Ocular surface disease is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance and tear film instability with the potential to damage the ocular surface. It is accompanied by increased osmolarity (saltiness) of the tear film and inflammation of the ocular surface.

This general term is used to describe a range of conditions that affect the surface of the eye:

• Dry Eye Disease (DED) – A reduction in the volume and quality of tears
• Blepharitis – An inflammatory condition of the eyelids
• Meibomian Gland Dysfunction (MGD) – Reduced oil production leading to tear evaporation from the surface of the eye

Ocular surface disease is often associated with ageing but may be exacerbated by certain medications and other medical conditions. Dry eye disease is due to either a lack of the watery layer (aqueous deficiency) or issues with the meibomian glands (evaporative) but most commonly is ‘mixed’. This means that there is an element of aqueous and evaporative dysfunction. Systemic health conditions and medications used to manage them can also lead to dry eye and dry eye symptoms.

Sjogren Syndrome and Rheumatoid Arthritis are examples of auto-immune diseases that cause not only dry eye but dryness of the mouth, nose and other mucous-lined membranes. Treatments for hay fever (antihistamines), acne, contraceptive medications, HRT and anti-depressants can contribute to dry eye. Even other drops (such as glaucoma medication) can cause associated problems.

You should always consult your medical practitioner before ceasing or changing any prescribed medications.

There are however, some environmental factors that can trigger ocular surface disease. Adopting healthy habits around these, can help to ease some symptoms.

• Technology: With so many people using computers and our reliance on smart phones and tablets, it’s not surprising that we’re seeing more people with ocular surface disease symptoms. When we are concentrating on screens, the rate at which we blink decreases and we tend to blink incompletely. This means that the tears that keep our eyes hydrated have more time to evaporate between blinks, contributing to dryness.

• The weather: Our eyes are also affected by the weather. In the winter, increased exposure to the cold wind and central heating can dry our eyes. But in spring, hay fever means ocular surfaces often get worse – it’s not helped by antihistamines which can actually cause further dryness!

• Contact lenses: People who wear contact lenses are far more susceptible to ocular surface disease, which is why regular appointments are vital. Discomfort from dryness is a major reason why people stop wearing lenses, but luckily there are things that we can do to help.

In some cases, symptoms can be relieved by altering the external influences mentioned above. Simple changes in environmental factors can help – for example, avoidance of dehydrating factors such as air conditioning or regular breaks away from work on computer screens. Protecting your eyes with spectacles or sunglasses from other factors such as cold wind may also help.

Your treatment may include in-practice procedures and at-home therapies depending on the cause of your ocular discomfort and/or signs of ocular surface disease.

Meibomian Gland Dysfunction accounts for 86% of ocular surface disease that can lead to irreversible structural and functional changes if left untreated. At-home therapies could include a combination of moist heat mask use and massage, eyelid scrubs, eye drops, prescription medications, blinking exercises and Omega-3 diet supplementation.

Our in-practice treatments include:

• E-Eye – Intense Regulated Pulsed Light treatment (IRPL / IPL)
• Mibo ThermoFlo – Thermal pulsation providing gentle heat and massage to the eyelids.
• Microblepharoexfoliation (Bleph-Ex) A deep clean of the eye lid margins and lashes.
• In-house treatments for Demodex blepharitis including prescription medications and manual lid / lash debridement.
• Fitting of dissolvable and / or permanent punctal plugs to create a reservoir of tears.

There is no cure for ocular surface disease, but it can be managed well with treatments once the cause is understood. Maintenance will be required to stay comfortable for as long as possible.