Dry Eye Disease & Blepharitis
(干眼症与瞼缘炎)
What is dry eye disease & blepharitis?
Dry eye disease is a common inflammatory eye condition which affects 5-50% of the population. It occurs when your eyes do not produce enough tears or the right quality of tears is not adequate to keep the surface of your eyes properly lubricated. This can cause discomfort and affect your vision.
Blepharitis is a one of the commonest causes of dry eye disease. It refers to inflammation of the eyelids where the oil glands are located, leading to poor quality of tear film and dry eye disease.
Photo credit: John Dart. Community Eye Health 2017;29:95.
Symptoms of dry eye disease
- Dryness, burning, or stinging sensation
- Redness and irritation
- Watery eyes (a reflex to dryness called reflex tearing)
- Sensitivity to light
- Blurred or fluctuating vision
Causes & risk factors
- Insufficient tear production – The lacrimal glands in the eyes do not produce enough tears to keep the eyes moist.
- Poor tear film quality – Tears are made up of three layers: oil (outermost), water (middle), and mucus (innermost layer, closest to the cornea). If any of these layers are out of balance, the tears evaporate too quickly, leaving the eyes dry.
- Environmental factors – Dry, windy, or smoky conditions can lead to increased tear evaporation. Spending long hours in front of computer screens or in air-conditioned rooms can also contribute.
- Contact lenses – Long-term use of contact lenses can irritate the surface of the eye and contribute to dryness.
- Medications – Some medications, like antihistamines, antidepressants, and beta-blockers, can contribute to dry eye.
- Aging – Tear production naturally decreases with age, especially for women during menopause.
- Health conditions – Certain conditions like autoimmune diseases (e.g., Sjögren’s syndrome), diabetes, and thyroid disorders can affect tear production.
Types of dry eye disease
- Aqueous-deficient DED: This occurs when there is lack of production of tears from the lacrimal glands.
- Evaporative DED: This occurs when the lipid layer of the tear film is affected (e.g. blepharitis), resulting the tears to evaporate too quickly.
- Mixed type DED: A mixture of aqueous-deficient and evaporative DED.
Treatment
- Lifestyle modifications: Adjust workplace circumstances, taking breaks from screen time, etc.
- Warm compresses / lid hygiene: Regular cleaning and warm compresses of the eyelids can help remove blockage of the oil glands.
- Lubricating eye drops: To help lubricate the eyes and relieve dry eye symptoms.
- Anti-inflammatory eye drops (e.g. steroids drops): This is to treat the inflammation related to DED (as DED is an inflammatory eye condition), which helps to break the vicious cycle of dry eye.
- Antibiotics: This may be given as eye drops/ointments (e.g. azithromycin, erythromycin) or tablets (e.g. doxycycline, azithromycin), which have been shown to improve the health of the eyelids in blepharitis.
- Punctal plugs: Tiny temporary plugs are inserted to the opening of the tear ducts (punctum) to reduce/prevent tears from draining too quickly from the surface of the eye.
- Serum eye drop: This is a type of eye drop made from the blood plasma of the patient (autologous) or another individual (allogeneic). The serum contains a large number of benficial biological factors that are present in healthy tears, promoting ocular surface healing and restoring tear film homeostasis. This treatment is usually reserved for very severe DED.
- Scleral contact lens: This is a type of special contact lens which is designed to vault over the cornea, resting on thie white part of the eye (sclera). The lens is then able to hold a reservoir of sterile saline solution between the lens and the cornea, keeping the eye constantly hydrated.
- Amniotic membrane transplantation: Amniotic membrane is a natural tissue derived from the innermost layer of the placenta. It contains various growth factors, anti-inflammatory cytokines, and collagen that help promote healing and tissue regeneration. This is usually reserved for severe DED that does not respond to other medical treatment. Amniotic membrane can be applied along with contact lens (e.g. Omnigen/Omnilenz) or glued/sutured to the cornea.
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