Ocular Surface Disease

Dry eye syndrome

What is dry eye syndrome?
Ocular surface disease, or dry eye syndrome is the result of inadequate tear production and/or excessive evaporation of tears. As a result, the surface of the eye becomes dry and inflamed. There is typically no cause for dry eye, although it may be related to blepharitis or a variety of other conditions, including rheumatoid arthritis.

What are the symptoms of dry eye syndrome?
The typical symptoms of someone suffering with dry eye(s) include grittiness and irritation of the eyes. Paradoxically, sometimes this is so severe that the eyes actually become watery in response to the irritation. As a result of dry eyes, the eyes will often become red, especially if there is an associated blepharitis contributing to it. In severe cases, the patient also complains of sensitivity to light and eye pain

How is dry eye syndrome treated?
The mainstay of management of dry eye includes appropriate ocular lubrication. There are a variety of ointments, drops and gels to treat dry eye, and it is often by trial and error that one finds the best combination of therapy to treat an individual patient’s condition.

Sometimes, implantation of punctal plugs (to preserve the tear film on the surface of the eye) is required to treat severe cases of dry eye.

Blepharitis

What is blepharitis? 
The term blepharitis refers to an inflammatory condition of the eyelid, which may be caused by a bacterial infection and/or an associated skin condition.

What are the symptoms of blepharitis?
The main symptoms of blepharitis include grittiness and general discomfort of the eyes, which may (if severe) contribute to reduced vision. The signs of blepharitis include redness of the eyelid rim, crusting on the eyelid margins (typically worse in the morning) and red eyes.

How is blepharitis managed and treated?
Blepharitis is typically and successfully managed by a routine of lid margin hygiene. Detailed instructions on how to perform lid margin hygiene are given below.

Occasionally and if associated with a skin condition, a course of oral antibiotics may also be required to clear up a severe case of blepharitis. It is important to note that there is no cure for blepharitis, but it can be managed with ongoing treatment.

Instructions on how to perform Lid Margin Hygiene

Mild to moderate cases

• Boil up a small pot of water with a teaspoon full of salt in it, and then let that water cool down until it is lukewarm;
• Next, dip a clean cotton bud into that lukewarm water and clean the lower eyelid edge quite firmly (exactly from where the eyelashes grow) from the inner corner to the outer corner.
• Repeat this with a dry cotton bud.
• Step 2 is then performed for the upper eyelid and also for upper and lower eyelids of the other eye.
• Do this twice daily for a week, then twice weekly thereafter.

Moderate to severe cases

Warm Water Massage:

Items required:

• Eye pads/cotton wool balls
• Hot water 
• Cotton buds

Dip the pad/cotton wool in the hot water, then hold a pad over each eye (while closed) for about 60 seconds and apply mild pressure over the eye.

Massage both eyes (still while closed) for about 60 seconds with a gentle circular motion applying pressure through the pad with the flat of the tips of the fingers.

Finally gently wipe along the margin of both lids with the pad, taking care not to scratch the eye. If there is any residual crusting, this can be removed by gently rubbing the margin of the lids with a cotton bud tip that has been dipped in the hot water.

This regime should initially be carried out twice per day (sometimes more frequently in severe cases), but will need to be continued indefinitely (about once or twice weekly) to keep symptoms at bay.