sight, but can cause fluctuating blurriness. Dry eye is more common as we get older, and is exacerbated by time spent in front of computer screens and in airconditioned environments. One in every three people over the age of 65 experience problems with dry eyes. Dry eye syndrome is a chronic, long-term condition and you may need to try several different treatments before you find the right one for you. Treating and managing your dry eye syndrome early can prevent permanent damage to the surface of the eye and therefore stop future vision loss. If you experience any of the symptoms of dry eye syndrome you should speak with your GP or optometrist, who may refer you to an eye specialist, known as an ophthalmologist. The image on the retina is converted into electrical impulses by a series of nerve cells. These impulses pass along nerve fibres in the optic nerve to the back of the brain, where the final image is processed. Keeping the eye surface and tear film healthy is also important for successful management of glaucoma. 3

6 Dry eye syndrome and glaucoma Dry eye syndrome and glaucoma commonly appear together. Studies suggest that per cent of people who are being treated for glaucoma also have dry eye syndrome. Managing both conditions effectively is important but can be challenging. Glaucoma is usually treated as a priority as it can cause vision loss, but dry eye symptoms are often reported as more troublesome for the individual. Eye drops used to treat glaucoma can cause dry eye symptoms. Switching to preservative-free glaucoma drops helps in patients who have dry eye and glaucoma. If your glaucoma eye drops seem to be causing redness and stinging of your eyes, talk to your glaucoma specialist. There may be alternative eye drops, or alternative ways to reduce the eye pressure, including laser treatment or other options. Alternative eye drops include preservative-free eye drops and eye drop solutions rather than suspensions. Maintaining good oily tear production by gentle daily hot eyelid compresses, addressing lifestyle factors and using artificial tear supplements are the best ways to manage dry eye associated with glaucoma. Both conditions are long-term but manageable. 4

7 Structure of the eye and eye surface The eye is shaped like a ball, and has a tough white outer layer called the sclera. The surface of the sclera is covered by a thin translucent layer called the conjunctiva. The sclera has a clear section at the front of the eye called the cornea, which is protected by the tear film. Several glands containing cells that produce different substances, in the eyelids and within and under the conjunctiva, help produce the tear film, including the lacrimal glands and meibomian glands. 5

8 What makes tears? Each time we blink, our eyelids create a new layer of tears over the front of the eye. Tears have three main components: 1. Mucous inner layer Produced by mucous cells in the conjunctiva. This is healthy in most people. 2. Watery (aqueous) middle layer This is produced by lacrimal glands, also known as tear glands, through openings in the upper eyelid. As we get older, particularly in women after menopause, the lacrimal gland produces less watery tears. 3. Oily outer layer Produced by the meibomian oil glands in the eyelids, which have openings just behind the eyelashes on both the upper and lower eyelids. Problems with these glands are the most common cause of dry eye syndrome. This smooth layer of tears acts like a waterproof barrier. It stops the watery tears from evaporating. 6

9 Why are tears important? A smooth layer of tears is essential for sharp vision. If the tear film has patchy areas where it has dried out, the light that hits the eye is scattered and does not focus clearly. A patchy, poor quality tear film also leads to discomfort and irritation. What are the symptoms of dry eye syndrome? In most cases dry eyes cause mild discomfort, but in some cases it can become painful and the dryness can cause permanent damage to the eye surface. The most common symptoms are: l l l l l l l l Heavy, tired feeling of the eyes Difficulty reading or working on the computer Blurriness of vision Excessive watering of the eyes (when they are very dry a reflex reaction in the brain causes more tear production) Discomfort when wearing contact lenses Stinging or burning of the eyes A sandy or gritty feeling, as if something is in the eye Pain and redness of the eyes 7

10 If you experience any of these symptoms you should discuss these with your GP or optometrist, who may then refer you to an ophthalmologist. Who is at risk of dry eye syndrome? Dry eye syndrome can affect anyone, but is more common in women and people aged 65 and over. As we get older we generally produce less tears, and the eyelids also become less effective at spreading the tears each time we blink. People who frequently use computer or video screens are also more at risk of developing dry eyes. Using screens for a long period of time can lead to reduced blinking, meaning the tears are not spread across the eye surface as well. Lack of sleep and excessive stress can lead to dry eye due to oily tear gland dysfunction. The use of some medicines, including anti-depressants, anti-histamines and oral contraceptives, can also affect the amount of tears produced. Dry eye syndrome is also more common in people with autoimmune diseases like Sjögren s syndrome, rheumatoid arthritis and lupus. Other risk factors for dry eye include long-term contact lens wear, laser or cosmetic surgery, long-term use of glaucoma eye drops and large blebs from glaucoma surgery. 8

11 How is dry eye syndrome managed? There are two main types of dry eye syndrome: A. Lack of watery tears B. Rapid tear evaporation due to lack of oily tears The first step is to evaluate which type of dry eye is present; both types can be present at the same time. The second step is to identify and treat or remove any underlying causes. You may be asked to stop certain medications, use a different type of glaucoma eye drop, use a different type of contact lens or reduce the number of hours you wear contact lenses. The next step is to treat each type of dry eye in turn. What can I do about dry eye syndrome? There are several things you can do yourself to help improve tear production, reduce evaporation and reduce the symptoms of dry eye. l l Drink lots of water, as this helps improve tear production Get enough sleep each night 9

12 l l l l l Avoid alcohol or spicy foods, as these can cause meibomian oil gland blockage Avoid smoking or smoky areas as this makes the eyes drier Wear glasses or sunglasses on windy days to protect your eyes from the wind Avoid air-conditioned environments and draughts near your face, and consider using a humidifier to put more water into the air Remember to blink more frequently when using a computer screen or reading, and close your eyes or look away from the screen for a break every 30 minutes What are the treatments for dry eye syndrome? There are several different options your optometrist or ophthalmologist may suggest for treatment of your dry eye syndrome, depending on the type and severity of your condition. Tear replacement Artificial tears are eye drops used as a replacement for watery tears. Gels and ointments are also available, and are thicker than eye drops. They usually last longer in the eye and need to be put in less frequently, but can blur the vision. 10

13 There are many different types of artificial tears available without prescription. Preservative-free eye drops are recommended for use with contact lenses, or if they are needed more than four times a day. Expressing natural oily tears to the ocular surface by daily hot eyelid massage can reduce the frequency of artificial tear drops required (see diagram on page 14). Switching to preservative-free glaucoma eye drops is recommended for patients with glaucoma who also have dry eye syndrome. Reduction of inflammation Steroid eye drops or topical ciclosporin eye drops may be prescribed by an ophthalmologist if the dry eye condition has led to inflammation of the surface of the eye. Prevention of tear drainage When there is lack of watery (aqueous) tears, punctal plugs can be inserted into the tear duct (puncta) to stop tears from draining away and keep them on the surface of the eye for longer. They should be inserted by an optometrist or ophthalmologist. If the plugs help your dry eye but fall out, then punctal cautery can be considered. This is a simple procedure where the opening of the tear drainage tube is permanently sealed. 11

14 What is meibomian gland dysfunction and how is it treated? Blockage of meibomian oil glands in the eyelids, known as meibomian gland dysfunction, is the most common cause of dry eye syndrome. This causes rapid tear evaporation due to lack of oily tears. Eyelid swollen and reddened Waxy material Inflammation of the eyelids associated with waxy debris on the eyelashes is known as blepharitis. In blepharitis, rather than producing clear oily tears, the meibomian oil glands are blocked with waxy solidified oil. The blockage of the oil glands leads to them becoming inflamed, causing a burning feeling in the eyelids, which is worse in the morning. The waxy material collects on the eyelashes, causing grittiness, stickiness and itching of the eyelids. There is also rapid tear evaporation due to lack of oily tears. What causes oil gland dysfunction is not well understood and likely to be multifactorial. It is thought that 12

15 microbiological changes lead to an increased melting temperature of the oily tears, leading to blockage of the meibomian glands. Lifestyle factors associated with meibomian gland dysfunction include lack of sleep, excessive stress, and in some people, drinking alcohol and eating spicy foods. Omega three fatty acids, available as tablet supplements, and eating oily fish such as salmon and sardines are thought to help improve meibomian gland dysfunction. Long-term use of certain types of glaucoma eye drops seem to be more likely associated with oil gland blockage than others. A simple way to help restore meibomian oil gland function is to carry out hot eyelid compresses and gentle massage daily. This will help to unblock the meibomian oil glands and express natural oily tears onto the surface of the eye. As an alternative to a hot towel, commercially available eye masks can also be used, but may not work for everyone. The waxy debris on the eyelashes can be removed using eyelash-cleaning wipes. Avoid using baby shampoo as this removes natural oils from the surface of the eyes. Once the oil glands are expressing clear oil every day, rather than being blocked with thick wax, there should no longer be any need to continue with eyelash-cleaning wipes. Clean eye make-up away carefully and have at least one or two make-up free days per week. If meibomian gland dysfunction is severe and has caused damage to the eyelids it may be necessary to take a course 13

16 of oral antibiotics. Artificial tear supplements, topical antibiotics and topical steroids may also be prescribed Heat a small, thin, folded towel with hot running water (as hot as you can tolerate) and place over the closed eyelids. This will melt the thick wax which is blocking the oil glands. Push gently backwards on the upper eyelids for 10 seconds, near where the eyelashes come out. Try to squeeze the oil glands open gently, to express natural oily tears onto the eyeball. Reheat the towel in hot water and repeat the same movement on the lower eyelid for 10 seconds, towards where the eyelashes come out, to express oily tears on the surface of the eye. 4 Repeat again, making sure to reheat the towel every 10 seconds. 14

17 Summary Dry eye and glaucoma frequently coexist and meibomian oil gland blockage, leading to rapid tear evaporation, is the most common type of dry eye associated with glaucoma. Both conditions are long-term but can be managed successfully. Daily hot eyelid massage and regular use of artificial tear supplements, combined with optimising glaucoma management, can ensure successful management of both conditions. 15

18 Glossary Autoimmune disease Blepharitis Conjunctiva Cornea Inflammation Lacrimal gland Meibomian gland A disease where your immune system, which normally defends your body against disease, decides that healthy cells are foreign. As a result your immune system attacks healthy body cells. Inflammation of the eyelids, which usually affects the part of the eyelid where eyelashes grow. The thin layer that covers the surface of the white of the eye and lines the inside of the eyelids. Transparent layer forming the front window of the eye. The body s response to an injury or infection. Symptoms include pain, heat, redness and swelling. Glands under the upper eyelids that secrete the watery (aqueous) layer of the tear film. Glands in the rims of the eyelids (near the eyelashes), which secrete the oily layer of the tear film. 16

19 Glossary Puncta Punctal cautery Reflex reaction Sclera Tear film Topical An opening in the corner of the eye that collect tears. Also known as tear duct opening. Local procedure to burn the puncta (tear duct openings) to close the opening with scar tissue. An involuntary response to an external action (stimulus). The white, protective, outer layer of the eye. Thin layer of tears across the surface of the eye, made up of three layers; oily, watery and mucus. Applied directly to a part of the body, e.g. topical eye drops applied directly to the eye surface. 17

20 Further help and information Telephone us The IGA operates a telephone advice line, called Sightline. If you would like to find out more about any of the information contained in this booklet, or you would like to discuss any concerns you may have about glaucoma, you can call the IGA s Sightline. Out of office hours there is an answer phone service where you can leave a message and you will be called back. Sightline: Monday - Friday 9.30am pm Visit our website: for a wide range of information, to order other booklets or leaflets, or to participate in our on-line discussion forum. us at: info@iga.org.uk A full list of references and information sources used in the compilation of this leaflet is available on request by phone: (Sightline) or by info@iga.org.uk 18

21 Other IGA booklets and leaflets The IGA produces a range of informational booklets and leaflets. These are constantly being reprinted, reviewed and updated so call Sightline, or visit the website, to find out what is currently available. How to contact us Telephone: (donations and general enquiries) Sightline (help and advice): Monday - Friday 9.30am pm info@iga.org.uk We value your feedback. Please help us improve our information by sending us your comments about the content and format of this publication to marketing@iga.org.uk or by writing to us at the address below. International Glaucoma Association Woodcote House, 15 Highpoint Business Village Henwood, Ashford, Kent TN24 8DH Charity registered in England and Wales No and in Scotland No. SC International Glaucoma Association

22 Patient support group We have many patient support groups around the country run by hospital staff for the benefit of people with glaucoma. A list of these, along with contact details, can be found in our newsletter or on our website at Buddies If you are due to have surgery or laser treatment for your glaucoma, you may feel that you would benefit from speaking to someone else who has already had that experience. We have a list of people who are willing to do this. You may find that after your own experience that you decide that you too would like to become a buddy. For further information on either of the above, please contact Sightline on or info@iga.org.uk 20

23 Additional information NHS Choices Dry eye syndrome Tear Film and Ocular Surface Society: The Dry Eye Zone: Resource centre for people with severe or chronic dry eye. British Sjögren s Syndrome Association Funding for this leaflet was provided by Santen, but Santen have had no influence over its content. 21

24 22 NOTES

25 Help us see well into the future Making a Will is essential to ensure your wishes are carried out but is also an opportunity to do something amazing. Glaucoma is the most common cause of preventable blindness in the UK and ever year over 11,000 people are newly diagnosed with the condition. By leaving a gift in your Will to the IGA, you will be continuing the fight against preventable blindness. You will ensure that everyone with glaucoma will have access to advice, care and treatment enabling them to retain useful sight for life. Your gift will also help to fund vital research; reducing the time it takes to find a cure. For more information please call International Glaucoma Association Woodcote House, 15 Highpoint Business Village, Henwood, Ashford, Kent TN24 8DH Telephone: Sightline: Administration: info@iga.org.uk Website: Charity registered in England & Wales No and in Scotland No. SC041550

26 The International Glaucoma Association is the charity for people with glaucoma Core values l Compassion We will treat everyone who needs our help and assistance with empathy, sincerity and care l Honesty We will conduct ourselves and our activities with trust and integrity l Excellence we are passionate about everything we do, and committed to going the extra mile individually and collectively l Equality We respect each other and value diversity l Relevance We will evolve to serve the needs of our audience so that we are relevant both today and tomorrow. Vision statement Our vision is that all people with glaucoma and those at risk should have the knowledge and access to the care they need to avoid preventable sight loss. Mission The International Glaucoma Association is the charity for people with glaucoma, an eye condition that may lead to loss of sight. Our mission is to raise awareness of glaucoma, promote research related to early diagnosis and treatment and to provide support to patients and all those that care for them.

27 Don t Forget! Use your eye drops as prescribed by your consultant to avoid further sight loss in most cases. Tell your close relatives that you have glaucoma. They are at higher risk than average so should be tested regularly, and first degree relatives over the age of 40 are entitled to free eye tests. Contact the IGA Sightline if you have any questions. We are here to help. Join us! A membership form is enclosed in the middle of this booklet. If you are a member already, please pass it to a relative or friend. You may save someone s sight: Support leaflets for other patients! Support research into the causes and treatment of glaucoma Receive the quarterly IGA News The information contained in this booklet was correct at the time of printing. 1

28 The International Glaucoma Association is registered under the Data Protection Act 1998 of the United Kingdom. Any information you provide will be held on a database within the UK. The database will be administered and controlled by the International Glaucoma Association, Woodcote House, 15 Highpoint Business Village, Henwood, Ashford, Kent TN24 8DH. You agree that we may use any information you supply in the following way: To maintain records of donations and requests for information To use for future requests for support Only the IGA will have access to your information. It will not be disclosed to other third parties except to the extent required by the laws of the United Kingdom. If you do not wish us to use your information in this way, please state when calling that you do not consent for your information to be used for this purpose. Printed: May 2017 Review: May