Today, we’re covering more about Severe Dry Eye, including symptoms, causes and treatments. Plus a special contact lens that can give significant relief from severe dry eye.
Ever had something in your eye? If so, you’ll know how sore it is.
What are the symptoms of severe dry eye?
Severe dry eye can cause symptoms like:
Severe or disabling pain
Episodes of stinging, burning or scratchy sensation in your eyes.
Frequent red eyes and red-rimmed eyes
Constant blurred vision or eye fatigue
Ongoing problems and reduced quality of life
Severe dry eyes can have bad days and not-so-bad days. Your environment can play a role in how your eyes feel.
You may experience constant watery eyes in an air-conditioned room . You may have staring at a computer screen for a few hours. Dry eyes can make it difficult to perform everyday activities, such as reading, driving or watching television.
Why don’t I have enough tears?
Your tears are a complex mixture of water, fatty oils and mucus. This mixture helps make the surface of your eyes smooth and clear, and it helps protect your eye from infection.
For some people the cause of dry eyes is increased tear evaporation and an imbalance in the makeup of your tears.
For others the cause of dry eyes is decreased tear production.
The tears protect the surface of the eye from infection. They also help things to stay in focus. Without adequate tears, you may have eye inflammation, abrasion of the corneal surface and if left untreated lead to corneal ulcer and vision problems.
Are there any auto-immune connections?
Autoimmune diseases such as:
Diabetes type 1
These are some of the autoimmune diseases that affect the eye and contribute to severe dry eyes. They can cause symptoms like:
In this article, we’ll discuss two medical conditions in more detail.
What is Stevens Johnsons Syndrome?
Steven Johnsons syndrome is a rare, serious disorder of the skin and mucous membranes triggered by medication, an infection or both.
It usually starts with fever, a sore mouth and throat, fatigue and burning eyes.
As the condition develops, it includes widespread skin pain, a red or purplish rash that spreads.
Blisters may form on your skin and mucous membrane of the mouth, nose, eyes and genitals and shedding of the skin within days after blisters form.
Stevens-Johnson syndrome is a medical emergency that usually requires hospitalisation.
Treatment for Stevens Johnsons Syndrome
Treatment focuses on removing the cause (i.e. ceasing the medication), caring for wounds, controlling pain and minimising complications as skin regrows. It can take weeks to months to recover.
During this stage, artificial tears or topical steroid is used to reduce inflammation of the eyes and mucous membrane.
Another autoimmune condition that affects the eyes is Sjogrens Syndrome.
What is Sjogrens Syndrome?
Sjogren syndrome is a disorder of your immune system identified by its two most common symptoms – dry eyes and a dry mouth.
The condition often accompanies other immune system disorders, such as rheumatoid arthritis and lupus.
Sjogrens Syndrome affects the mucous membranes and moisture-secreting glands of your eyes and mouth first. This causes decreased tears and saliva.
Treatment for Sjogrens Syndrome
Treatment for Sjogren syndrome depends on the parts of the body affected. Many people manage the dry eye and dry mouth of Sjogren’s syndrome by using over-the counter lubrication eyedrops and drinking water more frequently.
However, some people need prescription medications to reduce inflammation, such as:
Cyclosporine (anti-inflammatory drops)
What is autologous serum?
Autologous serum is customised eyedrop made from patient’s own blood diluted in sterile saline or hyaluronic acid.
It serves as lacrimal gland substitute to provide lubrication and its composition of the serum resembles that of tears.
It’s composed of a mixture of naturally occuring things in the body like:
Transforming growth factor B (TGF-B)
Immunoglobulin A (IgA)
Epithelial growth factor (EGF)
Vitamin C which promote healing of the ocular surface.
Autologous serum typically made in a concentration of around twenty percent. This is based on the concentration of biological factors in actual tears, although higher concentration have been used.
Research has shown autologous serum is more effective than over-the counter lubrication in patients with severe dry eye, This is because the serum is composed of a complex mix of growth factors, proteins, antioxidants and lipids which are not found in over-the counter lubrication eyedrops.
Some people may even need surgical procedures, to seal the tear ducts and help preserve tears on the eyes (i.e. punctal cauterisation).
Preservative vs preservative-free eye drops for severe dry eye
A variety of lubrication eyedrops are available over-the counter. Eyedrops with preservatives can be used up to four times a day. Preservatives help the eyedrop bottle to last longer.
However, preservatives drops more often can cause eye irritation in people with dry eye syndrome.
If you rely on eyedrops more than four times a day or allergic to preservatives, non-preservative drops are safer.
Lubricating eye ointments coat your eyes, providing longer lasting relief from dry eyes but are thicker than eyedrops and can cloud your vision.
Scleral lenses can provide significant pain relief for people with severe dry eye.
Regular soft contact lenses sit on the cornea, which can be extremely irritating and act as sponges soaking up moisture on the surface of the eye.
Scleral lenses, on the other hand, sit on the sclera, the white part of the eye and vault over the cornea.
These lenses do not touch the corneal surface at all, making this a very comfortable option.
Furthermore, when inserting a scleral lens into your eye, you first apply a saline solution which fills the gap between the cornea and the lens.
This provides moisture for the irritated eye and promotes healing by ensuring consistent hydration of the eye and shielding the cornea from external irritants, such as blinking from the eyelids and environmental irritants.
Scleral lenses significantly reduce discomfort, eye redness and simultaneously provide clear, crisp vision.
During this time of social distancing, can you still wear contacts?
Damon Ezekiel is current President of the International Society of Contact Lens Specialists (ISCLS). He is also a member of the Cornea and Contact Lens Society of Australia (CCLSA).
Here’s a position statement from CCLSA about Coronavirus and Contact Lenses.
Contact Lens Wear & COVID-19
There’s currently no evidence to suggest an increased risk of being infected with SARS-CoV-2, the novel coronavirus that causes the disease known as COVID-19, through contact lens (CL) wear.
For decades contact lens practitioners have advised thorough, correct hand-washing and strict hygiene practices for CL wearers in order to decrease the risk of eye infections.
There is however a history of a significant degree of non-compliance with proper hygiene techniques among CL wearers, and the general public at large.
Now more than ever it is critically important for a CL wearer to pay great attention to proper hygiene and for practitioners to strongly reinforce sound practices. This can be done at the time of consultation, or via Social Media, webinars, text messages, websites, email etc.
Contact Lens Wear is a safe activity with low rates of infections or other serious complications, despite poor compliance with safe practices.
Contact lenses, solutions and eye drops (where applicable) should be used, worn and replaced as prescribed by your eye care practitioner and according to manufacturer recommendations and expiry dates.
Storage case hygiene and care practices should be followed for reusable lenses.
Where possible, Daily Disposable Contact Lenses are advised as they improve compliance and reduce risks of complications in lens wear.
Cease Contact Lens Wear if Sick.
Practitioners have long advised against the wear of contact lenses if a wearer is unwell. This applies in particular to any signs or symptoms of colds and flu, respiratory tract infections, red sore eyes, discharge and so on.
Basically, if someone is feeling unwell they should terminate contact lens wear.
For healthy individuals, normal contact lens wear can be maintained. This advice has been around since long before COVID-19 but is even more critical now.
Public health organisations and government health officials are releasing information to ensure that people receive the right advice, care and support regarding COVID-19.
There are those with severe eye conditions who cannot function without contact lenses and cannot see with spectacles or while unaided. These wearers should liaise with their practitioner if unwell and seek specific advice to reduce risk of complications.
Please follow our latest updates via our Facebook page.
Advice for Contact Lens Wear & Care
In summary current advice is:
Contact lens wear is safe and can be maintained by healthy individuals.
Contact lens wear does not appear to increase the risk of developing COVID-19, compared to spectacle lens wearers, or those with normal vision who do not need any corrective devices. To date there is no known research suggesting any such link or risk.
It should also be noted that contact lenses provided by leading manufactures are manufactured in sterile conditions and the lenses are safe to wear. The majority of contact lenses provided on the market are in a state ready for wear. Customised lenses should be disinfected before use.
Contact Lenses obtained from dubious sources, including counterfeit lenses and those offered through unlicensed premises and providers should be avoided as these may not be sterile or safe to wear. Always seek professional advice and consult with your eye care provider. In these troubled times it may be best to call ahead before making an appointment.
In case of emergency visit your nearest eye hospital or clinic.
Avoid touching your eyes, face, nose and lips as far as possible and avoid eye rubbing.
There are a few basic messages we can apply to contact lenses.
Your eyes should ‘Look Good’, ‘See Good’ and ‘Feel Good’.
If in doubt, take them out and seek professional assistance.
Proper Handwashing: A Cornerstone of Safe Contact Lens Wear
Thoroughly WASH HANDS before:
Handling Contact Lenses and CL cases.
Applying contact lenses, even for brand new lenses direct from the pack. The aim is to prevent spreading any nasty pathogens (bugs, bacteria, fungi, viruses etc) from hands or fingers to the lens and therefore the eye.
The same applies to removing contact lenses from the eye.
Whether an optometrist, ophthalmologist, dispensing optician, assistant, technician or contact lens wearer, the importance of basic hand washing and hygiene with contact lenses is critically important and cannot be stressed enough!
There are many strong messages from numerous health organisations around the world that support our aforementioned guidance and advice urging people to properly wash their hands to help prevent infection or spread of novel coronavirus.
The US-based Centers for Disease Control and Prevention has issued COVID-19 guidance stating that eyes should not be touched with unwashed hands.
Advice provided by the CCLSA in this communication, is current at the time of dissemination, but may not be best practice as circumstances change and the knowledge base and understanding surrounding the COVID-19 crisis develops. The CCLSA provides this information in good faith with the intent of improving safety, best practice and ultimately saving lives. Opinions expressed via links or otherwise, do not necessarily reflect the views of the CCLSA.
Please stay up to date by consulting the resources conveyed in this document, elsewhere through reliable sources, and via our CCLSA newsletter, Facebook page and communications.
Our doors might be closed but we are still happy to see you!
At Ezekiel Eyes, we want to ensure that we can continue to look after our patients’ vision during these challenging times.
We have temporarily closed our practice for the majority of the time, however Damon and Felix are still ready, willing and able to help you. We can arrange specific consultations at any time, so please don’t hesitate to contact us by phone call or SMS as follows:
Damon Ezekiel 0417 862 886 Felix Sugiarto 0421 182 552
You can also contact us through Facebook Messenger (tap button below)
Ezekiel Eyes is committed to helping to reduce the spread of COVID-19. Please be assured that we are doing all we can to implement the highest levels of hygiene and cleanliness at the practice.
We truly appreciate your patience and support during this uncertain period. We are closely following the advice of the Australian Government and will update you if anything changes.
What is keratoconus? Keratoconus is a thinning of the central zone of the cornea, the front surface of the eye. As a result of this thinning, the normally round shape of the cornea is distorted and a cone-like bulge develops, resulting in significant visual impairment.
What causes keratoconus? The cause of keratoconus remains unknown, although recent research seems to indicate that it may be genetic in origin. Certainly, some cases of keratoconus have a hereditary component and studies indicate that about 8% of patients have affected relatives. If there is no evidence of keratoconus in successive generations of a family, there is less than a 1 in 10 chance of the children of a person with keratoconus also having the condition. Excessive eye rubbing has also been implicated as a causative factor.
How common is keratoconus? Keratoconus is estimated to occur in 1 out of every 2000 persons in the general population. There appears to be no significant preponderance with regards to either men or women.
What are the signs and symptoms of keratoconus? The initial symptoms of keratoconus are usually a blurring and distortion of vision that may be corrected with spectacles in the early stages of the condition. Frequent changes to the spectacle correction may be required as the cornea becomes progressively thinner.
What is the usual age of onset of keratoconus? The onset of keratoconus can be anywhere between the ages of 8 and 45. In the majority of cases, it becomes apparent between the ages of 16 and 30 years.
Does keratoconus affect both eyes? Yes, keratoconus generally affects both eyes. Only in a very small percentage of cases (<1%) is there just the involvement of one eye. Even though keratoconus is basically a bilateral condition, the degree of progression for the two eyes is often unequal; indeed, it is not unusual for the keratoconus to be significantly more advanced in one eye.
Is keratoconus associated with any other diseases or disorders? Keratoconus has been associated with conditions such as hay fever, asthma, eczema, double jointedness, Down’s syndrome, Marfan’s syndrome and mitral valve prolapse.
Does keratoconus cause blindness? Keratoconus does not cause total blindness. However it can lead to significant vision impairment resulting in legal blindness.
How is keratoconus treated? In the early stages of the condition, spectacles are usually successful in correcting the myopia and astigmatism associated with the keratoconus. As the condition advances, the cornea becomes highly irregular and vision is no longer adequately corrected with spectacles. Rigid contact lenses are then required to provide optimal visual acuity. Soft contact lenses are usually not an option, as they cannot correct for the irregular astigmatism associated with the keratoconus. In about 15% of cases, the keratoconus progresses to the stage where corneal transplantation is required.