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Dry Eyes

Dry eye is a very common condition and it results from a poor quality (not quantity) tear film. People with dry eye will often complain that their eyes water all the time, yet the quality of those excessive tears is poor and so the surface cells of the eye dry out and can become damaged.

Symptoms include this paradoxical watery eye, burning, grittiness and even blurry vision. The severe end of the spectrum, for example patients with Sjogren’s syndrome (triad of dry eyes, dry mouth and rheumatoid arthritis) can lead to corneal thinning and even “melting away” leading to perforation of the eye, fortunately this is rare.

Level 1 treatments for dry eye include:

  1. Hot compresses to get the small glands lining the eyelid margins secreting oils properly.
  2. Lid scrubs if needed to ensure the base of the lashes aren’t coated with mucous and debris.
  3. A diet that includes omega 3 fish oils/ krill or flaxseed (improves the lid margin glands).
  4. This is the main one. Artificial tears / topical lubricants. It is best to use non-preserved artificial tears, some people do better with aqueous based tear drops while others need oil based drops.

Level 2 treatments are when we add medications. They include:

  1. Topical steroids (usually just for one month to alleviate any inflammatory component of dry eye, long term risk beyond 1 month is an increase in eye pressure and even cataracts).
  2. Ciclosporin which is an immunosuppressant. Ikervis is a unit dose ciclosporin drop that has just been released in Australia. There are strict requirements to get these on the PBS though we can prescribe them privately if need be. They really sting but there is no risk of raising eye pressure or causing cataract. It’s simply one drop at night going to bed.
  3. Testosterone drops.

Level 3 treatments include:

  1. IPL (about $800 for course of 4 treatments), Lipiflow and Rexon eye. For these treatments we would currently refer patients to a dry eye specialty ophthalmology clinic.
Dry Eyed Man
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