Minor eye conditions
The various conditions described here are “minor” in these sense that they do not cause significant or permanent loss of vision. But our eyes are one of the most sensitive parts of our body, and constant irritation, discomfort and pain can make a significant impact on the quality of life.
Blepharitis is a chronic inflammatory condition of the eyelid margins. It is extremely common and affects both sexes. Symptoms may include soreness, redness and grittiness. The eyelid margins are red and inflamed and there can be crusts and flakes rather like a dandruff of the eyelashes. Blepharitis can cause or worsen dry eye syndrome. Factors that contribute to the development of blepharitis include inflammation of the sebaceous glands in the eyelash follicles and the larger sebaceous glands (called meibomian glands) in the eyelid that open on the edge of the eyelid; and bacterial and parasitic infections and the inflammatory and immune response to toxins produced by these organisms.
Appearance of the eyelids in blepharitis
Diagram of the structures that can be affected by blepharitis
The mainstay of treatment for blepharitis is eyelid margin hygiene that must be carried out regularly and continued in the long term. Eyelid hygiene has three essential steps:
- Application of heat to warm the eyelid gland secretions, to warm and liquify the lipid secretions produced by the sebaceous and meibomian glands. Warm water in a flannel, soaked gauze pads, or microwaved, soaked cloths can be used. Care should be taken to avoid the use of excessive heat.
- The eyelid margin should be scrubbed gently to remove discharge, crusts and flakes from the eyelid margin. Cotton-tip applicators or gauze pads dipped into a boiled or distilled water to which a small amount of salt or baby shampoo can be added can be used for this purpose. Tap water should not be used. Commercially available cleansing preparations are also available. Vigorous scrubbing is not necessary and may be harmful.
- An antibiotic ointment is applied to the eyelid margin. Antibiotic-corticosteroid ointment combinations can be used for short courses; if steroids are sued n the long term this can cause damage to the eye.
If these measures do not control the blepharitis additional topical or oral medications can be prescribed.
Dry Eye Syndrome
The continuous production and drainage of tears is important to the eye’s health. The cornea is covered by the tear film which consists of a layer of mucous nearest to the cornea, a middle layer of aqueous tears, and an outer lipid layer. The mucous acts as a wetting agent for the aqueous tears, and the lipid layer reduces the evaporation of the aqueous tears.
Tears are produced by the lacrimal glands in the upper outer part of the eye socket and leave the eye either by evaporation or drainage. There is a small channel in the inner part of each eyelid through which the tears can drain into the nose.
The tear Tears keep the eye moist, help wounds heal and protect against infection. The tear film smooths the surface of the cornea so that the light entering the eye is brought to a sharp focus.
The three layers of the tear film
Dry eye syndrome is very common, especially in women after the menopause.
Dry eye syndrome can arise if any of the layers of the tear film are deficient. Meibomian gland dysfunction has been identified as one of the main causes of dry eye syndrome, and dry eye syndrome is frequently associated with blepharitis.
Aqueous tears production can be deficient in people suffering with auto-immune diseases such as rheumatoid arthritis and Sjögren’s syndrome, which can damage and reduce the functioning of the lacrimal glands.
Dry eye syndrome can be a side effect of some drugs, including antihistamines, nasal decongestants, tranquillisers and anti-depressants.
Patients with dry eye syndrome complain of chronic discomfort, usually described as a burning, gritty sensation. Some describe a scratchy or sandy feeling as if something is in the eye. Other symptoms include stinging, stringy mucous discharge, heaviness and blurred vision. Dry eye syndrome can also cause the eyes to water, as disturbance and damage to the ocular surface can stimulate an increased production of aqueous tears from the lacrimal glands.
The eyes can become red. Light reflected from a healthy cornea will appear as a bright spot of light and this will be dulled if the cornea is dry. and lose its shiny appearance. To assess the degree of dryness a paper strip impregnated with fluorescein dye is placed under the lower eyelid. the fluorescein dissolves into the tears and spreads across the surface of the eye. If the eye is dry the amount of fluorescein between the eye and lower eyelid will be reduced and there may be staining on the surface of the eye (superficial punctate keratitis or SPK). A Schirmer’s test (the amount of moistening of a strip of blotting paper placed in contact with the inside of the lower eyelid) can measure the amount of tear production.
First line treatment for dry eye syndrome is lubricating drops and ointments. There are many different products available including Hypromellose®, Liquifilm®, Tears Naturale®, Viscotears®, Hypotears®, Gel Tears® and ointments: Lacrilube®, Simple Eye Ointment® The frequency of use and product preference will depend on patient preference. Many patients find that products containing hyaluronic acid offer the greatest relief of symptoms, and there are many different preparations available. Restasis® or Iverkis® which contain cyclosporine may be beneficial for severe cases but must be prescribed by an ophthalmologist.
For people with severe cases of dry eye, temporary or permanent closure of the tear drains may be helpful.
Blepharitis with inflammation of the meibomian glands can cause dry eye and should be managed with lid hygiene. Intense Pulsed Light (IPL) Therapy is a treatment where a pulses of light are delivered from a small handheld device to the meibomian glands. This can restore normal meibomian gland secretions and reduce the symptoms of dry eye.
Benign Lumps Around the Eye
Most of the lumps and bumps around the eye are not serious. The skin can harbour warts and cysts. A stye is a small abscess in an eyelash follicle that will usually resolve without treatment. If an opening of a meibomian gland becomes blocked the secretions will accumulate and stimulate local inflammation, giving rise to an eyelid lump called a chalazion. Often it will resolve spontaneously but if it persists for more than 6 months and causes discomfort or is a cosmetic issue, it can be incised under local anaesthesia in a clinic setting.