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SYMPTOMS, CAUSES AND TREATMENT OF DRY EYE

Dry eyes can happen when tears evaporate too quickly, or if the eyes produce too few tears. It is common in humans and in some animals. It can affect one or both eyes, and it can lead to inflammation.

Dry eye syndrome can occur at any age, and in people who are otherwise healthy. It is more common with older age, when the individual produces fewer tears. It is also more common in women than in men.

It is more common in places where malnutrition results in a vitamin A deficiency.

Causes
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Dry eyes can become red and irritated.

The eyes produce tears all the time, not only when we yawn or experience emotion. Healthy eyes are constantly covered with a fluid, known as a tear film. It is designed to remain stable between each blink. This prevents the eyes from becoming dry and enables clear vision.

If the tear glands produce fewer tears, the tear film can become unstable. It can break down quickly, creating dry spots on the surface of the eyes.

Tears are made of water, fatty oils, protein, electrolytes, substances to fight off bacteria, and growth factors. The mixture helps keep the surface of the eyes smooth and clear, so that we can see properly.

Dry eyes can result from:

  • an imbalance in the tear mixture, so that it evaporates too fast
  • insufficient tear production for good eye health

Other causes include eyelid problems, some drugs, and environmental factors.

Imbalance in the tear mixture

The tear film has three layers, oil, water, and mucus. Problems with any of these can lead to dry eye symptoms.

The top layer, oil, comes from the edges of the eyelids, where the meibomian glands produce lipids, or fatty oils. The oil smooths the tear surface and slows down the rate of evaporation. Faulty oil levels can cause the tears to evaporate too quickly.

Inflammation along the edge of the eyelids, known as blepharitis, as well as rosacea and some other skin disorders, can cause the meibomian glands to become blocked, making dry eyes more likely.

The middle layer is the thickest, consisting of water and salt. The lacrimal glands, or tear glands, produce this layer. They cleanse the eyes and wash away particles and irritants.

Problems with this layer can lead to film instability. If the water layer is too thin, the oil and mucus layers may touch each other, resulting in a stringy discharge, a hallmark sign of dry eyes.

The inner layer, mucus, enables the tears to spread evenly over the eyes. A malfunction can lead to dry patches on the cornea, the front surface of the eye.

Reduced tear production

After the age of 40 years, tear production tends to fall. When it drops to a certain point, the eyes can become dry and easily irritated and inflamed. This is more common in women, and especially after the menopause, possibly due to hormonal changes.

Reduced tear production is also linked to:

  • autoimmune diseases, like Sjogren’s syndrome, lupusscleroderma or rheumatoid arthritis
  • radiation treatment
  • diabetes
  • vitamin A deficiency
  • refractive eye surgeries, such as laser-assisted in-situ keratomileusis (LASIK), increase the chance of dry eyes, but the symptoms are usually temporary

Eyelid problems, medications, and environmental factors

Each time we blink, our eyelids spread a thin film of tears across the surface of the eyes.

Most people blink about five times a minute. Eyelid problems can affect the blinking motion that spreads the tear film evenly across the eyes.

Eyelid problems include ectropion, where the eyelid turns outward, or entropion, where it turns inward. Inflammation along the edge of the eyelids, known as blepharitis, may also cause dry eyes, as can contact lenses.

Medications that can cause dry eyes include:

  • some diuretics
  • angiotensin-converting enzyme (ACE) inhibitors
  • antihistamines
  • decongestants
  • some sleeping pills
  • birth control pills
  • some antidepressants
  • some acne drugs, specifically isotretinoin-type medications
  • morphine and other opiate-based painkillers

Climatic factors include a dry climate, sun, wind, and other types of hot blowing air or dry air, as in an airplane cabin.

High altitude, smoke, and the use of contact lenses are also risk factors.

Using a computer monitor, reading, or driving a vehicle, as the increased visual concentration may slow down the blinking rate, so that the eyes become dry.

Symptoms

A patient with dry eye syndrome may experience a range of symptoms, including:

  • a stinging or burning sensation, and a feeling of dryness, grittiness, and soreness in the eyes
  • a feeling like sand in the eye
  • stringy mucus in or around the eyes
  • eye sensitivity to smoke or wind
  • redness of the eyes
  • difficulty keeping the eyes open
  • eye fatigue after reading, even for a short time
  • blurred vision, especially towards the end of the day
  • sensitivity to light
  • discomfort when wearing contact lenses
  • tearing
  • double vision
  • eyelids sticking together when waking up

Some people find the pain very strong, and this can lead to frustration, anxiety, and difficulty functioning in daily life.

Complications may include a worsening of eye redness and light sensitivity, increasing painful eyes, and deterioration of eyesight.

Treatment

A doctor will do a physical examination and ask the patient about symptoms, their medical history, any current medications, and about their occupation and personal circumstances.

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The type of eye drops to use depend on the cause of the dry eye.

Tests can reveal the quantity of tears behind the eyelid, whether the tear film is functioning properly, and the rate of evaporation.

Treatment aims to keep the eyes well lubricated, but the approach depends on the underlying cause.

Three ways of keeping the eyes lubricated are:

  • making the most of natural tears
  • using artificial tears or eye drops
  • reducing tear drainage

If the problem stems from an ophthalmic or systemic condition, such as an eye infection or psoriasis, the underlying condition needs to be treated first.

Medications for patients with chronic dry eyes include cyclosporine eye drops, or Restasis. Cyclosporine reduces eye-surface inflammation and triggers increased production of tears. Patients should not use this drug if they have an eye infection or a history of herpes viral infection of the eye.

If the patient has blepharitis, they may need to clean the affected area regularly with a dilute solution of baby shampoo. The doctor may prescribe antibiotic drops or ointment for night time use. Sometimes, an oral antibiotic, such as tetracycline or doxycycline, is used.

Steroid drops may help reduce inflammation if symptoms remain severe, even after the frequent use of eyedrops.

Surgery

Eyelid problems, such as an incomplete blink, may be treated by an oculoplastic surgeon, who specializes in eyelid problems.

In more severe cases, tear ducts, which drain away the tears, may be deliberately blocked, partially or completely, to conserve tears. Silicone plugs can be placed in the tear ducts to block them. This helps keep both natural and artificial tears on the eyes for longer.

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Eye surgery can correct some problems that lead to dry eye.

A surgeon can shrink the tissues of the drainage area by using a heated wire in a minor operation known as thermal cautery.

A Boston Scleral Lens is a contact lens that rests on the sclera, the white part of the eye. It creates a fluid-filled layer over the cornea, preventing it from drying out.

Salivary gland transplantation is a surgical procedure that is occasionally considered in persistent and severe cases that have not responded to other treatments.

Some of the salivary glands are removed from the lower lip and grafted, or placed into the side of the eyes. The saliva they produce becomes a substitute for tears.

Home remedies

Various home remedies can help relieve dry eyes.

Using natural tears

Tips for making the most of natural tears include:

  • wearing wraparound glasses for protection from wind and hot air
  • consciously blinking more frequently when using the computer or watching TV
  • avoiding smoking and smoky places
  • keeping room temperature moderate
  • using a humidifier in the home to help moisten the air. Spraying curtains with a fine spray of water can help keep the air humid

Moisture-chamber spectacles wrap around the eyes like goggles. They help retain moisture in the eyes and protect them from wind and other irritants. New, sporty designs have increased their popularity.

Artificial tears and eye drops

Artificial tear or eye drops, available over the counter (OTC), can help lubricate mildly dry eyes. A doctor can advise which ones to use.

Eye drops without preservatives can be used as often as necessary, but those with a preservative usually have a maximum safe dosage of four times a day. Eye drops for removing redness should not be used.

It can be helpful to apply eye drops before doing activities that tend to exacerbate dry eye symptoms. Ointments are better for night time use, because they may blur vision.

Cleaning and massaging the eyelids

Other tips include:

  • Cleaning the eyelids by gently wiping the eyes with a piece of cotton wool dipped in warm water, to reduce the likelihood of them becoming inflamed
  • Gently massaging the eyelid in a circular motion, using a clean finger, to help remove mucus from the eyelid glands

Dietary tips

Some studies indicate that omega-3 and omega-6 fatty acids may help reduce the risk or the incidence of dry eyes.

Sources include oily fish, canola oil, walnuts, flax oil, ground flax seed, hemp oil, hemp seed, olive oil, pumpkin seeds, and soybeans.

However, there are not enough large-scale research studies in humans to support their use as primary treatment.

Complications

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Dry eye can lead to watery eye, as a different kind of tear tries to compensate.

Most people with mild dry eye syndrome have no long-term problems or complications, but severe symptoms can lead to eye inflammation, infection, and damage to the surface of the cornea.

This damage can lead to ulceration or scarring, which can be painful and affect the patient’s vision.

Conjunctivitis caused by dry eye does not normally require treatment, but if it is severe, long-lasting, or recurring, the patient should seek medical help.

Some people with dry eye syndrome sometimes have constantly watery eyes because they produce too many tears.

There are two types of tears, one that maintains the tear film and one that helps wash away dirt and foreign particles.

As a reaction to the irritation, people with dry eyes may produce more of the kind of tears that wash away dirt. This can lead to watery eyes.

WHAT TO KNOW ABOUT CATARACTS

Cataracts are the clouding of the lens of your eye, which is normally clear. Most cataracts develop slowly over time, causing symptoms such as blurry vision. Cataracts can be surgically removed through an outpatient procedure that restores vision in nearly everyone.

What is a cataract?

A cataract develops when the lens in your eye, which is normally clear, becomes foggy.

For your eye to see, light passes through a clear lens. The lens is behind your iris (colored part of your eye). The lens focuses the light so that your brain and eye can work together to process information into a picture.

When a cataract clouds over the lens, your eye can’t focus light in the same way. This leads to blurry vision or other vision loss (trouble seeing). Your vision change depends on the cataract’s location and size.

Who gets cataracts?

Most people start getting cataracts around age 40. But you probably won’t notice symptoms until after age 60. Rarely, babies are born with cataracts due to a birth defect.

You’re more likely to develop cataracts if you:

  • Smoke cigarettes.
  • Live in an area with bad air pollution.
  • Use alcohol heavily.
  • Have a family history of cataracts.

How common are cataracts?

Cataracts are common among older people. More than 50% of people age 80 and older have had cataracts.

Can you get cataracts in both eyes?

You can get cataracts in both eyes. But one eye may be worse than the other or develop at a later time.

SYMPTOMS AND CAUSES

What causes a cataract?

The lens of your eye is mostly water and proteins. As proteins break down over time, they hang around in your eye. These lingering proteins can make your lens cloudy, so it’s hard to see clearly. This is a typical — though unpleasant — part of aging.

Some things can speed up the formation of cataracts, such as:

What are the symptoms of a cataract?

Cataracts are a common part of the eye’s aging process. Eventually, they can cause:

  • Vision that’s cloudy, blurry, foggy or filmy.
  • Sensitivity to bright sunlight, lamps or headlights.
  • Glare (seeing a halo around lights), especially when you drive at night with oncoming headlights.
  • Prescription changes in glasses, including sudden nearsightedness.
  • Double vision.
  • Need for brighter light to read.
  • Difficulty seeing at night (poor night vision).
  • Changes in the way you see color.

Are cataracts painful?

Cataracts don’t usually hurt. But they can cause discomfort by making your eyes more sensitive to light.

DIAGNOSIS AND TESTS

How is a cataract diagnosed?

If you have cataract symptoms, see an eye doctor (ophthalmologist) for a complete exam. The doctor will need to dilate your pupil to see inside your eye. During this test, special eye drops widen your pupil (the black part of the eye). When the pupil is wide open, your doctor checks the health of your eye. Your doctor can see if you have cataracts or other problems and find out how much of your vision is blocked.

MANAGEMENT AND TREATMENT

How is a cataract treated?

If your cataract symptoms are mild, you might just need a new prescription for glasses or contacts. Cataracts usually worsen over time, though. Eventually, your doctor will likely recommend surgery to remove the cataract.

At what stage should cataracts be removed?

Most people wait until a cataract causes enough vision loss to be a problem, like making it hard to read or drive. Sometimes people need cataract surgery to see and treat other eye conditions, such as age-related changes in the retina (tissue at the back of the eye) or diabetic retinopathy.

Who removes cataracts?

An ophthalmologist (doctor who specializes in eye health) performs cataract removal surgery.

How are cataracts removed?

During cataract surgery, the surgeon removes the clouded lens and replaces it with an artificial lens implant. The new lens is clear, shaped to fit your eye and personalized to your vision needs.

Cataract removal takes about an hour. It’s done with local anesthesia (medication to numb a specific area). Your doctor will use eye drops or a shot to numb your eye. You’ll be awake, but you won’t feel or see the procedure.

What are the different types of cataract surgery?

There are two types of procedures to remove cataracts:

Phacoemulsification cataract surgery

Phacoemulsification is the most common procedure for cataracts. Your ophthalmologist makes a small opening in the eye to reach the clouded lens. Using high-frequency sound waves (ultrasound) or a laser, your ophthalmologist breaks the lens into pieces. Then the doctor suctions lens fragments from your eye and puts in a new plastic lens.

Extracapsular cataract surgery

Your doctor might recommend this procedure if the phacoemulsification technique isn’t a good option for you. For example, an advanced cataract might be too dense to break apart easily.

In extracapsular cataract surgery, your ophthalmologist makes a larger opening in the eye. Instead of breaking up the lens and then removing it, your doctor removes the lens in one piece. Then the surgeon inserts the manufactured lens.

What can I expect after surgery?

After surgery, it’s typical to have a day or two of:

  • Itching.
  • Mild discomfort.
  • Watery eye.
  • Sensitivity to light.
  • Blurry vision.

For a few weeks after surgery, you may need to use eye drops. The drops help you heal, prevent infection and control the pressure inside your eye. During those weeks you’ll also want to avoid:

  • Touching your eyes.
  • Bending over.
  • Lifting heavy things.
  • Doing anything that risks injuring your eye.

How much time does it take to recover from cataract surgery?

Your eye should heal within eight weeks. But you can go about your daily activities as soon as a day after the surgery.

Is cataract surgery safe?

Cataract surgery is one of the safest and most frequently performed surgeries in the U.S. The chance of any complications is extremely low. But you should always discuss the risks of any surgery with your doctor. Some people do have an infection or vision loss after the procedure.

How painful is cataract surgery?

You shouldn’t feel anything during the cataract removal surgery. Afterward, you may have mild pain and discomfort. Your doctor can give you a pain reliever to use for the first day or two.

PREVENTION

Can cataracts be prevented?

Developing cataracts is a typical part of aging. You can take a few steps to protect your eye health and slow the process:

  • Quit smoking.
  • Wear sunglasses and a hat with a brim to keep sun out of your eyes.
  • Get regular eye care. Have your eyes dilated once every two years after age 60. Surgery may be easier if you get treated sooner.

OUTLOOK / PROGNOSIS

How soon will my vision improve after surgery?

You may have some blurriness for a few days after cataract removal. But you should notice improved vision within the first several weeks. Nine out of 10 people see better after cataract removal.

You still may need to wear glasses or contacts after cataract surgery. Your prescription may change, so be prepared to buy a new pair of eyeglasses or contacts. If you’ve had laser vision repair (LASIK®), you may need to repeat it or wear glasses or contacts after cataract removal.

Will I need to have cataract surgery again in the future?

If both your eyes need cataract surgery, your doctor will probably schedule your surgeries several months apart. Separating the surgery gives both eyes a chance to heal. It also minimizes the disruption on your life. The lens implants for cataracts are permanent and usually don’t need to be replaced.

In some rare cases, you can develop what’s called a secondary cataract. Cloudiness builds up on the surface of the artificial lens weeks, months or years after surgery. It’s fixed with a quick laser surgery called posterior capsulotomy. The procedure takes just 5 minutes. Your ophthalmologist uses a laser to make an opening in the lens to let light in again. You sight should improve within 24 hours.

 

OUTREACH UPDATE

Restore Sight Africa Initiative in collaboration with the O5 Initiative and Delta State Ministry of Health organised the Grassroot Medical Outreach in the 3 Senatorial Districts in Delta State. It was a 4 days medical outreach in each of the Senatorial District; Delta Central at Eku, Delta South at Oleh and Delta North at Asaba.

The outreach covered

  1. General medical Screening for Diabetes, High Blood Pressure, HIV,  Tuberculosis and COVID
  2. Health Education and Nutrition
  3. Counseling amongst others
  4. Eye Screening and treatment
  5. Spectacle and Glass prescription for children and adult.
  6. Sight Restoration Surgeries

The high point was the commemoration of WORLD SIGHT DAY at Oleh, observed every 2nd week of October with the theme LOVE YOUR EYES. Her Excellency Dame Edith Okowa the founder O5 Initiative and wife of the Executive Governor of Delta State graciously flagged off the opening ceremony.

About 1,404 persons were screened for COVID,  1,575 for Diabetes and 2006 for High blood pressure.

In the eye session 6103 were screened, 3024 glass prescription were dispensed, 1998 eye drops was prescribed and 497 eye operations was done.

There was joy all over Delta State as many who did not have access and could not afford treatment had their needs met, received quality health education and better informed about their well being. For many who were led blind and had their vision restored the summary of the story was “once I was blind now I can see”.

 

Total number of patients seen for the 3 senatorial District _6103

Total number of glasses given for the 3 senatorial District _3024

Total number of eyedrops dispensed for the 3 senatorial District_1998

Total number of surgeries performed for the 3 senatorial District _497

 

We had 3 projects

In each we had General medical and Eye Screening and treatment

General Medical session

Blood Pressure Screening for hypertension

  1. Blood sugar Screening for Diabetes
  2. COVID Screening
  3. Tuberculosis Screening

Eye Screening

  1. Eye Screening a Nd treatment
  2. Dispensing of glasses for children and adult
  3. Eye Surgeries

Wellness Session

  1. Health Education
  2. Nutrition.

 

Data Captured and Location

EKU 6th_9th Oct, 2021

Number of Px seen_1480

Number of glasses_531

Number of eyedrop_676

Number of surgeries_108

 

OLEH 13_16 Oct, 2021 

Number of Px seen_1514

Number of glasses_669

Number of eyedrops_500

Number of surgeries_111

 

ASABA 19_23 Oct, 2021

Number of Px seen_3109

Number of glasses_1824

Number of eyedrop_822

Number of surgeries_278