There is a saying in medicine that structural loss precedes functional loss. This means that in general there is damage to cells before you feel or experience the loss of that sense. This is very true for glaucoma. For many years, eye doctors have been routinely “screening” all patients for glaucoma to detect early structural changes and thus are able to provide early treatment in order to reduce or prevent actual loss of vision.
In the past, dry eye disease was treated based on the patient’s symptoms. Patients would complain of dry, red, gritty eyes that could cause vision fluctuations and would eventually seek treatment options such as lubricating drops to relieve (often temporarily) the discomfort. Recently the definition of dry eye disease has been updated. Dry eye is “a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles”. Dry eye disease has a complicated definition because there can be many factors involved in upsetting the stability of the complex substance called the tear film. Basically, our tears coat our corneas which is the clear front surface of the eye, which allow us to see well and also feel well by protecting and coating the corneal nerves that are oh so sensitive. Remember that eyelash you may have had in your eye that felt like a needle or the scratch that was very painful?
Advancements in diagnostics have allowed eye doctors to detect chemical and physical changes much earlier than ever before, right in our clinical office setting. We can do a test to examine the Osmolarity of the tears. This test is basically a measure of the salt content of the tear layer (more salty indicates a higher degree of dry eye). Another powerful diagnostic tool is called Meibography. This is a scan of the inner eyelids that allows us to visualize the meibomian glands that open at the edge of the lids near the eyelashes. These glands produce the oily component of the tears and reduce evaporative effects.
Often these glands can become plugged (especially in patients using digital devices) and can become damaged over time. Meibography allows our doctors to image these glands to determine if there is structural loss even before any dry eye symptoms may be felt. We have decided to include this scanning technology in our routine examinations at two of our clinics to provide our doctors with the most information about the future potential for dry eye disease.
If you are interested in reducing the risks of developing dry eye disease consider doing the following:
Blink fully and regularly especially when on a computer or device, clean around your eyelids using appropriate lid washes. Use paraben-free mascara (or none at all) and ensure all makeup is well removed before bed. Consider using lubricating drops in dry environments (the best type for you can be recommended by your eye doctor). Wear glasses with a current prescription if required (improves blink rate). Have regular routine eye examinations to determine if any structural gland loss is present as well as examining other health aspects of your eyes