Dry eye is a disease of the tear film that involves the ocular surface. To understand dry eye disease, it’s crucial to explore throughout the tear film. 

The tear film consists of three layers: 

• Lipid layer: as a barrier to stop tear from evaporating
• Aqueous layer: waste is removed and flushed out of the eye’s surface
• Mucin layer: as a protective lubricant, ensuring smooth tear distribution across the eye’s surface. 

With each blink, a protective layer of tears is distributed. Any malfunction within this system will lead to dry eye disease.

How would I know if I have Dry Eye Disease?

Do you recall when ophthalmologists diagnosed dry eye with a slit lamp and treated it with only artificial tears? Those days when the options of treating dry eye disease were limited, addressing dry eye disease had a relatively lower efficiency. Nowadays, our knowledge of ocular surface disease has grown to encompass advanced and highly specialized testing.

Here is a list of the modernising testing techniques that ophthalmologists use for dry eye disease diagnosis. 

Dye staining of cornea and conjunctiva

Sodium fluorescein dye would be the most common dye being used for checking epithelial cells integrity. This yellow dye helps to stain and localise the dry spot on the cornea, and it is also useful for tear break-up time assessment and epithelial basement membrane dystrophy (EBMD) evaluation. 

While other dyes such as Lissamine green and Rose bengal are preferred for conjunctival staining. They could assess the inflammation of the ocular surface by staining dead cells on the cornea and bulbar conjunctiva.

Lid expression

Gentle pressure applied to the lid margin to assess the meibomian gland function is recommended to assess eyelid health. Those white clogs indicate blockage of the meibomian gland. As a result, lesser lipids are secreted and tears will be easily evaporated.

Meibography

Meibography with infrared imaging techniques allows assessment of meibomian gland structure and identification of gland loss. Losing of meibomian glands will greatly reduce the amount and quality of the tear lipid layer.

Blinking quality

Habit of incompletely blinking, or diseases that cause difficulty in closing eyes completely also causes dry eye disease. The tears distribution and exposed tears surface are causing tears to be easily evaporated. 

Tear lipid layer thickness assessment

It measures the stability of the lipid layer and likelihood of evaporative dry eye by assessing the interference pattern produced by the inner and outer surfaces of the lipid layer in tear film.

Tear break up time

It can be tested via sodium fluorescein dye or an non-invasive way, using placido disc. The break up zone of the tears can be visualised and the time it takes for the tears to break is recorded.  A shorter break up time indicates more severe dry eye disease.

Tear meniscus measurement

It accesses the volume of tears. It can be measured using infrared or visible light.

When Every Assessment Combines into One Single Measurement…

C.DIAG and I-DRA, are both equipped in OasisEye Specialists, are non-invasive dry eye diagnostic aids. They could provide one step assessment in analysing the patient’s tear film, meibography and anterior eye structure imaging. Referring from the results, the ophthalmologist could offer treatment to address the causes of dry eye disease.

They are well known for:

• Non-invasive (no dye required)
• Quick
• Automated analysis
• Imaging function available

Which Types of Dry Eye Disease Do I Have? 

Dry eye disease can be classified into two main types: aqueous deficient dry eye and evaporative dry eye.  

Aqueous deficient dry eye

The following factors can leads to aqueous deficient dry eye:

• Aging
• Sjogren syndrome
• Laser eye surgery
• Tear gland damage 
• Contact lens wear

These clinical findings suggest for aqueous deficient dry eye:

• Corneal staining
• Reduced tear break up time
• Low tear meniscus

Evaporative dry eye

The following factors can lead to aqueous deficient dry eye:

• Windy conditions or dry air 
• Reduced blink rate, results from long hours of near work or driving 
• Lack of lipid or abnormal quality of lipid due to blocked meibomian glands or eyelid diseases (e.g. blepharitis, meibomianitis)

These clinical findings suggest for evaporative dry eye:

• Corneal staining
• Reduced tear break up time
• Partial blinker/ Incomplete closure of eyelids
• Meibomian gland blockage or loss
• Reduced tear lipid layer thickness

What are the treatments for Dry Eye Disease?

The treatments aim to address the root cause of the dry eye disease. The options include:

• Artificial tears 

Not only to lubricate and nourish your eyes but some artificial tears are also formulated for extra protection against tear evaporation and decrement of ocular inflammation. Hence it’s important to identify the underlying reasons for dry eye disease with an ophthalmologist for a right prescription.

• Blephasteam

Blephasteam safely and effectively warms the eyelids to restore the flow of oil (meibum) from the meibomian glands. The heat and moisture provided by Blephasteam typically slightly above 40 Degrees Celsius melt the secretions that block the meibomian glands in case of MGD, making it easier to remove the secretions using massage and pressure of the eyelids.This specific temperature range is chosen because it is effective for liquefying the meibum (the oily secretion from the Meibomian glands) without causing discomfort or damage to the delicate skin of the eyelids or the eye itself. Blephasteam reproduces an environment that naturally enhances tear film quality and stability by reinforcing the thickness of the tear film lipid layer, that improves the eye surface health and daily comfort.

• BlephEx

BlephEx stands as a pioneering medical tool employed in the treatment of dry eye disease caused by an eyelid or meibomian gland disease. It is used to cleanse the eyelid by eliminating the scales and debris to prevent meibomian gland blockage and chronic eyelid inflammation. Following the procedure, an increase in the production of the lipid component of tears can be achieved to improve the stability of the tear film.

• IRPL

Intense Regulated Pulsed Light (IRPL) is designed to address dry eye disease caused by meibomian gland dysfunction (MGD). This method utilizes a light pulse to stimulate meibomian glands, promoting the natural secretion of lipids to deter tears evaporation and alleviate eye dryness.

• Warm compression

It can be as simple as using a towel. Soak the towel in the hot but not scalding water, wring out the excess water, and apply it on your eye. Warm compression could melt the obstructed oil in the meibomian gland.

• Plug

A punctal plug is a small device that sits in the tear duct to help prevent the drainage of tears, which helps to keep the eyes moist. 

What can we help you with?

If you are suffering from dry eye disease, dry eye services are available at the following locations; Nexus Bangsar South, Cheras South, Shah Alam, Seremban, Kuching, Johor Bahru, and Penang.