Good Hope, Heartlands, and Solihull Eye Clinics

Sore or dry eyes in brief

David Kinshuck Jan 2017

Introduction

Tears are made in a gland near the top of the eyeball, and spread over the front of the eyeball into tear ducts, and then down into the nose. 'Dry eyes' occur when there are not enough tears to keep your eyes lubricated, or the tears that are produced do not spread evenly across the eyes.

tear flow from lacrimal gland

Tears are normally made in the lacrimal gland, and flow over the surface of the eye. They run down tiny tear ducts into the nose. See animation.

 

dry eyes, side view 
Side view

dry eyes, front view

Front view

Dry eyes or poorly spreading tears: the surface of the cornea is covered with dry patches (like craters on the moon), and this makes the eyes very sore

Treatment

  1. diet
    • a healthy diet with fish and fresh vegetables (2 salads a day) and
    • pulses and grains, minimal sugar and fat, no processed food
  2. If you use the following drugs (or related drugs) ask your GP if the dose could be reduced: omeprazole, lansoprazole; furosemide, bumetamide. These drugs make the eyes dry/sore.
  3. Smoking makes the eyes much drier.
  4. Lid cleaning/bathing may be needed

    Very brief

    1. Heat compresses and massage twice a day
    2. Blephaclean or blephasol twice a day
    3. Preservative free lubricant
    4. vitaPos night

    More details

    • The cleaning helps to reduce the number of bacteria in the glands of the lid. This is the same treatment as for blepharitis and reduce all sorts of lid problems.
    • Gently clean with a cotton bud, looking in mirror

      Gently clean with Blepharaclean wipes ( or a cotton bud if unavailable), looking in mirror, pull the lower eyelid down with the index finger of one hand, and gently but firmly wipe the wipe or bud along the edge of the lid to scrape the debris off. With your chin up try the same on the upper lid, but this is harder.

    • Cleaning: clean lids with Blepharaclean wipes (these can be bought or obtained from a doctor's prescription, or if unavailable a cotton bud). Clean the edge of the eyelids (the eyelash edge) with the wipe or wet cotton bud. Gently scrape off the debris moving the wipe/bud side to side. If using a bud, warm tap water is usually quite safe. The Blepharaclean wipes are probably more effective.
    • Bathing: warm compresses with an 'Eyebag' hot compress: these can be bought or obtained on prescription, and one lasts a long time (or similar compress, there are may brands). If you don't have a compress or a microwave, use clean face cloth soaked in warm water, as hot as your eyelids can stand. Bath the eye (closed) for 5-10 minutes. Re-warm the cloth if it gets cold. This makes the debris easier to remove, as below.
    • massaging: gently pull the low lid down and (using a mirror) gently press on the lid margin moving fingers over the bone under the lid. (see text   YouTube video) WIth the upper lid this is much harder ..try to gently press on the upper lid. Repeat this over 30 seconds. Try to express he secretionsin the glands by massaging towards the edge of the lid.
  5. lubricant drops
    1. Slightly dry:                Xailin gel 4 times day and Xailin night at night
    2. More severely dry :    Hyloforte, VISUXL, or Thealoz duo every ½-2 hours, Clinitas (sodium hyaluronate 0.4% preservative-free) AND VitaPos at night
  6. This treatment takes about 4 weeks to work best
  7. See
    1. http://www.goodhopeeyeclinic.org.uk/sore%20dry%20eye.htm
    2. http://www.goodhopeeyeclinic.org.uk/blepharitis.htm
    3. http://www.goodhopeeyeclinic.org.uk/blepharitis.htm#lc     lid cleaning
  8. If this does not work consider
    1. If the eyes are red and inflamed, a short course of preservative free steroid drops such as dexamethasone preservative free twice daily for 3 weeks.
    2. (if that works, consider replacing with cyclosporine [Ikervis twice daily] for more long term use)
    3. If the eyes are still dry despite lots of lubricants, consider punctal plugs.
  9. Glaucoma drops for severely dry eyes or eyes with drop toxicity need to be preservative free, eg
    1. Monoprost nocte
    2. Cosopt preservative free (trusopt and timolol) twice daily
    alternatively
    1. Dorzolamide  preservative free twice daily
    2. No timolol if asthma
  1. Score your dry eye..the Ocular Surface Disease Index here