Dry eye was once thought to be nothing more than an irritating temporary discomfort of the eyes, dismissed as tiredness, reading for too long, or an expected symptom accompanying the itch of hayfever allergies. However, years later, the eyecare profession now recognises dry eye as an actual disease with potential for significant impact on an individual’s quality of life. Fortunately, dry eye technology has evolved from simply instilling saline drops every so often to even now including the revolutionary IPL for dry eye treatment.
Dry Eye Disease
Dry eye disease is often quoted with a global prevalence of up to 50%; however, this number may be even higher due to a large degree of underdiagnosis of this seemingly innocuous condition. The severity of dry eye symptoms varies widely from person to person – some individuals may not even realise the symptoms they experience are in fact due to dry eye. While some cases may be quite obvious and are easily self-diagnosed, other patients may require proper examination by an optometrist or ophthalmologist to discover the underlying cause of their red, irritated eyes. If you experience any of the following symptoms, particularly if they are frequent and recurrent, you may be suffering from dry eye disease:
- A dry sensation of the eyes
- Gritty, burning, stinging, or foreign body sensation in the eyes
- Variable vision that fluctuates particularly between blinking
- Tired eyes even if the rest of your body doesn’t feel physically tired
With ongoing research into the topic of dry eye disease, eyecare practitioners are also recognising that often the severity of symptoms that a patient reports does not always correlate to the signs of dry eye a clinician may observe in an examination. This works both ways, with a patient reporting very severe, debilitating dry eye symptoms but a clinical exam noting very few signs of dryness, and vice versa.
Dry eye symptoms can be expected to be exacerbated in certain conditions, such as prolonged reading or computer work, or in dry, air-conditioned environments.
Certain systemic diseases, such as autoimmune diseases, and certain medications, including antidepressants and antihistamines, can also worsen dry eye symptoms.
There are two basic categories of dry eye disease, separated by their broad underlying causes – Meibomian gland dysfunction and aqueous deficiency dry eye. While some cases of dry eye may be a combination of both Meibomian gland dysfunction and aqueous deficiency, the vast majority will have a Meibomian gland dysfunction component. As there may be multiple factors contributing to each individual case of dry eye, treatment is most effective when tailored to each patient.
Meibomian Gland Dysfunction
The tear film is a complex structure, comprised of a lot more than just water. The topmost layer of the tear film is actually an oil layer, produced by the sebum-secreting Meibomian glands lining the top and bottom eyelid margins. The purpose of this oil layer is to reduce evaporation of the aqueous layer, which makes up the bulk of the tear film. The third innermost layer is known as the mucin layer, which functions to adhere the tear film to the surface of the eye.
In Meibomian gland dysfunction, both the quality and quantity of the oils may be compromised, leading to what is termed “evaporative dry eye”. Accumulation of bacteria from the skin, inflammation of the eyelids and Meibomian glands, and narrowing of the glands and their openings all contribute to the overall picture of Meibomian gland dysfunction and subsequent dry eye.
IPL as Dry Eye Therapy
The benefits of IPL (intense pulsed light) for Meibomian gland dysfunction were discovered accidentally by an American ophthalmologist in 2002 when he noticed patients receiving IPL treatment for acne rosacea of the skin, also reported improvement to the comfort of their eyes. Further investigation found that application of the 500 to 800nm wavelength intense light to the facial areas around the eyes improved the function of the Meibomian glands by reducing the bacterial load and softening the solidified oils within the glands. Abnormal blood vessel growth around the eyelids as a result of chronic inflammation was also successfully treated with IPL therapy, helping to disrupt the cycle of inflammation and red eyes. More importantly, the subjective dry eye symptoms reported by patients improved under IPL therapy.
The treatment protocol may vary depending on the practitioner and specific IPL device, but will usually involve skin typing to allow the machine to be fixed to the appropriate setting, and then application of an ultrasound gel to the face, from the temples to the nose. The eyes themselves are protected with goggles or specialised pads and do not directly receive any light. Pulses of light of specific wavelengths are then applied across the face around the eye area. Your clinician may perform this twice for each side.
Many patients will require maintenance treatments of IPL to keep their dry eye disease at bay. Depending on the individual, these visits can range from every three months to once a year.
IPL therapy can be very effective for Meibomian gland dysfunction and evaporative dry eye but is just one in a suite of dry eye treatments. If you think you may be suffering from dry eye, contact Eye Laser Specialists here at 1300 297 583 to book in a dry eye assessment.