Looking after your eyes is an important part of your overall health and wellbeing.
Regular eye examinations allow us to monitor your vision and the internal structures of your eyes, often detecting changes long before you notice any symptoms.
At D.I. Blow Opticians, we take the time to check your eye health thoroughly, explain what we see and answer your questions clearly. By understanding how your eyes work and recognising early signs of change, we can help protect your vision for the years ahead.
Simple tips for healthy eyes.
Have a comprehensive eye exam.
You might think your vision is fine or that your eyes are healthy, but visiting your eye care professional for a comprehensive eye exam is the only way to really be sure. When it comes to common vision problems, some people don’t realize they could see better with glasses or contact lenses. In addition, many common eye diseases such as glaucoma, diabetic eye disease and age-related macular degeneration often have no warning signs. An eye exam is the only way to detect these diseases in their early stages.
Know your family’s eye health history.
Talk to your family members about their eye health history. It’s important to know if anyone has been diagnosed with a disease or condition, since many are hereditary. This will help to determine if you are at higher risk of developing an eye disease or condition.
Eat right to protect your sight.
You’ve heard carrots are good for your eyes. But eating a diet rich in fruits and vegetables, particularly dark leafy greens such as spinach, kale or collard greens is important for keeping your eyes healthy too. Research has also shown there are eye health benefits from eating fish high in omega-3 fatty acids, such as salmon, tuna and halibut.
Maintain a healthy weight.
Being overweight or obese increases your risk of developing diabetes and other systemic conditions, which can lead to vision loss, such as diabetic eye disease or glaucoma. If you are having trouble maintaining a healthy weight, talk to your doctor.
Wear protective eyewear.
Wear protective eyewear when playing sports or doing activities around the home. Protective eyewear includes safety glasses and goggles, safety shields, and eye guards specially designed to provide the correct protection for a certain activity. Most protective eyewear lenses are made of polycarbonate, which is 10 times stronger than other plastics. Many eye care providers sell protective eyewear, as do some sporting goods stores.
Quit smoking or never start.
Smoking is as bad for your eyes as it is for the rest of your body. Research has linked smoking to an increased risk of developing age-related macular degeneration, cataract, and optic nerve damage, all of which can lead to blindness.
Be cool and wear your shades.
Sunglasses are a great fashion accessory, but their most important job is to protect your eyes from the sun’s ultraviolet rays. When purchasing sunglasses, look for ones that block out 99 to 100 percent of both UV-A and UV-B radiation.
Give your eyes a rest.
If you spend a lot of time at the computer or focusing on any one thing, you sometimes forget to blink and your eyes can get fatigued. Try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds. This can help reduce eyestrain.
Clean your hands and your contact lenses properly.
To avoid the risk of infection, always wash your hands thoroughly before putting in or taking out your contact lenses. Make sure to disinfect contact lenses as instructed and replace them as appropriate.
Practice workplace eye safety.
Employers are required to provide a safe work environment. When protective eyewear is required as a part of your job, make a habit of wearing the appropriate type at all times and encourage your co-workers to do the same.
Understanding Your Eyes...
Your eyes are finely tuned, working together to focus light and send visual information to your brain. Each part plays a role in helping you see clearly.
Hover over each dot to find out more.
Iris
Controls how much light enters the pupil.
Lens
Further refracts light to focus it onto the retina
Cornea
Refracts light – bends it as it enters the eye
Pupil
Sclera
Tough white outer layer of the eye. It helps protect the eye from injury
Retina
Contains the light receptors.
Common Eye Health Conditions
- 20 Million British people risk avoidable sight loss because they fail to have regular sight tests.
- One in ten British adults have NEVER had an eye examination.
- 85% of us admit to having problems with our vision.
- More than 30 million Britons are entitled to FREE eyecare (sight tests and / or optical vouchers to cover the cost of any vision correction required) paid for by the NHS.
- Everyone should have an eye examination once every two years unless advised otherwise by their optometrist. The Eye Care Trust recommends children aged under 9 and people aged 70 and over have annual eye examinations.
- It’s estimated that 1 in 5 children has an undetected problem with their vision.
- Fifty per cent of us think an NHS sight test costs £20 or more, despite it being free!
- A quarter of over 60 year olds say the quality of their vision affects their daily routine.(Source of information. The Eyecare Trust)
Don’t put your eye sight at risk – Be sure to have regular eye examination.
In Myopia (short sightedness), the eye is longer than normal or the cornea is too steep, so that light rays focus in front of the retina. Near objects are clear, but distant objects appear blurred. For the most part, this is an inconvenience considering how frustrating it can be to be dependant on contact lenses or spectacles. In addition, eyes with a high degree of Myopia are at an increased risk of developing a serious condition like retinal detachment or glaucoma.
In Hypermetropia (long sightedness), the eye is shorter than normal or the cornea is too flat, so that light rays focus behind the retina. Light rays from close objects such as pages of a book cannot be focused on clearly by the retina. Someone with hypermetropic eyes may find their vision is blurred when looking at objects near to them, and for vision to be clearer when looking at far away objects. Placing a plus powered (convex) lens in front of a hypermetropic eye allows the image to be moved forward allowing for correct focus on the retina.
A degree of long-sightedness is common in many people, although this only presents a problem when our ability to see is significantly affected or where headaches and eye strain are common.
When we are young, the lens in the eye can change its shape allowing us to focus on near objects. After the age of 40, the lens becomes noticeably more rigid and reading at close range becomes increasingly difficult. This condition is called presbyopia and is a normal part of ageing.
What are the symptoms of Presbyopia?
Presbyopia is usually first noticed by difficulties reading in low light. Often, you may find it will take longer for eyes to refocus from reading to distance and from distance to reading. Spectacles may be required to give additional focusing power to the eye as reading proves more problematic.
The distance of reading dictates which power you would require. For example, looking at a computer screen will require a different power for reading a book. We will ask you about your lifestyle and take this into account when prescribing your reading addition to ensure clarity of vision for the required visual task.
What is Glaucoma?
Glaucoma is the name for a group of eye conditions which damage the optic nerve. This nerve carries information from the light sensitive layer in your eye, the retina, to the brain where it is perceived as an image. The retina can be thought of as akin to the ‘film’ of a camera where light is focused. The information is then sent along the optic nerve.
All glaucomas have certain key features in common. These are increased pressure inside the eye, ‘cupping’ of the optic disc, and loss of the peripheral visual field. Any two of these 3 features is usually enough for there to be very strong risk of having glaucoma.
What controls pressure in the eye?
The eye is filled primarily with water based substances and liquids. Think of there being a ‘tap’ inside the eye – constantly producing fresh liquid. This ‘tap’ is a layer of cells behind the iris (the coloured part of the eye). The fluid produced is called ‘aqueous’. This liquid is inside the eye, and is not connected to the tears.
The eye also has a ‘drainage’ system. The drains are located at the front of the eye, between the edge of the cornea and the iris.
So, increased pressure in the eye is due to increased production of fluid, or decreased drainage of fluid from the eye (or a combination of both).
How does increased pressure damage the nerve?
The mechanism of damage is unclear. Certainly, when the pressure goes up very suddenly (as in acute glaucoma), there is clearly a lack of blood supply to the nerve head in the eye. There are various other theories as to how the nerve damage actually occurs.
What is certainly known, is that LOWERING this pressure delays the progression of glaucoma. In sudden acute glaucoma, lowering the pressure can save the sight in an eye which is otherwise destined to lose vision.
How common is Glaucoma?
It is one of the commonest reasons for blindness in the Western world. There are several different types. These include chronic simple glaucoma (the commonest type), acute glaucoma, congenital glaucoma and secondary glaucoma`s which arise secondary to some other condition or influence.
Who gets chronic Glaucoma?
There are several ‘risk factors’ for developing chronic glaucoma. These are:
- Age – Chronic glaucoma is uncommon below the age of 40, but affects 1% of people over this age and 5% over 65.
- Race – People of Afro-Carribean origin have an increased risk of developing glaucoma.
- Family History – There is a ‘genetic’ element to glaucoma. If a close relative (parent/sibling) has Glaucoma, you should not worry, but ensure you have regular check-ups to detect any changes as early as possible, should they ever occur.
- Myopia – Very short sighted people are more at risk of developing chronic glaucoma.
Why can untreated chronic Glaucoma cause serious loss of sight?
The main reason is that chronic glaucoma usually has NO SYMPTOMS. There is no pain and your eyesight will seem to be normal too, but silently, your vision is slowly deteriorating. Glaucoma tends to damage the peripheral field of view first so is not noticed by most. Only when the peripheral field has been significantly damaged, do some people start bumping into things, or see oncoming vehicles at the last minute for example.
How is chronic Glaucoma detected?
There are few tests that can help detect glaucoma. These are:
Measuring the pressure inside the eye – often a puff of air or a special contact ‘tonometer’.
Examination of you ‘visual field’ – usually, a machine where you press a button when you see lights in your peripheral vision.
Examination of your optic nerve by your optometrist.
All these tests are very straightforward, don’t hurt and are be done by our optometrists at the practice.
Can chronic Glaucoma be treated?
YES. A simple regimen of daily drops to the eye can delay progression of glaucoma in the vast majority of people. Sometimes, an operation called Trabeculectomy is required. Both of these treatments have been shown to be very effective indeed.
Acute Glaucoma
What is acute Glaucoma?
This is a form of glaucoma where the pressure inside the eye shoots up very suddenly. It happens because of a physical blockage of the drainage channels inside the eye at the ‘angle’ of the eye (where the cornea meets the iris). This is why it is often referred to as ‘Angle Closure Glaucoma’.
What are the symptoms of acute Glaucoma?
Severe Pain – often, people wake up in the night with a very severe pain in 1 eye (although it can happen in both eyes simultaneously – this is uncommon).
Redness of the eye.
Blurred Vision – sometimes ‘haloes’ can be seen around bright lights.
Nausea & Vomiting.
How is the Acute Glaucoma treated?
Acute glaucoma is initially treated with powerful drugs to help bring down the pressure inside the eye very rapidly. Subsequently, depending on the nature of the cause of the attack, drops, laser, and surgery are the various options available to the surgeon.
A similar treatment, usually with laser only, is usually performed in the other eye, to ensure the same acute attack cannot happen there too.
Approximately 3% of the population is affected by diabetes. Increases in the blood glucose concentration (hyperglycaemia) occur when there is a lack of naturally produced insulin in the body. There are two main types of diabetes, Type 1 (Insulin Dependent) which affects those with damage to certain cells in their pancreas and usually occurs for individuals in their teens. Insulin injections must be administered regularly. Type 2 (Non-Insulin Dependent) diabetics do not necessarily have to inject insulin and often has a later onset (50+ years). It can be controlled through good diet and with the occasional use of tablets.
Any diabetic should have their internal eye health checked annually using pupil dilation in conjunction with retinal camera photography. These images will be archived for future comparison. The diabetic retina characteristically shows a progression of circumstances including different types of “exudates”, “haemorrhages”, “cotton wool spots” and ultimately end-stage retinal detachment. Although, with good blood glucose regulation most diabetics can prevent significant eye damage.
While the partial treatment offered (photocoagulation) can be effective, the best means of prevention is accomplished solely through good diabetic respect and frequent eye assessment.
What is Macular Degeneration?
Age-related macular degeneration (ARMD) is the commonest cause of vision loss in people aged over 50 years old. The prevalence (number of new cases each year) increases with age. It is caused by degeneration of the macula, the central and most sensitive part of the retina at the back of the eye.
What is the Macula?
The macula is the central part of the retina which is responsible for enabling fine detail to be discerned. The remainder of the retina enables ‘peripheral vision’ only. Without the use of the macula, tasks like reading small print and recognising faces become difficult or impossible. The macula contains a yellow pigment (hence the term macula lutea).
The disease becomes increasingly more common amongst people in their 60s and 70s. By the age 75, almost 15% of people have this condition to some extent. The biggest risk factor is thus age. Other risk factors are a family history of the condition, cigarette smoking, and being white caucasian.
What are the types of ARMD?
There are two main types of ARMD often termed ‘Dry ARMD’ and ‘Wet ARMD’. The pathological process is different between the two. In the wet form, there is a proliferation of abnormal blood vessels under the macula. In dry ARMD, there is the collection of small yellow deposits within the retina called drusen, and degeneration (atrophy) of the retinal tissue at the macula. The dry form is more common, but the wet form is usually more sudden and devastating to the vision.
The paler elevated area at the macula represents the area where the retina is elevated, under which there is an abnormal ‘membrane’ due to abnormal proliferation of blood vessels.
What does ARMD do to the vision?
ARMD affects only the central area of the vision. The condition thus never causes complete blindness or loss of sight.
Is there any treatment for ARMD?
Currently, there is no cure for ARMD. The risk of developing ARMD can be reduced by not smoking. Studies have given us some evidence that a diet rich in antioxidants and certain pigments (found in dark green vegetables like broccoli and kale) may reduce the risk of progression of the disease process.
For a very small percentage of ‘wet’ ARMD cases, a treatment called ‘Photo Dynamic Therapy’ (PDT) may be used to reduce the risk of further visual deterioration.
LUCENTIS Injections
There is now a NICE (National Institute for Health and Care Excellence) approved treatment for wet ARMD called LUCENTIS. This is known as an ‘Anti-VEGF’ agent. VEGF is an acronym and stands for Vascular Endothelial Growth Factor. Lucentis is able to reduce the proliferation of the abnormal blood vessels that grow under the retina in wet ARMD. The drug is administered by injection into the eye. A minimum of 3 injections are required, with the average number of injections required being 7.
LUCENTIS has been shown to significantly improve the final visual outcomes for a large proportion of patients with wet ARMD. However, the treatment only works in the early stages of disease onset, and is not effective once the wet ARMD has caused chronic scarring of the retina.
Cataracts are extremely common. In fact, the majority of those over 65 have some cataract development. If you have been told you have cataracts, DO NOT be alarmed.
The word “cataract” comes from the Greek word “Cataracti”, which means waterfall. The lens can appear to look a bit like a waterfall when the cataract is quite advanced.
What is a Cataract?
A cataract simply refers to ‘opacity of the lens’ inside the eye. Looking through a cataract can be thought of as a little bit like looking through an old stained piece of glass – instead of a clear new sheet.
There are many different types of cataract. Not all cataracts cause symptoms. If a cataract causes no symptoms, it can usually be left alone. If symptoms such as blurred vision occur, then cataracts can be treated very successfully with surgery.
What is the lens?
The lens of the eye is a transparent body located behind the iris (the coloured part of the eye). The lens is able to change shape, and in doing so, is able to accommodate to keep things focused on the retina at the back of the eye.
What are the causes of a Cataract?
Cataracts are commonest in older people. However, they can occur at any age. some children are born with cataracts (congenital cataracts).
Cataract are associated with the sun – and so are far more common in areas of the world such as India & Africa. Other causes include injury, diabetes, certain drugs, and some ocular diseases.
What are the common symptoms of Cataracts?
For most people, the main complaint is some deterioration in the quality of vision. Most people usually feel they just need another sight test to get their glasses updated.
Sometimes, people can complain of a ‘shadow’ behind objects they are looking at.
Certain types of cataract can cause glare in bright light conditions.
Because cataracts normally develop very slowly, over many years, most people don’t notice the gradual deterioration in their vision until it starts to interfere with their daily activity or indeed, it is spotted by their optometrist.
How are Cataracts treated?
The most effective treatment for cataracts is an operation to remove the cataract, and replace the cloudy lens with a clear artificial lens implant.
The lens of each eye should be clear in order for your eyes to work properly. The clear lens allows light to reach the retina at the back of the eye, which enables you to see things. With a cataract, less light can reach the retina, so your vision is affected. A cataract can be present for a while before you notice you have one. If you have a cataract, it will continue to develop. When spectacles can no longer improve your vision, the only way to restore your vision is by having the cataract removed by surgery.
The Cataract operation
Cataract surgery is one of the most common and quickest surgeries performed today. Modern cataract surgery (called phacoemulsification) is usually performed under local anaesthetic as a day case procedure. During the surgery, a tiny incision is made into the eye and the lens removed with an ultra-sound probe. The capsule of the lens is left behind and this is used to house the new lens implant. The whole procedure takes between 15 and 20 minutes, and the visual recovery is very quick with most patients noticing improved vision within a matter of days.
Lens implant types
Each patient and each eye is different. Measurements are taken prior to surgery (called biometry) to establish the correct lens power for the individual eye. Lens implants also come in different types. The two major categories of lens implant are:
Monofocal lenses
(the vast majority of patients have this lens type put in). These provide good distance vision but glasses are required for close work.
Multifocal lenses
These lenses offer a high probability of achieving spectacle independence i.e. providing patients with the ability to see far as well as to read without glasses.
Multifocal lenses have been shown to offer a high chance of reducing dependence on glasses for near and middle distance vision. However, patients can experience a reduction in contrast sensitivity (especially in dim lighting), as well as halos and glare around lights at night. Some patients are prepared to accept these visual effects because they are very keen to reduce their reliance on glasses.
The pre-operative preparations for patients interested in multifocal lens implants are more involved than when monofocal lenses are being used, a wider range of issues needs to be discussed and the post-operative management is more intensive. These are the major reasons that these lenses are not offered on the NHS.
There are three types of retinal detachments. The most common form is where a break in the retina’s sensory layer causing fluid to seep underneath. This eventually causes a separation in the layers of the retina. Individuals who are particularly short sighted, with historic eye injuries or who have undergone eye surgery are most susceptible to this type of detachment. This is due to the thinner and more fragile retina in short sighted people. The second most common type is due to increased traction on the retina by strands of scar or vitreous tissue which can ultimately pull the retina loose.
The third most common type occurs when small pockets of liquid form within a special gel (the virtreous) which usually lines the inside of the eye. Eventually, some of this fluid moves in between the gel and the retina, causing the vitreous to peel away from the retina. The retina, which is like the film of a camera, is then able to see the outer part of this gel floating inside the eye – and this is what causes floaters. Sometimes, when the vitreous gel comes away from the retina, it can cause a hole or tear to appear in the retina. This is because the vitreous gel sometimes has areas where it is strongly attached to the retina. As the gel falls away from the retina (a bit like wall-paper falling from the wall), the gel can tear the retina (like the wallpaper may take a piece of paint or plaster from the wall).
If a hole or tear develops in the retina, then there is an increased risk of there being a retinal detachment. A detached retina can cause loss of vision, and requires a surgical operation to put the retina back in the right place. Thus, it is very important that you have your eye examined urgently on the onset of symptoms. There are other less common reasons for floaters – e.g. bleeding into the gel in the back of the eye from a blood vessel (usually in diabetic patients).
Floaters are extremely common, and are sometimes associated with flashing lights in the eye, especially when they first appear. When they first appear, they normally affect one eye, but may affect both eyes at the same time.
In fact, they’re so common, that approximately two thirds of the population will have floaters by the time they are in their mid sixties! However, they can occur at any age.
What do Floaters look like?
Most people describe floaters as little ‘blobs’ or ‘cobwebs’ or ‘string like’ or ‘amoeba like’ features that move around in the eye, and can be best seen when looking at a light plain surface. However, floaters can take any number of appearances and are different in everybody.
What causes these Floaters?
The commonest cause of floaters is called ‘vitreous detachment’. The main section of the eyeball is filled with a special gel known as ‘the vitreous’. Normally, the gel fills the back of the eye, and so the outer part of the gel is in contact with the retina (which lines the inside of the eye).
As we get older, small pockets of fluid form within the gel. Eventually, some of this fluid moves in between the gel and the retina, causing the vitreous to peel away from the retina. The retina, which is like the film of a camera, is then able to see the outer part of this gel floating inside the eye – and this is what causes floaters.
Sometimes, when the vitreous gel comes away from the retina, it can cause a hole or tear to appear in the retina. This is because the vitreous gel sometimes has areas where it is strongly attached to the retina. As the gel falls away from the retina ( a bit like wall-paper falling from the wall), the gel can tear the retina ( like the wallpaper may take a piece of paint or plaster from the wall).
What causes the Flashing Lights?
As the gel comes away from the retina, the tractional pull on the retinal tissue causes the flashing lights in the eye. Once the traction has ceased, the flashing lights normally subside.
Why do I need my eye examined if I have new onset Floaters and/or Flashing Lights?
The vitreous detachment may tear the retina. If a hole or tear develops in the retina, then there is an increased risk of there being a retinal detachment. A detached retina can cause loss of vision, and requires a surgical operation to put the retina back in the right place. Thus, it is very important that you have your eye examined urgently on the onset of symptoms. There are other less common reasons for floaters – e.g. bleeding into the gel in the back of the eye from a blood vessel (usually in diabetic patients).
Should I be worried about Floaters?
Most floaters are innocuous and there is no need to worry. However, if you have had new onset of floaters, then you need to have your eyes examined by an optometrist as a matter of urgency. THIS IS ESPECIALLY IMPORTANT IF YOU ARE SHORT SIGHTED.
By seeing an optometrist early, if there is a problem, it can be diagnosed and treated before it progresses into something more serious.
Dry eyes occur when the eyes either don’t make enough tears, or the quality of the tears produced is reduced, which means the tears can evaporate rapidly from the surface of the eye, allowing the eye to dry. Often, the reduced tear quality is a result of blockage or inflammation of the oil glands within the lid margin. When the surface of the eyes dry out, the eyes become inflamed. They appear red, and the whites of the eyes can appear to be pink and swollen. Normally, the eyes become very irritable. When seen on a microscope, using a fluorescent dye called fluorescein and a special cobalt blue light, the denuded surface areas can be seen as green specks on the surface of the eye.
Dry Eyes can be divided into two broad categories
If the main problem is a lack of tear production, then the term ‘keratoconjunctivitis sicca’ or ‘aqueous deficiency’ is used. However, if the main problem is poor quality of tears (but plenty of them) as a result of inflammation or blockage of the oil secreting glands in the lid margin, then the condition is called ‘obstructive meibomian gland disease’, more commonly referred to as blepharitis.
Who gets Dry Eye Syndrome?
It is more common in women than men, and is found most commonly in the over 60s age group. However, it can happen at any age.
What are the symptoms of Dry Eye Syndrome?
The symptoms can be extremely variable, causing anything from mild irritation to severe discomfort.
Symptoms include
- Foreign body sensation/feels like something is in the eyes
- Eyes feel ‘gritty’ – often worse in the mornings
- Blurred vision
- Burning sensation in eyes
- Irritable eyelids
- Light sensitivity
- Redness of the whites of the eyes
- Painful eyes
- Excessive watering
In Dry Eyes, why do the eyes sometime water excessively? How can the eyes be dry if they are watering all the time?
This a paradox which is explained as follows:
Blinking spreads a tear film over the surface of the eye – the eyelids do the opposite to what a windscreen wiper does on a car. The eyelids spread a thin film of tears over the front of the eye. When there are not enough tears, or if the quality of tears is poor, the surface of the eye becomes dry, and this causes inflammation.
Special receptors on the surface of the eye are then stimulated by this inflammation, which causes a ‘reflex tear production’. This leads to the main tear glands to literally ‘switch the tap on’ in an attempt to wet the dry surface. The result is often the production of excessive watery tears (as opposed to oily tears), which results in watering of the eyes.
What causes Dry Eye Syndrome?
- Ageing over 60’s are the commonest group to suffer
- Hot, dry or windy climates – causes evaporation of tears
- Inflammatory diseases – e.g. Rheumatoid arthritis affecting joints, is associated with higher risk of dry eyes.
- Side effects from medications – e.g. The oral contraceptive pill
Does Dry Eye Syndrome cause loss of vision?
Normally dry eyes causes no visual deterioration. However, in severe cases where the eye is allowed to dessicate, the cornea may scar and this could cause reduced vision.
How is Dry Eye Syndrome treated?
There is no absolute ‘cure’ for dry eye syndrome. However, most people can get significant relief from symptoms using a variety of treatments and measures.
Lid Margin Hygiene
If the underlying cause is blepharitis/lid margin disease, then treating this can often improve the ocular surface and reduce symptoms.
This can be done by simply applying a hot compress using hot tap water and a clean flannel to the eye each day, and then cleaning the lid margin with the water and flannel. Some people recommend using chemicals such as baby shampoo and sodium bicarbonate, but more often than not, these can cause ocular surface irritation, and so at least initially, are best avoided.
Lubricants
Regular lubrication in the form of gels or drops can help keep the surface of the eyes wet, and thus reduce symptoms. Often, this is combined with lid margin hygiene.
There are a wide range of eye drops available – consult our optometrist for advice on which one to use.
Tear Duct Surgery
When there is severe dry eye with reduction in tear production, blocking the drainage of tears down the tear ducts can help keep the tears that are produced on the surface of the eye.
Temporary plugs are normally inserted first. In some cases, permanent closure with surgical cautery may be used.
Other Measures
Diet omega-3 oils and flax seed oil in the diet may help improve tear quality.
‘Think Blink’
When concentrating (e.g. using a computer or driving), we can blink up to 5 times less often, leading to increased tear evaporation. Remembering to blink more often can help keep the eye surface wet.
Humidifiers
Moist air leads to less evaporation of tears. Avoiding air conditioned environments and direct heat (e.g. an open fire or heat from a cooker) can help for the same reason.
How is Blepharitis diagnosed?
Blepharitis refers to inflammation of the eyelid margins. There are two broad categories of the condition – Anterior Blepharitis and Posterior Blepharitis.
Anterior Blepharitis
affects the front part of the eyelid margin, near the roots of the eyelashes. It is commonly caused by bacteria that normally live on our skin, that produce an irritative toxin that causes inflammation. The lid margin often looks ‘crusty’ and when seen under a microscope, the appearance can be similar to dandruff. Anterior Blepharitis can cause the eyelids to become red, itchy and sometimes slightly swollen too.
Posterior Blepharitis
is also referred to as Obstructive Meibomian Gland Disease. The meibomian glands are located within the eyelid, and the pores of the glands open onto the lid margin, behind the roots of the eyelashes. The glands normally produce a special oily secretion for the tears. The meibomian glands sometimes become inflamed and blocked, causing a reduction in amount, and disturbance in quality of the oily secretions. This can not only cause eyelid margin irritation, but also has secondary dry eye effects on the ocular surface.
Who gets Blepharitis?
Blepharitis is very common indeed – 5% of eye problems in primary care are said to be related to blepharitis. People of any age can be sufferers, but it is more common in older people over the age of 50. It is not something ‘caught’ or inherited. The reason for some people developing blepharitis is poorly understood.
What are the symptoms of Blepharitis?
People who have blepharitis may not suffer from any symptoms at all. However, for those that do report symptoms, one or any combination of the following symptoms are common:
- Irritation of the eyelids and/or eyes
- Redness of the eyes
- Sore eyelids – sometimes red and swollen lid margins
- Crusting of the eyelid margins
- Eyelids may stick together on waking in mornings
- Burning and tearing of the eyes
- Gritty sensation in eyes
- Pain on looking at bright lights (photophobia)
- Small eyelid margin cysts
How is Blepharitis diagnosed?
Blepharitis is normally diagnosed in primary care by GPs on the clinical history alone. When a slit lamp microscope is available, for example at the optometrist’s or ophthalmologist’s clinic, the lid margin can be examined closely. Simple visualisation of the lid margin along with the history is how the diagnosis is normally made.
How is Blepharitis treated?
Unfortunately, there is not a definitive cure for blepharitis. There are many different ways clinicians have managed patients with blepharitis over the years. The fact there is not a definitive treatment is an indicator that no single treatment works significantly better than all others.
Lid Margin Cleaning
Both types of blepharitis can be helped with what is commonly referred to as ‘lid margin hygiene’. Put simply, this means regular cleaning of the lid margins. The use of the following regimen works for most people. The use of additives to water such as baby shampoo or sodium bicarbonate may actually increase the amount of irritation, and so at least initially, this is not recommended. Use clean hot tap water (boiled sterile water is not necessary).
- Take a clean flannel and soak in hot tap water (not too hot).
- Place the flannel onto the closed eye and apply gentle pressure for 30 seconds to 1 minute, or until the flannel cools.
- Then, take the flannel, and again wet with hot clean tap water.
- Use this flannel to scrub along the lid margin (top and bottom eyelids), being sure to scrub the area at the roots of the lashes. Do this for a good 30 seconds to 1 minute. Don’t use cotton wool, as it is too smooth and doesn’t remove debris as well as a simple clean cloth.
- Repeat on the other side.
Carry out this cleaning regimen twice a day for at least a month. Most people will experience a reduction in symptoms. If not, seek expert help from your optometrist who will be able to make further recommendations, or refer you to an ophthalmologist, if required. Other management measures are briefly mentioned below.
Avoid Irritants
Minimising chemical irritants that include certain eye drop preservatives and makeup can help reduce blepharitis symptoms.
Dietary Changes
There is some evidence to suggest omega 3 oils such as those in Flax seed can improve the quality of meibomian gland secretions.
Antibiotics
Occasionally, if there is marked bacterial anterior inflammation, or if there is an associated skin condition such as seborrheic dermatitis, or even Rosacea, your doctor may prescribe antibiotic eye ointment, or indeed oral tablets.