How we diagnose dry eye at The Dry Eye Clinic
At Custom Eyecare, we have a passion for managing moderate to severe Dry Eye, and providing relief for patients with stubborn symptoms. The right treatment can help even a mild dry eye sufferer to lead a more comfortable life.
We have a range of diagnostic tools for diagnosing dry eye, identifying the cause and monitoring developments including;
Clinical history
This includes occupation, work environment, general health, medications, allergies, drops/nutrition and other treatments tried thus far for dry eye.
Symptom questionnaires
Symptom questionnaires for diagnosis and monitoring. We ask dry eye sufferers to complete a standardised Dry Eye Questionnaire and we score their responses. This symptom score enables us to grade the severity of symptoms and to monitor for improvements over time. It’s important to know the treatments are working!
Visual acuity and baseline refraction
Knowing dry eyes can cause fluctuations in vision, it’s important to have an accurate baseline to monitor for improvements in both signs and symptoms over time.
Infrared imaging
Infrared imaging of meibomian glands is called meibography. This allows us to visualise the oil glands within your eyelids, looking for signs of blockages, distortions and cell damage.
Corneal hydration
Damaged or dehydrated corneal surface cells can be visualized with a special naturally occurring dye called fluorescein. Normal healthy corneal tissue will not absorb this dye so we can readily visualise any areas we need to be concerned about. Once corneal dehydration or desiccation has occurred, we know we are no longer dealing with a mild dry eye. Damaged corneal tissue poses an infection risk as the top layer of the cornea is our barrier to prevent infection.
Eyelid and conjunctival health
Another special dye called Lissamine Green can be used to inspect for damaged or dehydrated patches on the eyelids, eyelid margins and the whites of our eyes. Excess friction between blinking eyelids and the eyes surface can result in insult to the lids and cause the eyes to feel very uncomfortable.
Comprehensive Slit lamp microscope examination
Careful inspection of the eyelids, eyelashes, conjunctival redness, lid roughness and blink rate assessment.
Digital meibomian gland expression
Putting pressure on the small oil glands along the eyelids allows us to visualise the colour and quantity of the oil secreted. In some dry eye sufferers, gland expression reveals the oil has already solidified into a buttery substance. The goal then becomes to improve the gland secretion and return it to a free flowing smooth oil to coat our tears.
Dry eye testing: Lash follicle microscopy
Lash follicle microscopy for diagnosis of demodex mites. Demodex mites live on our skin and you will find demodex mites on every adult over 18 years old and this is natural. However, the incidence of a demodex infestation increases with age, and Demodex numbers are 15-18x higher in patients with acne rosacea which can cause dry eyes. An overpopulation of Demodex can trigger inflammation and cause red sore eyelid rims as the mites live in the hair follicle at the base of our eyelashes. Diagnosing Demodex and treating them correctly is key to controlling the infestation
Measurement of Tear quantity and quality
Quantitative measurement of tear quantity and quality: Using Schirmers and Phenol thread test we can measure the volume of tears produced over a period of time. This guides us on whether it’s the watery component of the tear film that is deficient and we can target our treatment to boosting the water layer of the tears.
Tear Quality TBUT
We can measure what is known as Tear Break Up Time (TBUT) which is the time taken for the tears to evaporate from the eye’s surface between blinks. The traditional way to perform a TBUT test is to instill a dye into the tears and watch what happens to the tear layer. This is now known as Invasive TBUT as you added a solution to measure the tear film thickness and quality which could artificially alter the results. Emerging technologies are focussing on noninvasive techniques to observe the tear film as we want techniques that cause minimal disturbance to the tear film dynamics.
Non-invasive Tear Quality
Tear Quality using Non invasive TBUT. Using the technology of a corneal topographer we are able to track and measure how thick and stable a tear film is, and how quickly it evaporates, with accuracy and without invasive eye drops. Again this enables us to monitor for improvements over time in both the quality and quantity of your tears.
Tear Volume
Measuring the height of the tear meniscus, which is the reservoir that collects along the bottom eyelid with blinking, is an indicator of the volume of tears being pumped into the eye with each blink.
Please contact us to arrange a dry eye assessment appointment along with your comprehensive eye & vision examination at The Dry Eye Clinic within Custom EyeCare Newcastle.
