Dry Eye Assessment

Dry Eyes and Dry Eye Assessment

There are three layers to the tear film. The bottom layer is layer of mucous called the mucin layer. The mucin layer produces surface tension to fight gravity so that your tear film stays on your eye and does not run down your face.  Acetyl Cysteine  eye drops can help with a poor mucin layer but this is very rare.

THM Tear Meniscus Height

The middle layer of the tear film is the aqueous layer

The tear meniscus height THM is the second diagram shown which measures the middle aqueous layer. Sometimes with severe dry eye it can be mixed  dry eye when both the middle (aqueous) layer and the top (Oily) layer are reduced. Common problems with the middle (aqueous) layer are dehydration and nutritional deficiencies such as zinc deficiency.

For dehydration – on waking the urine is yellow as patients have not drunk all night. During the day it is fine to drink tea, coffee, wine etc., which can be diuretics but enough water (or water with squash) should be drunk to keep the urine relatively clear. On a hot day or if you have been exercising you may be dehydrated so if your urine is yellow please drink a glass of water.

Two years after becoming vegetarian or vegan you may have depleted on Zinc as the biggest source of Zinc is red meat. This also applies to patients who only eat fish or chicken . There are over a 108 micro-nutrients in your tear film including copper, magnesium, manganese, B12, etc. We recommend a nutritional support from France called Lagad Lacrima.

The surface layer of the tear film is the oily layer of Meibum

The top layer or Meibum Layer

The oily layer is secreted by the meibomian glands in the eyelid margin. As we age the melting temperature of the oil goes higher and higher so the oil sets blocking the glands. The Myah machine can measure how many glands are blocked using infrared. Heat treatments help to open the glands and get the oil to cover the eye surface and prevent evaporation of the aqueous layer below.

We use three heat treatments

Heat Treatments for MGD

Meibomian Gland Dysfunction
  1. The Bruder Eye Bag which is put in the microwave for up to 30 seconds (depending on the power) and placed on the eyelids for six minutes twice a day for six months then once a day. It takes five minutes to reach the temperature hot enough to start melting the solid fat.
  2. The Blephasteam goggle with inserts that you put water in and plug in to the electricity so a microwave is not required. The steam opens the pores.
  3. The IPL pulsed blue light treatment and mask (as pictured). This requires four treatments every year to keep the pores open.

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