One of the most frequent tasks a Dispensing Optician performs is the routine management of Dry Eye Syndrome or Blepharitis.
The ‘Big Umbrella’ with which a lot of the diagnosed conditions, such as Dry Eye Syndrome or Blepharitis comes under, is called Meibomian Gland Dysfunction or MGD.
The normal tears of the eye are made up of three layers – an oily (lipid) layer, a watery (aqueous) layer, and a sticky (mucous) layer. MGD is when the glands that make the oily layer of the tears are not working properly and this allows the watery layer of the tears to dry out.
The meibomian glands are inside the eyelids, and the openings are on the edge of the eyelids. The outer oily layer stops the watery layer of the tears from evaporating. When the glands become blocked, the oily part of the tears cannot be released. This causes the watery tears to evaporate more quickly which results in the eye becoming dry and can make it feel sore. It is not usually a serious condition but can cause discomfort and sometimes blurry vision. If it is not treated, the glands may stop working permanently.
MGD can cause dry eye. It is common to have a combination of MGD, dry eye and blepharitis.
MGD is a common condition and can affect anyone. However, it is more likely to happen after the age of 50, if you have diabetes or oily skin conditions and it is also more common in women.
The Dry Eye Management Process
Once the clinician has discovered that the patient has blocked Meibomian Glands they will usually recommend that the patient begin on a ‘Lid Hygiene’ routine with lubricant management alongside.
This involves, warming up the blocked glands/lids using a compress that will stay hot for at least 5 minutes, preferably 10 minutes. This can be achieved using an EyeBag, 30 seconds in the microwave, then set your phone/oven/clock even Alexa! For 10 minutes, lie back and relax with the EyeBag placed over your eyes, and temples.
The process of the heat enables the solid blockage inside the glands to soften, I often use the simile, like when honey has crystallised in a squeeze bottle…we must soften with heat before it will squeeze out again. This is the same concept; the heat softens the blockage and then we start the ‘milking’ of the meibomian glands.
This is done via ‘lid massage’. Using the index finger of both hands and when needed thumbs we can massage the eyelids for both eyes simultaneously. The area which needs the attention is where the eyelashes grow from, NOT above or below. It is extremely important that the direction of the massage starts nasally and progresses towards the ear. Done the other way around could cause the tear ducts to get blocked. The massage technique to adopt is as follows:
- With eyes closed use index finger and press gently whilst agitating along the top lid at lash point. When reach the corner nearest the temple, open eyes, look upwards then repeat the technique for the bottom lid lashes.
- Eyes closed again, with finger and thumb pinch and slide along the top lids, then open eyes and repeat for the bottom lids.
- The last part is just with the index finger to press and slide from nose to ear direction the closed top lid. Open and repeat for the bottom lid.
The whole ‘massage’ process takes less than 1 minute from start to finish; You can do this in less than 30 seconds! The point being it takes no time at all and really does help to clear out those meibomian glands, opposed to just heat alone ‘drawing’ the blockage out.
The vision will now feel very blurred as we have extracted some of the blockage from the glands, this is when we need to clean the eye lids/lashes. We recommend Lid Scrub or Lid Wipes to do this. The gentlest approach is the Ocusoft Lid Scrub. If the eyelids are already inflamed, the most gentle is often preferable to stop even more inflammation occurring.
A small pea sized amount of Ocusoft foam on a fingertip can be massaged/shampooed into the lashes of a closed eye. When done this is washed off using warm water.
The final stage to the routine is more about comfort rather than a cure. This is the part where we lubricate the eyes. The eyes are not receiving enough lubrication due to insufficient tears or poor-quality tears getting through, therefor, lubricate, lubricate, LUBRICATE! The comfort will be immediate and help to reduce the inflammation as the lids will glide over a nice surface rather than a dry surface. We recommend an eye Gel, such as Clinitas Hydrate or Visco Tears at night and first thing in the morning, then a thinner more aqueous lubricant, Blink for instance, can be used during the day.
A simple daily routine like this can bring a major improvement in eye comfort, something the patient will be eternally grateful (Provided they follow the instructions!).