Everything You Ever Wanted to Know About Dry Eyes

 

By Dan Edwards, FBDO
Partner/Dispensing Optician at Patrick & Menzies Brightlingsea branch
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The subject of dry eyes and the associated symptoms is so vast whole books have been written about it, but today we’ll try to tackle the basics of an increasingly common problem for all ages.

What do tears do and why are they important?

The tear layer sits on the front of your eye, over the cornea and the white of your eye. It’s there to do several jobs – it lubricates the eyelids as you blink (if you had no tears it would be like blinking with two bits of sandpaper! Ouch!), it protects the eye from dust and particles to minimise irritation. It is also the first thing that starts the process of refraction to produce a clear image, because the light hits the tear layer before anything else. In addition, the tear layer allows the cornea to absorb oxygen.

Diagram showing layers of the eye | Causes of dry eye and running eyes
Diagram showing layers of the eye

The cornea (the clear bit over your iris and pupil) has no blood vessels in it, but its cells still need oxygen to stay healthy, so the eye diffuses it from the air, into the tears, then into the cells. (Aha! I hear you ask, what about when you’re asleep?! Well, at night it’s the same process but the oxygen diffuses through the thin vessels on the inside of your eyelids. At much lower levels but just enough to sustain the system while you’re asleep). So, you see, tears are essential for healthy, comfortable eyes, and good vision.

What are tears made of?

Tears are actually quite a delicate balance of three different types of fluid: The bulk of tears are made of water, but equally important are the mucous layer and the lipid (fatty) layer. The mucous layer sticks the tears to the front of the eye and stops them falling off and running down your cheeks. The lipid layer helps prevent the tears from evaporating too quickly, so both are essential to maintain a good quality tear film. An imbalance in these different layers is what gives rise to the many different types of problems associated with dry eyes.

What type of problems do dry eyes cause?

One of the most common problems we see are people complaining of their eyes ‘watering’, especially if it’s windy outside. It seems counter-intuitive to say this is a dry eye problem but technically that’s what it is. If your eye is missing the mucous layer then the cornea is exposed – the wind irritates the eye, so it responds by watering (as it thinks it has a foreign body in it), that water won’t stick, so the tears run off, and the problem spirals.

We often see people with intermittent blurry vision and uncomfortable eyes which can stem from the lipid layer being missing or inadequate. The watery layer evaporates, leaving the mucous layer, which as the name perhaps indicates, gives rise to smeary vision, varying with the blink (a bit like putting petroleum jelly on a camera lens).

People often complain of sore eyes, poor vision and eyelids being stuck together when they wake up in the morning. Assuming infection has been ruled out, this is again happening because the tears are inadequate. If you go to sleep with little or no tear film, what you have got evaporates overnight, and as you don’t produce tears while you’re asleep, you’re left with a mucous residue that stick the lids together and sore eyes as the eyelids haven’t been able to absorb much oxygen.

People with allergies, particularly hay fever, can have dry eye issues as they tend to over-produce the watery part of the tears which washes out the other layers, making the tears badly balanced and unstable.

All of these issues can cause uncomfortable eyes which can look red and sore depending on the severity of the problem. Blinking with reduced tears is a really big irritant and in very severe cases it can actually damage the cornea leading to potentially sight-threatening infection. Thankfully this is rare and the vast majority of people come and see us or their GP before things got to that stage.

What causes dry eyes?

It’s true that dry eyes are more of a problem in older people. This is because as you age you tend to produce a reduced volume of tears and lose elasticity in the eyelids: Droopy lower eyelids expose more of the part of the eye below the iris which not only increases irritation but more importantly, if the lid is falling forward the mechanical support for tear volume is lost and tears run off the eye.

Some medical conditions such as Sjogrens syndrome and other auto-immune diseases in the spectrum of arthritis can reduce the amount of tears we produce. Some medications, including some cancer treatments, also reduce tear production.

Most commonly though lid hygiene is a big factor: the fatty and mucous layers of the tears are produced by tiny glands on the inside of the eyelids just behind the line of the lashes. These ducts are very fine and are easily blocked, so if make up isn’t removed very well, or the lids aren’t cleaned very well, over time the ducts can get blocked with dead skin cells, make-up, dried tear residue etc. This obviously results in inadequate tear production and an unstable tear layer.

The lids can also be affected by something called Blepharitis, an inflammation of the edges of the eyelid which is again more prevalent in older people and leads to a dandruff-like appearance which blocks the ducts and affects tear production.

Environmental factors also play a part. With increasing use of screens, both desktop and handheld, people find themselves staring at these for most of the working day. Each time you blink, you refresh your tears, but when you stare at a screen your blink rate goes down, increasing the amount that the tears evaporate. But it’s not just air-conditioned offices – people on long drives often complain of dry, uncomfortable eyes after staring down the motorway for hours (although this can also be because they need specs!) We also see a spike in dry eye problems when the weather gets cold and everyone cranks the central heating up.

Finally, we have to mention Demodex. Demodex is a tiny mite which we all have on our skin, it lives in harmony with us and is harmless. However, it does like to hide in hair follicles, particularly eyelash follicles, causing inflammation and clogging up the lid margins. Don’t be horrified – we do all have them, and mostly they don’t cause a problem, but if there are too many present they can be the cause of a stubborn dry eye problem that keeps recurring as the mites multiply.

What can be done to resolve dry eye issues?

The best way to tackle dry eyes is to try and find out what’s causing it in the first place, which is sometimes very hard to pin down. An appointment with one of our opticians gives us an opportunity to really have a look at your tear layer and lids and see what the issue is. We can measure your tear break-up time (how fast it evaporates), the tear volume (how much there is and if it’s too thin) and see why it is the way it is: Most of the time there is no one clear answer or treatment, and in some cases, while the problem cannot be ‘cured’, it can often be very well managed.

Options include hot compresses to clear blocked eye ducts, eyelid wipes to remove blockages and kill any mites that are present, drops to re-balance the tears, lifestyle and health advice. There is some evidence to suggest some vitamin supplements can increase tear production, and for some chronically blocked ducts, steam treatments are sometimes used. Sometimes just understanding why something is happening can make one feel better and remove some of the frustration felt.

If you have any of the issues detailed above dont hesitate to come and see us at any of our branches. We have specific dry eye consultation appointments available where your optician will focus on dry eye issues and help you find ways to improve the symptoms. Pop in or give us a call.


What is a PD Measurement and Why is it Important?

 

What is PD?

Pupillary Distance, or PD, is the distance between the pupils of your eyes. When it comes to spectacles, PD is specifically the distance between the pupils when focused at distance and the eyes are in the primary position –so, imagine when you are behind the wheel of your car, staring down the motorway into the far distance.The near PD is when the eyes are focused on something closer, for example, when you’re reading. In this situation the eyes will typically converge so the PD will be smaller.

Why does my optician need to know my PD?

Because of how lenses in spectacles work, your PD measurement is a critical piece of information needed to produce your glasses correctly: Every lens, be it in a camera, microscope, magnifying glass or spectacles, has an optical centre (OC). The OC is actually the only point on the lens where its strength is absolutely true. At every other point the power differs from what was originally ordered. This is due to the physics of how light travels through lenses and is therefore to be expected. However, the further away from the OC (and this is especially so for stronger prescriptions) the more the power differs and the more error you will note towards the periphery of your lens.

So, when we put together an order for your glasses we carefully measure your PD so that we can make sure the OC coincides exactly with your pupil centres, to give you the most accurate and comfortable spectacles.Incorrectly centred lenses can lead to blurry, uncomfortable vision or even double vision. The alignment of the centres is always important but, again, gets increasingly so the stronger the lens is or if you need a multifocal.

Once the lens is glazed to the frame the OC becomes a fixed point, but obviously our eyes are constantly moving so while it’s not the case that we are always looking through the OC, it is crucially important that the alignment is correct for things like driving or watching TV. If you are a glasses wearer, you may recognise that strange feeling when you first got glasses or had your prescription changed –when things just suddenly looked and felt a bit odd? This is due to your brain becoming accustomed to and tuning out the error from the periphery of the lenses as your eyes move around. (How our brains process our vision is a subject all of its own – we’ll expand on that in a later blog!)

Can you give me my PD so I can order glasses online?

We often get asked why we don’t note your PD on the copy of the prescription that we provide after an eye examination. This is partly because it isn’t a legally required part of a prescription but also because it is information which should only be measured by the supplier making your spectacles: Obviously it’s impossible for an online glasses supplier to measure your PD and doing it yourself is tricky and unreliable.

So, at Patrick & Menzies our policy is not to provide a PD measurement on request: Your PD will vary depending on the fit of the frames you choose and if we provide a PD measurement which is then used to buy glasses online, some of the responsibility of whether those glasses are correct or not, falls to us. However, if we have had no opportunity to assess the fit and suitability of the frame, or your lenses, let alone be able to check them upon manufacture, then we’re sure you will understand that we wouldn’t feel comfortable taking that responsibility on.


New Nikon Lenses

 

Following our succesful switch from Rodenstock spectacles lenses to Nikon towards the end of last year. The Nikon lens portfolio goes from strength to strength.

Designed using the very latest technolgy and research in Japan, made in the UK, Nikon have developed the Ultimate varifocal.

Seemax Ultimate represents a real breakthrough in how your lenses are tailored to your vision and visual preferences. Each of us sees things in our own unique way and has our own demands on how we view the world. With the new Ultimate technology, available in thin lens forms, Transitions and polarised, your lens design can be tailored like never before.


Our new Website is here!

To coincide with our birthday year, we have updated our website to make it fresh, engaging and provide you with lots of information about us and what we do. It’s taken a few months to get things right and we’ll still be polishing things and updating the site over the next few weeks as we add more content; but we hope you’ll agree it looks lovely! It’s designed to give you a feel for our practices and how we like to look after people. There are links to book appointments online, get to know who we are and who you might see. Have a nose around and let us know what you think!


30 years of Patrick & Menzies

It’s a special year

2018 sees Patrick & Menzies celebrate 30 years of providing eyecare in Essex. Andrew Patrick and Gill Menzies opened our Braintree practice in October 1988 and two years later acquired the practices in West Mersea and Brightlingsea from Mary Mudd. Having worked for larger, multiple chain opticians, Andrew and Gill wanted to open a practice that was able to offer something a bit different. To put the customer at the heart of the practice and make them the focus. Ever since, Patrick and Menzies have stayed at the forefront of technology and clinical standards. We were early adopters of computer-based lens catalogues and practice management to minimise errors in the ordering process; we installed digital retinal imaging years before most other opticians and continue to offer scanning and diagnostic methods often only available in hospitals. To have not only survived but thrived over the 30 years is a testament to the ethos Andrew and Gill have driven the business by. We always aim for the very best customer service and go the extra mile and it’s stood us in good stead, here’s to the next 30 years!


MSTC’s 1st Anniversary!

 

The newest part of our family celebrates it’s first year open this month. The Multi-Sensory Training Centre, formerly part of Essex County Hospital, opened as part of Patrick & Menzies in May 2017. They do brilliant work helping children with Dyslexia, Autism Spectrum Disorders, Auditory Processing problems and many other learning difficulties.  If you know of anyone who might be helped by Dr Grounds and her colleagues, take a look at the website www.mstcentre.co.uk and contact them. They will be only too happy to talk to you, discuss any concerns and tailor-make a program to help.