A new study links tender and sensitive lower eye lids with evaporative dry eye. Dry eye should be treated before LASIK or PRK laser vision correction. A patient from Camarillo recently told me his lower eyelid had been tender and sore and his eyes were quite irritated. These are all symptoms of a particular type of dry eye which should be treated before LASIK or PRK laser eye surgery is performed.
Most people think of dry eye as simply a lack of tears. It turns out that the situation is often much more complex as there are several types of dry eye, including dry eye due to insufficient tear volume and also dry eye due to tear quality problems. The tears actually are composed of three layers: a water layer, covered by a protein layer, covered by an oil layer. The job of the oil layer is to float to the top of the tears and prevent evaporation of the tears. Many people have a poor quality oil layer which results in evaporative dry eye — eyes that become irritated with staring activities such as prolonged computer use or reading during which time the tears simply evaporate too quickly off the eyes.
The oil layer of the tears is made by vertical glands in the eyelids known as “meibomian glands.” There are 50 meibomian in the lower lid and 40 meibomian glands in the upper lid. Due to either genetic or nutritional reasons, many people’s meibomian glands make sludgy, thick oil which results in a poor quality oil layer in the tears.
A recent study in the October issue of Optometry and Vision Science showed that patients with increased eyelid sensitivity were more likely to have poor oil gland function and therefore poorer quality tears. This study therefore was helpful in determining the type of dry eye patients were experiencing. This study of 27 patients was conducted at the University of New South Wales in Sydney, Australia. A special technique called “esthesiometry” was used to measure the sensitivity of the eyelids and a dye was used to assess the function of the meibomian glands. The authors found that increased lower lid sensitivity, more than upper lid sensitivity, was associated with poor tear quality. The authors concluded that testing lower lid sensitivity with an esthesiometer may be a good diagnostic tool to determine if patients have oil layer tear quality problems due to poorer functioning of the meibomian glands.
Tear quality problems involving the oil layer can be treated with oral omega three supplements. A combination of both flax seed oil (ALA) and fish oil (DHA, EPA) are helpful for improving the quality of the oil layer and improving evaporative dry eye. Medical approaches include the use of Azasite eye drops, Restasis eye drops, and oral doxicycline or minocycline. Recent studies have also shown that light based skin treatments such as controlled spectrum light therapy (CSL) or intense pulses light (IPL) can also improve meibomian gland function and therefore tear quality in some cases.
It is important to treat underlying dry eye before LASIK or PRK laser eye surgery to optimize outcomes.
See Also
Study Shows Eyelid Sensitivity Measurement May Reflect Dry Eye Causes
A study from Australia shows that lower lid sensitivity is associated with evaporative dry eye and eye irritation
Got Dry Eyes? Measuring Eyelid Sensitivity May Reflect Dry Eye Cause
Measuring eyelid sensitivity may help determine the cause of a patient’s dry eye.
Lid Margins: Sensitivity, Staining, Meibomian Gland Dysfunction, and Symptoms
Article in the Journal of the American Academy of Optometry examining relationship between lower lid sensitivity and dry eye causes.
Optometry and Vision Science
Website for the Journal of the American Academy of Optometry
American Academy of Optometry
Website for the American Academy of Optometry
University of New South Wales
Website for the School of Optometry at the University of New South Wales
Azasite
Patient information on Azasite eye drops
Restasis
Website for Restasis eye drops