Dry Eye Clinic
What to expect in our dry eye clinic
We offer a personalised management and treatment plan customised to your particular type and severity of dry eye by utilising cutting edge, state-of-the-art diagnostic equipment and software combined with our clinical expertise and experience.
The aim of our specialist dry eye clinic is to evaluate your tear film with regards to quality and quantity, lid margin health and tear producing glands, to understand why you have dry eye and how best to alleviate your symptoms using the latest and most appropriate treatments available.
The dry eye examination normally includes the following procedures:
- Dry eye pre-examination questionnaire – this helps us understand and track the improvement in your symptoms
- High definition, high resolution photographs of the anterior eye (front of the eye) using our video/photo slit lamp biomicroscopes
- Meibography – we visualise and assess the meibomian glands (glands which produce complex oils to stabilise your tears) to ensure their optimum performance
- Anterior OCT – produce 3-dimensional cross sectional images of the cornea to monitor changes in the cornea and tear film thickness
- Corneal topography – maps the shape and irregularities in the cornea
- Non-invasive Tear break up assessment – using the Oculus Keratograph to measure the speed at which your tears evaporate
- Assessment of the lipid layer (oil layer) of your tear film using the Keratograph
- Use of fluorescein and lissamine green diagnostic dyes – these are used to assess the health of the front of the eye using our video/photo slit lamp biomicroscopes.
This causes no discomfort or change in vision.
- BlephEx professional eye lid cleaning – if you also suffer from blepharitis or meibomian gland dysfunction we may wish to clean your eyelids using the Blephex system, using a surgical microsponge to clear bacteria and debris from the eyelid and eyeslashes
The Oculus Keratograph 5m
We are the first practice in Scotland and amongst the first in the UK to offer the Oculus Keratograph K5. The Keratograph 5M technology is a revolution in corneal topography and dry eye analysis.
The Oculus K5 evaluates the tear film with the aid of white and infrared illumination. The new high definition colour camera makes the finest structures visible. NIKBUT (non-invasive Keratograph break-up time) allows for assessment of the quality of the tears important in the diagnosis of evaporative dry eye. Tear meniscus height measurement evaluates tear volume, useful in aqeous deficiency dry eye. Imaging of the lipid layer and tear film particle movement allow assessment of tear viscosity. All of these exams are non-invasive and reproducible allowing for better understanding, diagnosis and treatment of dry eye.
Tear meniscus height - Evaluation of tear film quantity.
With an integrated measuring guide and various magnification tools we can measure tear meniscus height and evaluate its characteristics along the lower lid margin. We can then track improvements in tear volume during your dry eye treatment plan.
Lipid Layer - Evaluation of lipid layer thickness
The colour and structure of the lipid layer are visualised and can be recorded. Measurements are taken of lipid layer thickness, which correlates with tear film evaporation and dry eye symptoms. If the lipid layer is too thin or absent, the tear evaporation rate and tear film instability increase.
TF dynamics - Evaluating the particle flow characteristics
A video recording with up to 32 images per second, permits observation of tear film particle flow characteristics and shows tear film viscosity.
Meibography - Meibo-Scan
The new Keratograph 5M is a multi-purpose diagnostic device that easily and efficiently integrates complex examinations such as meibography into ophthalmological and optometric practices.
Dry eye is most commonly caused by meibomian gland dysfunction (MGD). Meibo-Scan reveals morphological changes in the glandular tissue. The ability to assess and grade the quality of meibomian glands allows us to specifically target and treat dry eye with more accuracy.
How many visits will I require?
This varies depending on the type and severity of your dry eye. In most cases we will review you 2-4 weeks after the initial examination to ensure the treatment is working well and make changes to the treatment plan if required. Again depending on the extent of your dry eye we may then re-exam your eyes on a 3-6 monthly basis.
Are the treatments available on the NHS?
In Scotland the NHS will pay for a full examination every 2 years (every 12 months in patients over 60 with eye disease, diabetic patients of any age every 12 months, patients with glaucoma or ocular hypertension every 12 months, patients over 40 with a positive family history of glaucoma every 12 months and children aged 16 and under every 12 months). The NHS will also fund supplementary examinations to evaluate symptoms such as those of dry eye. The NHS funded eye examination does not cover all of the techniques used to fully exam the eye for dry eye such as corneal topography, meibography, anterior eye photography and Blephex lid cleaning.
How does it work if I am referred by another optician?
If you have had an up-to-date and recent eye examination you simply book in for a dry eye evaluation appointment. If you have not had a recent eye examination we will first perform a comprehensive eye examination followed by the dry eye evaluation.
How much does it cost?
Initial dry eye examination = £250 (£180 for Eye Care for Life members. A £120 deposit is required for new patients to secure an appointment.
Follow up examination = £60 (£45 for Eye Care for Life members)
BlephEx Treatment = £48 (£36 for Eye Care for Life members)
Does it hurt?
No, none of the examinations or treatments causes pain or discomfort. We may instil drops into the eyes in some cases which can be mildly stingy for a few seconds. However, the majority of the examinations involve nothing touching the eye. The Blephex lid cleaning session slightly tickles the eyelid but is not unpleasant.
What is dry eye?
Dry eye syndrome (sometimes referred to as dry eye disease or keratoconjunctivitis sicca) is a very common condition that occurs when the eyes do not make enough tears (aqueous deficiency dry eye) or when the tears evaporate too quickly (evaporative dry eye). This leads to the eyes drying out causing irritation and discomfort due to inflammation.
What are the symptoms of Dry Eye Syndrome?
The symptoms of dry eye syndrome commonly affect both eyes and include:
- Red eyes
- Feeling of dryness
- Grittiness and soreness that worsens throughout the day
- Eyelids being stuck together upon wakening
- Intermittent and temporary blurred vision, which clears after blinking
More severe symptoms of dry eye include:
- Very red and painful eyes
- Photophobia – extreme sensitivity to light
- Deterioration in vision.
These severe symptoms can be an indication of the potentially serious complications of dry eye syndrome which can lead to scarring of the cornea (the transparent layer at the front of the eye) which can permanently affect our sight.
What causes dry eye syndrome?
Production of our tears is a highly complex process and can be disrupted by numerous factors thus leading to dry eye syndrome. Common causes include:
- Age, dry eye is more common in older individuals
- Previous refractive corrective laser surgery
- Hormonal changes, such as during the menopause
- Side effects of certain medications such as anti-histamines, anti- depressants, beta-blockers and diuretics
- Underlying medical conditions such as rheumatoid arthritis, lupus, bell’s palsy, contact dermatitis, Sjögren's syndrome
- Underlying eye conditions such as blepharitis, allergic conjunctivitis
- Being in a hot or windy climate
- Working in an air conditioned environment
- Reaction to contact lens solutions or poorly fitted contact lenses
Dry eye can affect people of any age; however your chances of developing dry eye syndrome increase as you get older and occur more commonly in woman than men.
Around 1 in 3 people over the age of 65 experience problems with dry eye.
How is dry eye treated?
Dry eye syndrome is not usually a serious condition. But can have a significant effect on our vision and lifestyle and therefore should be treated appropriately.
There are a variety of treatments available to relieve the symptoms of dry eye including lid hygiene treatments, eye drops to lubricate the eyes, medications to reduce inflammation and if required surgery to prevent tears draining away easily. If your dry eye syndrome is secondary to an underlying condition such as arthritis or blepharitis treating the condition may help relieve the symptoms. If it is as a result of certain medications altering the medication may alleviate the symptoms.
Changes to your environment and diet may also help prevent dry eye symptoms.
Lubricant treatments (artificial tears)
Mild to moderate cases of dry eye syndrome can usually be treated using lubricant eye treatments that consist of a range of drops, gels and ointments.
Some eye drops contain preservatives to prevent harmful bacteria from growing inside the medicine bottle. If your symptoms mean you need to use these eye drops more than six times a day, it's better to use preservative-free eye drops. This is particularly important if you have severe dry eye disease because preservatives used in large quantities or over a prolonged period of time (months or years) may damage the delicate cells on the surface of the eye or cause inflammation.
If you wear soft contact lenses, you may also need to use a lubricant that is preservative-free, as preservatives attach to the contact lens and damage the eye. These types of eye drops may be more expensive..
'Oily' tear eye drops
Eye drops that replenish the oily part of the tear film and reduce evaporation from the surface of the eye are also increasingly used. These preparations include synthetic guar gums or liposomal sprays.
Liposomal sprays are over-the-counter medications and do not require a prescription. They are sprayed onto the edges of your eyelids when your eyes are closed. When you open your eyes, the solution spreads across the surface of the eye, creating a new oily film.
Oily tear drops are particularly useful if you have blepharitis (inflammation of the rims of the eyelids) or dry eye syndrome caused by your tears evaporating too quickly.
Eye ointments or gels
Eye ointments or gels can also be used to help lubricate your eyes and help keep them moist overnight because your tears can evaporate while you sleep if your eyes are not fully closed. These ointments tend to be used overnight because they can cause blurred vision. If you wear contact lenses, do not use eye ointments while wearing them.
The underlying problem with long-term dry eye syndrome is inflammation in and around the eye. Therefore, one of the anti-inflammatory treatments mentioned below may also be recommended.
Corticosteroid eye drops and ointments
Corticosteroids are powerful anti-inflammatory medications that can be given as eye drops or ointments in severe cases of dry eye syndrome. They have side effects such as cataract formation and raising the pressure within the eye in about one in every three people. This group of treatments should only be used if you are being supervised by an ophthalmologist in an eye clinic.
Low doses of medications called tetracyclines can be used as anti-inflammatory agents for a minimum of three to four months, sometimes much longer. The most common tetracycline used is doxycycline, but others such as oxytetracycline and lymecycline are sometimes prescribed.
Ciclosporin eye drops
Ciclosporin is a medication that suppresses the activity of your immune system and is sometimes used in the treatment of dry eye syndrome.
Autologous serum eye drops
In very rare cases, where all other medications have not worked, autologous serum eye drops may be required. Special eye drops are made using components of your own blood. It is only available from the National Blood Service through an ophthalmologist and after funding is approved.
To make autologous serum eye drops, one unit of blood is taken under sterile conditions (as for regular blood donation). The blood cells are then removed and the remaining serum is put into eye drop bottles. Because of quality standards, this process can take several months before the treatment is finally available to use.
If your dry eyes are severe and fail to respond to other forms of treatment, surgery may be an option. Two types of surgery sometimes used to treat dry eye syndrome are described below.
Punctal occlusion involves using small plugs called punctal plugs to seal your tear ducts. This means your tears will not drain into the tear ducts and your eyes should remain moist.
Temporary plugs made of silicone are normally used first to determine whether the operation has a positive effect. If it does, more permanent plugs can replace the silicone ones. In more severe cases, the tear ducts are cauterised (sealed using heat). This permanently seals the drainage hole to increase the amount of tears on the surface.
Salivary gland autotransplantation
Salivary gland autotransplantation is an uncommon procedure that is usually only recommended after all other treatment options have been tried. This procedure involves removing some of the glands that produce saliva from your lower lip and placing them under the skin around your eyes. The saliva produced by the glands acts as a substitute for tears.Back