The Eye Practice

Dry Eyes can soe serious consequences and need to be aggressively managed - sometimes by a number of different specialists.  One of these conditions, which we see a lot of at The Eye Practice is Sjogren's Syndrome.

Sjogren's Syndrome is a serious auto-immune disorder where the immune system attacks the mucus membranes. Considering you have mucus membranes throughout your whole body, this can become quite serious.  In particular Sjogren's syndrome attacks the salivary glands of the mouth and the tear glands of the eyes.  Dry mouth and dry eyes are the most common symptoms.

Many eye doctors wind up working in conjunction with Rheumatologists in order to make sure our patients with Sjogren's are getting the best treatments possible for their symptoms and complications. Sometimes, patients don't even know they have Sjogren's, until they see their eye doctor – and we ask about any other potential systemic problems. Once the assessment has been made, we can refer you to a Rheumatologist for a proper evaluation.

       

The major characteristic of Sjogren's Syndrome, and the reason we see patients with this disorder, is dry eye. In severe cases, or during a flare-up (when the eye is under attack from the immune system), corneal inflammation can occur, along with other issues, such as blepharitis.

Relief for dry eye from Sjogren's Syndrome is possible. There are several measures that can help, that can be done in our office, and when you get home from your treatments.

•    LipiFlow® Treatments – These treatments are done in office with a patented medical device that uses heat and vibrations to soften and loosen blockages from the meibomian glands to increase the lipid layer output into the tear film. We hope to have this device at The Eye Practice in the near future.

•    Moisture goggles – like the Blephasteam goggles we've talked about in the past, these goggles use warm steam to add water to the tear film, and encourage proper meibomian gland function.

•    Antibiotic gels – With dry eye caused by Sjogren's Syndrome, eye infections become common, and conjunctivitis is often seen as a complication. Antibiotic gels and drops are used to control infections, and provide relief to the eyes. These need to be preservative free as preservatives of any type can cause severe irritation in Sjogren's syndrome.

•    Cyclosporine – These drops encourage aqueous tear production – it is an immunomodulator that decreases swelling in the eye.

•    Warm compresses – Once you've been treated for dry eye, you can use warm compresses to help alleviate any additional eye discomfort. Use at bedtime and upon awakening for five minutes in order to get continued relief.

•    Over-the-counter (OTC) eye drops – Drops recommended by your eye doctor can help keep your eyes comfortable when you have Sjogren's – prevention of discomfort is much better than trying to treat the discomfort once it returns! These also must not have preservatives.

•    Eye hygiene – Avoid getting eye creams and lotions too close to your eyelids, as they can irritate the eye. Remove eye makeup completely every night, and never sleep with eye makeup on – this will help reduce risk of infections. Additionally, make sure that you wash your eyelids with proper eyelid cleansers.

•    Special lenses – People with Sjogren's Syndrome related dry eye have a tendency to be photosensitive – meaning bright lights are a hazard. Lenses with an FL-41 filter can help diminish the intensity of sunlight.

If you have Sjogren's Syndrome, or want help with chronic dry eye, give us a call on 9290 1899 or click here to book an appointment.

Dry Eyes on average tends to be treated using some sort of eye drop or just ignored by most practitioners.  What has become clear is that in very mild cases this is satisfactory but when the dry eyes become moderate to severe treating with eye drops is no where near enough.

Treating Dry Eyes – Some Novel Approaches

If you've ever experienced dry eye, you know how uncomfortable it can be – it can sting and burn, and just be generally uncomfortable. It's pretty hard to live with!
There are a lot of new treatments for dry eye that provide relief, that we've mentioned in previous posts. Below is a look at three of the most unique treatments we've discussed before, with a deeper look at them.

Punctal Plugs

Punctal plugs keep eyes moistened by blocking the drainage ducts in the eye through the tear ducts (“puncta” plural, “punctum” singular). This is just like placing a plug in your bathtub – it keeps the water in the tub – and punctal plugs keep tears in the eye. The procedure is often referred to as “punctal occlusion.”

The first step to see if punctal plugs will be a good solution for dry eye is to test them with temporary plugs made from collagen. Collagen dissolves in about 24-48 hours, and it's how we test your eyes to see if they will be adequately moistened without causing tears to overflow (a condition called “epiphora”). If you respond well to the plugs, then permanent, silicone plugs are put in place. After some initial discomfort from the insertion (soreness), many patients report their dry eye has been relieved.

Meibomian Gland Expression

With evaporative dry eye, there is typically a blockage or dysfunction of the meibomian gland – the gland that produces the oily level (lipid level) of tears. Using simple tools, such as cotton swabs and topical anesthetics, meibomian gland expression can be done in the office by squeezing and massaging the upper and lower eyelids. By doing this, the meibomian gland will release its plugged areas, and wash away the “gunk” and pus left behind. 

There is usually some discomfort for about a day after the procedure, with stinging and pus production. Luckily, that can be relieved with eye wash and topical steroid and antibiotic combinations.

  

LipiView® and LipiFlow®

Now there is an even better solution for those who benefit from meibomian gland expression – in a two-part diagnostic and treatment process. First, the medical device called LipiView® is used to get a view of the tear film of the eye. The imaging device is painless, and uses a type of analysis called interferometry. In other words, the device can see the clear tear film on the eye and help us interpret the cause of the dry eye.

The next phase is treatment – which is where LipiFlow® comes in – to treat meibomian gland dysfunction. The device is placed over the eye and uses heat and pulsations to massage and open the glands, which unblocks the glands, allowing the lipid layer of tears to return to normal. It is comparably painless and gives patients great relief.

 

Currently we are investigating this unique technology and hope to bring it to The Eye Practice.  We will be the first in the country to start offering this treatment, as not only is dry eye a huge issue for many people, it can make the difference between successful and unsuccessful contact lens wear and laser eye surgery success. 

We can help you find the right solution if you're suffering with dry eye – call us on 9290 1899 or click here to book an appointment. 

Dry Eyes are involved in at least 50% of the consultations we see at The Eye Practice.

As we said in a previous article, dry eye can be from a lack of lacrimal gland production, resulting in a lack of water in the eye, or a lack of meibomian gland function, resulting in a lack of oil in tears, which leads to dry eye. Another previous article discussed aqueous deficiency dry eye – the lack of water. Now, we look at oil deficient dry eye – also known as Evaporative Dry Eye.

What is Evaporative Dry Eye?

Evaporative Dry Eye is a dysfunction seen in the meibomian gland in the eyelids – the glands that give tears their slick, oily consistency. When these glands malfunction, tears wind up being too watery, and therefore, they evaporate too quickly. This rapid evaporation results in dry eye.

The meibomian gland produces what is known as the lipid layer of tears – it is a fatty and oily discharge, or secretion, that is supposed to prevent the aqueous (water) layer from rapid evaporation. Now you know that when the meibomian glands are damaged, they will not produce the lipid layer efficiently. This creates an imbalance, and a perfect formula for Evaporative Dry Eye.

A common cause of Evaporative Dry Eye is blepharitis – a chronic type of eyelid inflammation which is based at the eyelash follicles, and often results in meibomian gland dysfunction. Blepharitis symptoms are red, crusty eyelids with swelling, itching, and burning.

Obstructed meibomian glands, either by inflammation or by sebum plugging up the glands, is the main reason Evaporative Dry Eye occurs. 

What you can do about Evaporative Dry Eye

It's important to find out what's causing your meibomian glands to malfunction in order to get the right treatments done to bring you relief. Drops won't solve everything. In fact the best they can do is just mask the underlying problem.  Often dry eye patients will say that the drops help but 10 minutes later their eyes are irritating again.

Sometimes, warm compresses and eyelid massages can alleviate the symptoms. If you come into the office, we can have a closer look at the meibomian glands and expel anything that's plugging them up, such as sebum.

Other treatments for Evaporative Dry Eye include macrolides – anti-inflammatory antibiotics – a course of steroids along with antibiotics, and special formulas of artificial tears that have certain types of oil have helped ease the discomfort of Evaporative Dry Eye. Currently, macrolides are seeing an increase in use for this condition, due to their highly effective anti-inflammatory properties.

A new technique to treat Evaporative Dry Eye while in the office is the use of a thermal pulsation system. By simultaneously delivering heat to the inside of the eyelid, and massage to the outside of the eyelid, any blockages can be removed from the meibomian glands, providing you with relief.

If you have dry eye, even if you don't know which form, we'd be happy to help you. Call us on 9290 1899 or click here to book an appointment.

Dry Eyes as mentioned before can have many causes, which essentially can be classified under two types of dry eye.

The first type of dry eye occurs when your eyes don't develop enough tears to keep the eye lubricated with water – that comes from the lacrimal glands of the eye.This is called aqueous deficiency.

The second type of dry eye occurs when your eyes don't have enough oily lubrication to keep the eyes properly lubricated – that comes from the meibomian glands in the eyelids. This is called meibomian gland dysfunction.

These two types of dry eye can come from a variety of sources, some of which we will cover in later posts:

• Sjogren's Syndrome and other conditions – Sjogren's Syndrome is a type of immunological disorder that is characterized by dry eye, dry mouth, and either Rheumatoid Arthritis (RA) or Lupus. Dry eye can also occur with Ocular Rosacea and stand-alone Lupus or RA.

• Contact lens wear.

• Menopause in women and aging in men can contribute to dry eye.

• Environmental factors such as forced hot air, or arid climates. Even staring too long at a computer screen without adequate blinking can cause dry eye.

• Side effects of antihistamines, blood pressure medications, and other medicines can cause dry eye.

Whether or not you can identify the source of your dry eye, it's a good idea to see your therapeutic credentialed optometrist to determine the best course of treatment.

 

There are several different treatments that are commonly used to help ease dry eye:

• Eye Drops or Eye Sprays will always be the first thing offered.  They are simple to use and relatively effective if the dry eye symptoms are mild.  It is worth noting that where possible it is best to use eye drops that do not have preservatives.

• Corticosteroid eye drops are commonly used to calm down inflammation of the eyes that nearly always is part of the irritation.  These are quite safe to use assuming the cause of the eye problem has been diagnosed properly and are not used long term.  Any more than 2 weeks of treatment needs very careful follow up in case of complications.

• Cyclosporine: These are anti-inflammatory drops that repair corneal damage and help increase natural tear production. The treatment is required twice per day, and results take some time to see – anywhere from three to six months.

Less common treatment options include the following:

• Medication switching: If the cause of your dry eye is due to the side-effects of a medication, we may recommend switching to another medication that doesn't have such a side-effect.

• Punctal Plugs: These plugs, also known as lacrimal plugs, are temporary, silicone (or collagen) plugs that we can insert into the drainage holes of the eye that allow tears to pass from the eye into the nose. By doing so, more moisture is left in your eye. Permanent plugs are also an option for those with severe cases of dry eye.

• Punctal cautery: This surgical procedure does the same thing as punctal plugs, but it is a permanent solution.

• Blephasteam: These goggles have been shown on our blog before. While not a fashion statement, they add water and encourage more oily product from your glands. Treatment required is two, ten-minute sessions every day. The equipment costs 200 Pounds UK. Currently these are not available in Australia.

• Testosterone cream: This novel treatment is probably best used for post menopausal women.  Studies have shown great results with 3% cream applied to the upper lid.

No matter what the source of your dry eye, or type of dry eye you have, there are plenty of treatments available that can fit your specific needs. If you're having a problem with dry eye, call us on 9290 1899, or CLICK HERE to book an appointment.

Contact Lenses since the 1970’s have been popular corrective vision appliances. After glasses, contact lenses represent around 8% of the vision correction market in Australia.  In the USA it is over 20%.

Believe it or not approximately 50% of all people that begin wearing contact lenses will discontinue within one year. Most of the time this is because of discomfort.

According to expert optometrists it is quite clear that use of contact lenses and dry eye syndrome can be a troublesome cycle that seems to have no end in sight. On one hand the lens can protect the eye from dust and airborne irritants. On the other hand the lens can dehydrate and create a feeling of roughness and discomfort after a number of hours of wear.

    

Other contributing factors include incomplete eyelids closure, diseases that affect the eyelids (blepharitis) and insufficient tears due to deficiency in the tear-producing glands. It has also been shown that dry eye syndrome tends to occur more in females than in males. One of the explanations that has been given for this occurrence is that women go through more hormonal upheavals than men. A more recent survey has shown that aging increases the possibility of dry eye conditions in males and in females.

Dry eye conditions have baffled optometrists for ages. Most of time any treatment that is offered will be palliative (to try and suppress the irritation) but because the underlying cause is often unknown the dry eyes are only masked with symptoms often returning. 

One of the most popular methods in dealing with dry eyes is to instill artificial tears that top up the natural tears in the human eye. This artificial replacement helps to decrease the irritability and the dry feeling that accompanies the condition. Scratching the eyes due to the irritation is likely to result in a red eye effect due to inflammation. The artificial tears act to lubricate the eyes thus providing relief to the scratchy feeling which may act to give relief in the short term and sometimes in the long term. Wrap around sunglasses also help wearers of contact lenses to deal effectively with the problem of dry eye as they seal the moisture inside the eyes thus preventing their evaporation.  There are many treatments that need to be considered and tried, when it comes to contact lenses causing discomfort.

Other treatments will be discussed in more detail in later posts.  This is such an important topic that we are setting up a dedicated website to dry eyes called DryEyes.com.au - what else would we have called it?  We hope to have this up and running in a few months.

Another bizarre method of dealing with the dry eye syndrome is to administer allergens, which act to stimulate the production of more tears, which lowers the possibility of dry eye conditions. This is a homeopathic treatment, which even though has potential to stimulate tear production will also cause inflammation and significant potential for itchiness and irritation.  Do we think this is a good treatment - NO!

Before using any eye concoction or corrective measures with contact lenses it is important to consult with an expert optometrist to be sure that the measures or medication is safe and for the common good of the eye. Consulting with such professionals can be the saving step as they are likely to offer only the best treatments, which are long lasting and have lesser side effects to the user.

Even though contact lens wear can be tricky and it is unfortunate that so many people fail, the failure rate would be dramatically less if both the patient and the optometrist work together as a team. Contact lenses are a fantastic lifestyle enhancer and careful diligence maximizes their success rate.

Visit us at The Eye Practice, problem solving contact issues is what we do.  Call us on 92901899 or book an appointment on line.

Contact Lenses are normally just another form of vision correction.  You go to the optometrist with blurry vision and after glasses, contact lenses are the next most common form of vision correction that is chosen.

Contact lenses can have other functions, other than correcting vision blur.

They can change your eye colour from brown to blue. 

They also can protect your eye after being scratched, similar to a bandage.  By placing the contact lens on top of the injured eye (and normally adding antibiotic eye drops to protect the eye from infection) it buffers the eyelid from blinking on the wound.  A scratched eye can be excruciating, so a bandage contact lens can be a godsend!

In a previous post we discussed how contact lenses are in the preliminary stages of adding electrical circuitry which can be used to measure the internal pressure of the eye 24 hours of the day.

Now it seems that accurate eye medicine delivery can be achieved using contact lenses.Does this mean that eye drops could be a thing of the past?  See the video below for an introduction to eye medicine delivery through a novel contact lens design.

The Byrne Lab in the USA has developed polymers that can be moulded into contact lenses.  These contact lenses can be impregnated with therapeutic medication, whether it be for bacterial infection, reducing eye pressure in glaucoma or to reduce inflammation. 

Potentially this could be a tremendous step forward for eye disease management. 

Eye drops have significant disadvantages:

• The patient or their carer has to remember to put the eye drops in the eye/s. Compliance is a huge issue with up to 50% of patients not compliant with any form of disease treatment.  Eye treatment is no different.
• In eye drop form, the drug needs to be in relatively high concentration as the contact time with the treated eye is short.  This is because most of the drop will quickly either spill out of the eye or will be drained away through the nose into the gut.
• Most eye drops need to instilled multiple times per day, in fact in some severe bacterial infections eye drops are required every 15 minutes, around the clock.  Realistically this needs to be done in a hospital environment so is very expensive.

Delivering eye medication through contact lenses has a number of significant advantages:

• Once the medicated contact lens is put in the eye by the treating optometrist or ophthalmologist, the patient does not have to do anything else, so compliance will be no longer an issue.
• Treatment will be more effective, as a calculated dose will consistently be delivered for what ever time frame is required.

Possible pitfalls with this treatment will be:

• Often treatment requires two or more eye drops.  Normally with eye drops, one medication is used followed by the second one 5 minutes later so that they will not dilute each other. Mixing two medications in the matrix of a contact lens will have all sorts of unexpected chemical reactions.
• We suspect multiple medication contact lenses will take significantly longer to get to clinical trials if they make it at all. 

Future eye medicine delivery techniques:

Even though eye drops are a reasonable way to treat most eye issues there certainly is a need for superior methods.  The contact lens delivery method is one such enhancement but this will have strong competition from Nanoparticle technology.  Nanoparticles are microscopic entities that have very specific chemical properties that allow the nanoparticle with the medicine piggybacked on it to more efficiently enter the eye.

Time will tell which technology takes over from the traditional eye drop approach.

Cataracts have affected humans, maybe since the homosapien first walked the earth.  Even the ancient Egyptians, 2000 odd years BC have documented in hieroglyphics and have left surgical tools assumed designed for cataract surgery in tombs.

We now go forward some 4000 years and cataracts are still very prevalent.  In fact if you live long enough you are bound to get one.

In third world countries sadly, cataract still represents the most common cause of blindness, even though we are used to it being a relatively benign procedure to fix them here.

The biggest contributor to cataract is one's age - can't do much about that. Diabetes,long term use of steroids, trauma to the eyes, long term exposure to ultraviolet light, smoking and significant alcohol consumption are also contributors to cataract formation.

Currently other than removing the lens of the eye surgically and replacing it with an artificial one, there is no other treatment.

            

Wouldn't it be great if there was something that could prevent the development of cataracts.  For a while now it has been known that a protein called Calpain is implicated with cataract development.  An Adelaide based scientific company seems to have developed an eye drop that inhibits the protein.  Human studies still have some time to go but if this great technology comes to fruition the leading eye disease in the world could be a thing of the past.

Getting an eye drop to be effective in the eye and also penetrate the lens is not as easy as it sounds.  There are very complex chemistry pathways that need to be understood and overcome.  These need to be proven in animal models and then transferred safely into human use.  This is a very slow and tedious process.  One might question the need to even develop such a novel eye drop.  After all cataracts are so easy to fix with very few side effects using surgical procedures.  In fact surgical procedures have the advantage of being able to correct any vision problem the patient might have due to wearing glasses for distance vision blur.

Possibly the eye drop to inhibit Calpain and ultimately stop or slow down the development of cataracts might have little use in a society like Australia that has access to sophisticated eye care.  Third world countries though have little access to expert surgical techniques and being able to eliminate cataracts in such a society would have huge health benefits.

In the near future we might be brushing and flossing our teeth to prevent tooth decay and gum disease, while instilling eye drops in our eyes to prevent cataracts from developing later in life.  These same eye drops could be used in third world countries to dramatically reduce the incidence of cataracts, without having to train their doctors in expensive surgical techniques.

Unfortunately just like brushing ones teeth, prevention of cataracts with eye drops will depend on compliance.  Compliance with any medication at best tends to be 50% effective, even when a huge education education process is put in place.  People just forget to do it.

Then again 50 percent is better than no percent!

Conjunctivitis, which is also known as Pink Eye, we have discussed in past posts.  It means that the eye or eyes are red and inflamed but does not tell us anything about what caused the conjunctivitis.

One of the most common causes of conjunctivitis or pink eye is a viral eye infection. There are many strains of viruses that can cause a Viral Conjunctivitis.  We need to be clear that antibiotics are a waste of time in treating Viral Conjunctivitis, as antibiotics are only effective against bacteria.

What are the signs and symptoms of Viral Conjunctivitis?

Pink Eye

Watery discharge

Gritty, Itchy feeling

Sensitive to light

Swelling of a gland adjacent to ear (preauricular node)

White spots on cornea (infiltrates) in more significant presentations

               

Pressing around the gland adjacent to the ear (preauricular node, photo on left) will give the eye practitioner a good idea whether you have a viral conjunctivitis, as it is often raised and tender.

Having white spots (infiltrates, photo on right) in the cornea is a sign of the immune system trying to kill off the virus, going in overdrive.  This can be extremely uncomfortable and even causes blurry vision.  Aggressive treatment is normally indicated. 

What is the treatment for Viral Conjunctivitis?

This can vary depending on how intense the presentation and the symptoms are.  We need to remember that if the diagnosis is viral conjunctivitis, then antibiotics are not part of the treatment plan.

Viral Conjunctivitis treatment is normally termed palliative.  This means that anything that is given to the patient is to make them more comfortable.  The disease process in other words just needs to run its course, while the immune system finally recognises the offending virus and over a period of 2 weeks develops an antibody response, which finally kills it off.

Palliative Treatment for Viral Conjunctivitis:

• Cold Compresses - this is probably best done using a gel sporting injury cold pack, that is stored in the freezer.  It needs to be wrapped once in a clean tea towel and then moulded into the eye sockets for at least 10 minutes once or twice a day.

       

• Unpreserved Lubrication - This forms the basis of nearly any eye irritation.  The key though is using eye drops that do not have preservatives.  All too often we see patients that have had all forms of conjunctivitis that is treated with preserved eye drops.  The preservatives can set off an allergic or toxic conjunctivitis.  Instead of having one problem now the patient has two forms of conjunctivitis.  So where possible, use eye drops that have NO PRESERVATIVES!

Anti-inflammatory treatments for Viral Conjunctivitis:

Inflammation which is caused by the aggressive immune response of the eye in defense against the viral infection is what is responsible for all the symptoms that the patient perceives.  What we need to remember though, is that it is the inflammatory response that ultimately will kill off the virus.  It is a balancing act for the treating therapeutic optometrist to try and keep the patient comfortable, whilst allowing the immune system to do its job.  If anti-inflammatory treatment is chosen, it sometimes means being on treatment for a few months and weaning off gradually.  Stopping the eye drops too quickly sometimes can cause a rebound reaction.

• Corticosteroid eye drops - these are very effective in relieving most of the annoying symptoms of viral conjunctivitis.  This is especially true if white spots (infiltrates) affect the cornea.  There are various strengths of steroid eye drops starting from unpreserved prednisolone to the king of steroid eye drops Prednefrin Forte.
• Non-steroidal eye drops - these also suppress inflammation but are not as potent as steroids.  If possible non-preserved eye drops should be given to avoid irritation from preservatives.

Novel Treatment for Viral Conjunctivitis:

A new treatment for Viral Conjunctivitis seems to be using a single treatment of Iodine solution (Betadine 2.5% - 5% concentration).  Iodine solution is very irritating to the eye so anaesthetic must be used before the treatment.  Once the eye is anaesthetised (takes 30 seconds), a few drops of Iodine solution are instilled, the patients is asked to move the eye around and blink to make sure all parts of the eye are covered.

After 60 seconds the eye should be rinsed out carefully with unpreserved saline solution.  Steroid or non-steroidal anti-inflammatory eye drops should then be used for a few days to keep things comfortable.

This treatment has not been investigated fully to date and treatment protocol is still being investigated, but it seems that it will revolutionise Viral Conjunctivitis treatment.

If you have a red irritated eye, the best follow up is an appointment with a certified therapeutic optometrist.  Dr Jim Kokkinakis is available for conjunctivitis appointments usually on the same day.  Call 9290 1899 or BOOK AN APPOINTMENT ONLINE NOW.

DRY EYES like Eye Strain is an epidemic - Why?

Before we try and answer this question lets describe why the eyes need to be wet.

Eyes are made up of living cells.  Cells are made up of primarily water so being in a wet environment helps them function.  The coloured part of eye called the iris has a clear window in front of it called the cornea.  It is imperative for the corneal cells to be wet so that they remain clear and transparent.  If this window (cornea) loses its transparency good quality vision is also lost.

The eye is also wet so that if debris or germs enter the eye, they are able to be washed out.  The eye is able to defend itself against irritation and infection by increasing its water supply via extra tears.  It is not surprising then that the smallest bit of dust in your eye will set off the water works!  It is also normal if the eye is infected that it appears "glassy" due to the extra tears that have been produced in the eye to try and ward off the infection.

 

For many reasons the eyes need to have enough moisture to function at their best.  Dry Eyes though seem to be an increasing problem that at least half the people seeking an eye examination complain about to our optometrists at The Eye Practice.

The most severe form of dry eye is called Xerophthalmia.  This is caused from vitamin A deficiency in under developed countries and in particular affects children. 

Luckily for us in Australia it is not an issue.  What is an issue though is that many people complain of the following symptoms:

• Gritty eyes
• Sore eyes
• Stinging eyes 
• Itchy eyes - although this is often allergy
• Sensitive to glare

There are basically two forms of dry eye:

1. Evaporative dry eye.
2. Aqueous deficiency dry eye.

The first is caused to to lack of oil in the tear film and the second is caused due to lack of water in the tear film.  These types and their respective treatments will be discussed in future posts.

 

At The Eye Practice we believe there seems to be a significant increase in the number of people complaining of dry eye because many more people are working in front of computer screens and in air-conditioned environments.

Studies have shown that when the average person is doing computer work, their concentration increases and with this a reduction of blinking occurs.  Blinking is required to create tears to lubricate the eye.  In fact it has been estimated that when someone is working on a computer screen their blinking rate reduces down to 30% of what is normal.

To make matters worse most people that are working in front of computer screens are doing so in dehumidified air-conditioning.  This also dehydrates the surface of the eyes, which in turn creates irritation.

Dietary factors could also play a role and once again smoking rears its ugly head.  Smokers seem to suffer more from dry eye.  Another huge group of dry eye sufferers are contact lens wearers.

Treating dry eye at The Eye Practice is one of our specialities.  We can treat it from many perspectives.  If you think you have a problem with dry eyes call us and make an appointment as soon as practical.  Dry Eyes causes significant discomfort and reduces productivity.  Call us on 9290 1899 or BOOK AN ONLINE APPOINTMENT.

 

 

Glaucoma is well known amongst the general population.  This is partly by government advertising and partly by eye practitioners advising their patients about it.

There are many risk factors for developing glaucoma:

1. Age
2. Race
3. Cardiovascular problems
4. Migraines
5. Cold fingers and toes (Raynaud's syndrome)
6. Central Corneal Thickness
7. Intraocular pressure
8. Suspicious looking optic nerve
9. Abnormal visual field
10. Narrow eye drainage system
11. Pseudoexfoliation
12. Pigment dispersion
13. Myopia
14. Taking steroid medication, especially in eye drop form
15. Others...

There are a number of different types of glaucoma.  Occasionally a mixed mechanism glaucoma can occur, which requires a number of different treatments.  At the end of the day the main treatment is to somehow reduce the pressure of the eye.

The above image demonstrates optic nerve appearance vs visual field disturbance in the presence of glaucoma.

Treating the pressure in the eye can occur in a number of ways. This will depend on the type of glaucoma, taking into consideration possible side effects of any medications and the severity of the initial presentation of the disease.  Treatment once it has started can vary depending on how the individual patient responds.

Even though glaucoma management does follow a recipe to a certain degree, it is imperative to individualise the treatment because like any disease treatment the spectrum of individual responses is huge.

Many patients that are diagnosed with glaucoma are treated with glaucoma eye drops.  There are a number of different classes of drugs.  Careful instruction on how to use the eye drops is critical for a favourable and maximum possible response.

What is unfortunate is that occasionally the patient is either not educated properly in using the drops or what is very common is not complying with the use of the drops.  Often patients just forget to take the drops.  In future posts we will discuss what drops are used in glaucoma management and most importantly how to use them effectively.

 

THE IMAGE ON THE LEFT SHOWS THAT WITH INCREASING EYE PRESSURE THE RISK OF GLAUCOMA RISES. 

THE IMAGE ON THE RIGHT DEMONSTRATES THE PRESSURE BEING MEASURED IN THE EYE.

Other glaucoma pressure reduction techniques include taking Diamox tablets, lasering the drainage system of the eye so that it drains more effectively, surgical drainage formation called trabeculectomy, implanting drainage devices and often just performing cataract surgery will reduce the pressure.

In very severe cases of glaucoma, the ciliary body of the eye is destroyed using a laser.  The ciliary body makes the fluid which causes pressure in the eye.  If all other treatments have been tried unsuccessfully then ciliary body destruction might be the only option left.