Dry Eyes

Dry Eye

Dry eye syndrome is an eye disorder caused by reduced tear production (hypolacrimia), excessive tear evaporation or altered tear quality and composition (dyslachrymia).

Since 2013 Dr. Lodovico Dubini has been working with dry eye in his practice in Samedan.

"About 30 percent of my patients suffer from it," says Dubini, "about three million people throughout Switzerland could have this problem.

What sounds like a general term is a recognised disease, known in international medical terminology as "Dry Eye Disease". The symptoms are watery, reddened eyes, sensitivity to light, itching, foreign body sensation, visual disturbances when driving a car or in front of the television/computer screen.

What are the causes of dry eyes?

 The natural ageing process, especially the menopause

 Diseases that affect the ability to produce tears, such as Sjogren's syndrome, rheumatoid arthritis and collagen vascular disease

 Conjunctivitis

 Environmental conditions. Exposure to smoke, wind and dry climate can increase tear evaporation and cause symptoms of dry eyes.

 Insufficient regular blinking and problems that do not allow the eyelids to close properly

 Treatment with cataract surgery

 Treatment with medicines including antihistamines, decongestants, blood pressure medicines and antidepressants

 Other factors. Long-term wearing of contact lenses can lead to dry eye

 Refractive eye operations, such as LASIK, can reduce the production of tears.

"This is not only a multifactorial but also a chronic disease that affects more and more people," says the ophthalmologist. Until recently, treatment was limited to the administration of drops to improve eye hydration. The results were unsatisfactory. "In many patients no cure was achieved". According to Dubini, the reason for this is the inaccurate diagnosis and the corresponding summary therapy.

Diagnosis

Our practice is specialised in the diagnosis and treatment of dry eye.

First, the patient receives the OSDI questionnaire (Ocular Surface Disease Index - 1995), which allows the symptoms to be analysed and classified using an international scale of values.

The osmolarity test and the evaluation of the stability of the tear film with fluorescein allow a first assessment of dry eye.

Hydra: the final limit for the diagnosis of dry eye

Hydra is the new tear film analysis tool that analyses all layers: lipid, aqueous, mucin. In this way we can identify the type of dry eye and determine which layers can be treated with a specific treatment depending on the type of deficiency. Hydra is also useful for follow-up, allowing us to evaluate the improvements achieved with the treatments.

Innovative therapies (BlephEx therapy)

Eyelid inflammation (Blepharitis)

The meibomian glands located in the edges of the eyelids form the so important fat part of the tear film. If these glands are blocked, only insufficient amounts of fat are released: the tear film evaporates too quickly, causing the surface of the eye to dry out. Two things happen as a result:

 The eye remains dry and becomes inflamed, which in turn affects the Meibomian glands. A vicious circle develops.

 The eye tells the brain that the surface is dry. As a result, the brain produces more water and the eyes overflow. Paradoxically, if the eye is too dry, it will continue to water over and over again.

Treatment: Eyelid margin cleaning

The inflammation of the eyelid margin is improved by regular cleaning of the eyelid margin. This also improves the dry eye. The aim is to reactivate any congested sebaceous glands. In a first step, you clean the eyelid margin with a special solution. Then warm the edge of the eyelid with a special eye mask: sebum consists of fat. The warmer fat becomes, the thinner it is. The now thin sebum can now be spread out by gentle massage. Massage the upper and lower eyelids with gentle circular movements.

BlephEx therapy: deepening of the eyelid margin

The BlephEx therapy is a deep cleaning of the edge of the eyelid with a BlephEx device. This cleaning is carried out in our institute and takes about 20 minutes. If there is pronounced inflammation of the eyelid edges, this therapy should be carried out twice a year.