New products and treatment methods, ranging from special eye drops to eye-warming devices, are being tested.
Dry eyes can cause so much pain in some patients that doctors have to sew up their eyes as a last resort. However, that happens only in a minority who have very severe dry eyes. Usually, only part of the eyelids (at the outer cornea of the eye) are stitched up.
Consultant ophthalmologist Louis Tong from Singapore National Eye Centre (SNEC) said he has done only a few such cases over the last five years. He said: “These patients usually suffer from severe dry eyes as a result of other autoimmune conditions such as rheumatoid arthritis and they do not respond to non-surgical treatment.”
The surfaces of part of the eyelids are scraped raw and then sewn together. As this heals, it forms scar tissue that seals up the opening. This reduces the amount of eye surface that is exposed so the tear glands do not have to work so hard to lubricate the eye. Patients may need to continue using eye drops.
For the majority of patients, non-surgical treatments are enough to relieve the symptoms. These include using lubricating eye drops and ointments, warming devices to unclog blocked tear ducts and plugs to stop the tears from draining into the tear ducts.
Treatment methods are getting better, said Dr Lee Sao Bing, medical director of Shinawaga Lasik Centre. While conventional eye drops merely lubricate the eyes, eye drops such as Restasis (cyclosporine) also treat inflammation and increase tear production in dry eye patients. More recently, eye drops have been developed to improve not just the quantity, but also the quality of tear fluid. Better eyelid treatments have also been introduced.
Some promising treatments that are being offered or in the pipeline include :
1. Tea Tree Oil Scrub
Recently, SNEC started offering a tea tree oil scrub (by prescription only) that cleans the eyelids and lashes.
An American study found that tea tree oil in a certain concentration kills a common parasitic mite called demodex that lives around the eyelids. The mite causes inflammation and blocks the oil-producing meibomian glands.
Previously, there was no effective way of killing the mite. Regular use of the oil helps to improve dry eye symptoms.
2. Moisture Retention Eyewear
These wraparound glasses or sunglasses have a moisture shield that seals all or part of the gap between the spectacle frame and the skin. The shield creates a moisture chamber from the build up of humidity from the tear film, artificial eye drops and body heat. The shield also blocks airflow over the eye.
Such eyewear has been found to be effective in relieving symptoms of dry eyes, such as grittiness, especially when worn in dry or windy places. It is available in countries such as the United States for about US$100 (S$124).
3. Three New Types of Eye Drops
Singapore Eye Research Institute (SERI) is testing the possibility of using eye drops made from the patient’s own blood – or rather, its yellowish serum called plasma – to heal his dry eyes.
Unlike conventional eye drops, plasma is rich in proteins, which makes it similar to tear fluid. After it is extracted in a haematology centre, the plasma is put in self-contained vials and given to the patient. These must be kept sterile in the freezer and used like eye drops.
Results from overseas studies show this treatment is more effective in relieving dry eye symptoms than conventional eye drops.
SNEC and SERI are also comparing patients who use another new type of eye drop from the brand Systane Ultra, with those on conventional eye drops. This new eye drop turns the water and mucous layers in the tear film more gel-like so that they do not evaporate easily. It is prescribed by doctors in other countries such as the US.
SERI is recruiting participants for a study on a third new type of eye drop. It wants to test the effectiveness of this mucus-secreting eye drop in holding the tear film more closely together. It hopes to recruit 100 people. Those interested can call SERI on 6322-4500/1 from 9am to 5pm.
4. Warming Devices
Hot towels or gel packs are often used to unclog blocked meibomian glands. They may soon be joined by three new warming devices, soon to be tested by SERI, said Dr Andrea Petznick, a post-doctoral researcher.
One is a mini disposable eye masseur-cum-heat generator which massages the eyelid as well as produces heat to melt the globules of oil blocking the meibomian glands. The other two are a battery-operated eye goggle, which can emit both heat and moisture, and self-warming sachets which can be slipped into an eye mask.
5. Acupuncture
Recent clinical trials in places such as South Korea, Taiwan and Sweden found that patients who used traditional Chinese medicine (TCM) treatments to treat their dry eyes showed some improvement in symptoms, compared to those who used conventional eye drops.
The TCM treatments used were acupuncture and the consumption of the Chinese herb, chi ju di huang wan.
SERI research officer, Lan Wanwen, a qualified TCM practitioner, said the institute is exploring the possibility of future collaborations in dry eye research with TCM practitioners.