Tear Clinic

What is ocular surface disease?

Ocular surface disease is a multifactorial disease of the tears and ocular surface. This general term is used to describe a range of conditions that affect the surface of the eye:

• Ocular surface disease (DED)—Reduction in the volume and quality of tears
• Blepharitis—Inflammatory condition of the eyelids
• Meibomian gland dysfunction (MGD)—Reduced oil production leading to tear evaporation from the surface of the eye

1. Scope Ophthalmics Market Research, 2015

Early intervention is crucial in preventing progressive and possibly permanent damage to the eyes.

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What is ocular surface disease?

Your Optometrist will assess the severity of your condition, diagnose the root cause and prescribe the most appropriate treatment plan.

The evaluation will involve measuring the saltiness of your tears with a TearLab osmolarity test, the thickness of your tear film’s oil layer, and the number of partial blinks over a 20-second interval. Your oil glands will be imaged using LipiView II Dynamic Meibomian Imaging technology and your lashes, lids and ocular surface will be assessed using the Korb Meibomian gland evaluator and diagnostic stains that will not affect your ability to drive.

We will monitor your ocular surface health using these non-invasive tests and questionnaires to help track your symptoms at each visit.

E-Eye

E-Eye is a device which uses IRPL® (Intense Regulated Pulsed Light) to help treat dry eye caused by Meibomian Gland Dysfunction. The light pulse algorithm is designed to act on the parasympathetic nervous system to stimulate and re-boot the meibomian glands. This ensures the glands produce natural oils which maintain the tear film structure. A similar treatment is used by dermatologists for the treatment of conditions such as rosacea. E-Eye uses a lower energy light for the treatment of MGD.

The procedure only takes a few minutes per eye and a series of three treatments will be required to ensure the treatment is effective and long-lasting. The benefits can last between 6 months- 2 years following treatment.

Why is tear film important?

The surface of our eyes is coated with a thin layer of tears, called the tear film, which washes, protects, nourishes and lubricates the eye.

Blinking smooths the tear film evenly across the surface of the eye and stimulates the glands to produce more tears.

What causes ocular surface disease?

"Ocular surface disease is often a natural part of getting older, but may be exacerbated by certain medications and other medical conditions. While these causes often can’t be changed, managing the condition is the key to healthy, comfortable eyes. There are however, some environmental factors that can trigger ocular surface disease and adopting healthy habits around these can help ease some symptoms,” explains Optometrist Laura Williams.

• Technology: With so many people using computers, and our reliance on smart phones and tablets, it’s not surprising that we’re seeing more people with ocular surface disease symptoms. When we’re concentrating, the rate at which we blink decreases and we tend to blink incompletely. This means that the tears that keep our eyes hydrated have more time to evaporate between blinks, contributing to dryness.
• The weather: Our eyes are also affected by the weather. In the winter, increased exposure to the cold wind and central heating can dry our eyes. But in spring, hay fever means ocular surfaces often get worse - it’s not helped by antihistamines which can actually cause further dryness!
• Contact lenses: People who wear contact lenses are far more susceptible to ocular surface disease, which is why regular appointments are vital. Discomfort from dryness is a major reason why people stop wearing contacts – but luckily there are things that we can do to help.

How is Ocular Surface disease treated?

In some cases, symptoms can be relieved by altering the external influences mentioned above. Simple changes in environmental factors can help – for example avoidance of dehydrating factors, such as air conditioning or regular breaks away from work on computer screens. Protecting your eyes from other factors, such as cold wind, with spectacles or sunglasses may also help.

Your treatment may include in-practice procedures and at-home therapies depending on the cause of your ocular discomfort and/or signs of ocular surface disease.

Meibomian Gland Dysfunction accounts for 86% of ocular surface disease that can lead to irreversible structural and functional changes if left untreated. At-home therapies could include a combination of moist heat mask use and massage, eyelid scrubs, eye drops, prescription medications, blinking exercises and Omega-3 diet supplementation.

Our in-practice treatments include:
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• LipiFlow Thermal Pulsation treatment
• BlephEx Micro blepharon-exfoliation for deep cleaning of the eye lashes and eye lid margin
• Tea tree oil & 40 day Cliradex treatment for Demodex blepharitis
• Fitting of Dissolvable and Permanent punctal plugs to create a reservoir of tears
• E-Eye Intense Pulsed Light treatment

There is no cure for ocular surface disease, but it can be managed well with treatments once the cause is understood. We offer flexible payment plans to cover your ongoing clinical care and home delivery of products for ocular surface health maintenance.

LipiFlow

BBR Optometry is one of the few UK practices that can offer LipiFlow Thermal Pulsation treatment to decongest blocked oil-producing glands to help restore their function and improve symptoms. The safety and effectiveness of the LipiFlow System have been shown in clinical studies and are supported by years of scientific research.

The Lipiflow uses a special eyepiece which delivers heat and gentle pulsating pressure over a 12-minute cycle to treat the meibomian glands. The heating of the underside of the eyelid helps liquify any blockages in the glands and the pulsating pressure moves the blockages along to the gland opening.