Eye Comfort

Many people are told incorrectly that they have dry eyes and that they are unsuitable for vision correction surgery because of this. Vision correction surgery, including laser vision correction, is often a good solution for eye comfort problems, particularly if you are having increasing difficulty with contact lens wear.

Genuine deficiencies of the watery part of the tear film are actually quite uncommon, but problems with eye comfort are near universal – almost everyone has gritty discomfort in the eyes from time to time. Comfort problems labelled as ‘dry eye’ relate much more commonly to factors such as prolonged screen work in an air-conditioned office environment, contact lens wear, allergy problems and blockage of specialised oil glands in the eyelid called Meibomian glands. Improving eye comfort involves looking at each of these common issues that commonly combine together to upset your eye comfort.

Meibomian gland problems

Working from the outside in, the tear film has an oily layer produced by the Meibomian glands, a watery layer produced by the lacrimal glands, and a mucous layer (like saliva) that helps the eye surface to stay wet. The oily layer floats on top of the watery layer of the tear film, a bit like petrol floating on water, and helps to prevent tear film break-up and evaporation between blinks.

Each time we blink, the Meibomian glands pump out a small amount of additional oil, keeping the tear film stable and healthy. As we get older, the eyelids get looser, and this pump action gets less effective. The oil glands tend to block up, and it is often a good idea to incorporate warm compresses and lid massage into your daily hygiene regimen. We can advise you about how best to do this at your consultation. We can also advise you about clinic treatments to help restore a healthy oily layer.

Another common cause of Meibomian obstruction is a low grade allergic inflammatory reaction to a build-up of the normal bacteria that live in the oil glands of the skin, including the Meibomian glands. This is called Meibomitis, or blepharitis, and may be associated with similar problems affecting the facial skin such as Acne in teenagers and Rosacea in mid-life. Treatment involves warm compresses and lid massage, as for Meibomian obstruction, but with courses of anti-inflammatory and anti-biotic treatment during flare-ups of discomfort. Again, we can advise you about the best approach to suit your eyes at your consultation.

Contact lens intolerance

Contact lenses accelerate tear evaporation, they also reduce eye surface sensitivity. If you are having problems with comfort in your contact lenses, tear supplements can be helpful. Tear supplements should not contain any of the preservatives (low concentration disinfectants) that are commonly found in eye drops, as these can build up in soft lenses and irritate your eyes. Preservative-free tear supplements are widely available, and switching over to these may be all you need to do to restore good comfort. You should switch to daily disposable contact lenses if possible, this helps avoid problems with protein deposition and inadequate cleaning.

Daily disposable contact lenses also reduce the risk of serious corneal infection associated with contact lens wear, but they do not eliminate it, and it is important not to swim, shower or sleep in your contact lenses to keep this risk to a minimum.

Contact lens tolerance often diminishes with age, and many disposable contact lens wearers are concerned about both the cost and the contribution to plastic waste.

Vision correction surgery is a good solution to contact lens related discomfort, and is cost neutral over time. All forms of eye surgery, including lens implantation and laser eye surgery, temporarily destabilise the tear film. To minimise discomfort in the recovery phase, you need the right advice about optimising your eye surface health prior to treatment. This is an important component of your pre-surgical consultation.

Office and screen work

You blink less frequently when you are concentrating on a screen. Over the course of a day, and particularly if you are wearing contact lenses and working in a dry office environment, this can lead to ‘tired eyes’ or dry eye discomfort.

Screen work is not harmful. The eye surface is very robust, and designed to regenerate overnight. So, if you have a bad day, things will normally be better by the morning. Using unpreserved tear supplements can be very helpful, but if you are having continued problems, it is worth having a medical check of your eye surface health to make sure you do not have an underlying problem with your Meibomian gland health or allergy.

Allergic eye problems

Itchy eyes are common, particularly in the hay fever season, and over-the-counter remedies available at your local pharmacist, such as Opticrom (Sodium Dichromoglycate) eye drops, may be all you need to restore comfort if you have mild allergic conjunctivitis.

Problems lasting year-round can be caused by common allergies such as an allergy to house dust mite. Damp dusting and other measures to improve your home environment can be helpful, but regular eyedrop treatment is normally required. Dual action drops such as Olopatidine (Opatanol) are a good background treatment. These can be supplemented by stronger drop treatments if you are having continued problems – particularly if you suffer with eczema and asthma too.

A good way of reducing itching is to keep unpreserved tear supplement eye drops in the fridge, and apply them when you feel you want to rub your eyes. The cooling action is soothing, and better for your eyes than vigorous rubbing.

Allergic inflammation accelerates tear evaporation, so it is good to use unpreserved tear supplements in addition to any medical eye drops you have been prescribed. But wait five minutes after using the medical eye drops before putting the tear drops in to avoid dilution.

Chronic low-grade inflammation can also affect Meibomian gland health, leading to a build-up of staphylococcal bacteria. We look at this and all the other components of your eye surface health together at your diagnostic consultation.

Appointments and enquiries

To arrange a private consultation, please telephone Angelique Thomas on 020 7566 2156 or 07484 081815 (or from outside the UK +44 20 7566 2156 or +44 7484 081815) or email moorfields.ballan@nhs.net

For NHS treatment with Mr Allan’s team at Moorfields, you will need a referral from your GP or Ophthalmic Surgeon. Referrals should be addressed to Mr Bruce Allan, Consultant Ophthalmic Surgeon, Moorfields Eye Hospital, City Rd, London EC1V 2PD. If you have any difficulty with your NHS referral, please call Barbara Stacey, NHS secretary to Mr Allan on 020 7566 2320, or email barbarastacey@nhs.net.