Dry eye is probably the largest problem that we have to deal with as an Optometrist. There are many reasons people get dry eyes and a lot of simple things we can do to relieve the discomfort. Your tears provide a cushion between your eyes and your eyelids and act like the oil in an engine, preventing the two irritating each other.

What you consider to be your tears is actually a fine film that stabilises over the surface of your eye. Although it is only a fraction of a millimetre thick, it is actually composed of 3 different layers. Cells in the surface of your eye secrete a mucus that forms the base layer of your tears. The lacrimal gland (which is just above and to the outside of each eye) secretes the watery layer that composes the majority of your tears. The final layer is an oil which comes from glands in your eyelid margin. If any part of this triad is working incorrectly, it affects the whole stability of your tear film. Too little of any of them, and the tear film gets broken up and dry patches form which in turn causes discomfort. Too much mucus will cause crusting and discharge from the eyes. Too much water will flush out the remaining mucus and oil and destabilise the tears causing a vicious circle of watering and imbalance. Often we tell people they have Dry Eye Syndrome (DES), and they are surprised as they feel they are producing too many tears. In many ways they are, but they are producing too much of the wrong type of tears, which actually has a drying effect. Too much oil only tends to be a problem for contact lens wearers who will find that deposits build up on their lenses very quickly. DES is an umbrella term for the dryness caused from other conditions. Often people are diagnosed with Blepharitis (inflammation of the eye lid margin), Meibomian Gland Dysfunction and may also suffer from Styes (Chalazion).

When you come to see us for an appointment, we ask you a lot of questions. Much of this is to establish if you have any conditions which we need to take into consideration when doing our examination. Things that can cause dry eye include:
• Age
• Medication
• Menopause or other hormonal imbalances
• Arthritis
• Sjorens syndrome
• Skin rashes and Rosacea

DES symptoms and severity can vary a lot between individuals. Common symptoms are:
• eyes feeling dry
• feeling that there is something in your eye
• eyes feeling tired
• excessive watering of the eye (yes, you did read that right)
• stinging or burning sensation in eyes
• redness
• blurred vision
• light sensitivity
Many people will only get one or two symptoms, some will get all of the above and it is often quite difficult to put the feeling of dry eye into words.

When we talk about Dry Eye Syndrome, the main problem is too little of the oil to stabilise and prevent the tears from evaporating. There are many things we can do to increase this oil production.

1. Increase our intake of omega 3 oils which provide the essential fatty acids we need to make the oil layer. The obvious one for this is increasing our intake of oily fish (salmon, mackerel etc) or to take supplements. But, if you don't like fish or follow a vegan or vegetarian diet, what are your alternatives? There are other foods which contain high amounts of Omega 3, such as Flaxseeds (which need to be ground to get full effect) or Chia seeds and it's easy to add a spoonful to cereal in the morning, or even when you cook your evening meal as it adds an earthy nuttiness. Dark leafy green are also good for this, especially kale, and this is also known to be beneficial in preventing Macular Degeneration.  We also stock the Theratears Nutrition capsules, for an easy alternative to making sure you get all the essential fatty acids your tears need.

2. Hot lid massage is a simple and effective treatment to assist with melting the oils and preventing blockage and build-up of the oil producing glands. Here is a great demonstration in how to perform it. The Therapearl mask is available at Ladybrook Eyewear and can also be used chilled for irritation from hayfever as well as heated for hot lid massage.

3. If you are prone to crusting along the eyelid margin, this also reduces oil to the tears and can also cause further redness along the eyelid. This can be treated by a homemade solution of cooling boiled water with a small amount of baby shampoo. This is then soaked onto cotton wool pads (make up remover ones are best) and then rubbed along the lash line on closed eyelids to remove any build up and stimulate the glands. Sounds like a lot of effort? We also stock Supranettes which are specialised hygienic wipes which can also be used on children as well as adults which are a lot less hassle.

4. Never underestimate the power of water! Have you ever woken up after one too many glasses of wine, and your eyes are sore and dry? If you are dehydrated, even only slightly, you are likely to not be producing enough of the watery part of your tears and the best way to change this is to drink more water. Most of us are guilty of not drinking enough water, and it is easy to change. Don't forget that tea, coffee and many carbonated drinks are caffeinated so don't hydrate adequately.

5. If you are on certain medications such as for sinus issues, or the above treatments haven't been effective, you may need to add lubricants to further increase the volume and stability of your tears. I tend to go at this in two ways, a thick ointment for when you sleep when your eyes get driest as you aren't blinking, and a thinner lubricant for using through the day. There are different lubricants which vary in how long they last but even the best ones don't last longer than an hour in the eyes, therefore it needs to be instilled regularly. Most people I talk to only use their lubricants (or artificial tears) a couple of times a day. 6 times a day is not excessive! Twice a day is generally too little. Use them frequently. We stock various ones which are longer lasting than most that are available on NHS prescription and are preservative free (to reduce the chance of allergic reaction) so can be used as often as you like. Struggle to use drops? There is also the Actimist spray instead. It doesn't add as much moisture as drops, but is much better than doing nothing.

6. Do you work in a dry or air conditioned environment? Some of us have the ability at work to do something about our environment but we appreciate this isn't available to everyone. We also notice and increase in DES complaints when the weather goes cold and we put the heating on, drying our home environment. We can add moisture to the atmosphere around us which can also counteract these drying environments. Small desktop humidifiers add that extra moisture and are an inexpensive solution. Some (such as the one available from Muji) allow essential oils to be added to also add fragrance to the room, you may have walked past it in Selfridges, it appears almost like a mini smoke machine.

Not sure if you are suffering from dry eye? It is always best to have a proper diagnosis, and to find which type of DES you have so that the correct management plan can be worked out for you. Feel free to book in for a full assessment. Most importantly, once your eyes feel better, it's easy to forget to continue with the treatment. It is essential to continue (which may be possible at a reduced level once the major issues have been dealt with) to prevent symptoms recurring.