Best Dry Eye Clinic In Mumbai

Normally, the eye constantly bathes itself in tears. The tears lubricate the eye, maintain nutrition and provide oxygen to eye structures, acts as a refractive component and helps remove debris from the surface of the eye.

Dry eye is an extremely common condition, which affects most people at some stage in their lives. Dry eye is a disorder of the tear film which occurs due to tear deficiency or excessive tear evaporation; it causes damage to the surface of the eye and is associated with a variety of symptoms reflecting ocular discomfort.

Dry eye symptoms may be a manifestation of a systemic disease, therefore timely detection may lead to recognition of a systemic disorder. Additionally, patients with dry eyes are prone to potentially blinding infections, and also at an increased risk of complications following common procedures such as laser refractive surgery.

The usual symptoms include:

• Stinging or burning eyes,
• Scratchiness,
• Stringy mucus in or around the eyes,
• Excessive eye irritation from smoke or wind,
• Blurred vision,
• Eye pain
• Eye fatigue
• Sensitivity to light
• Excessive tearing, and
• Discomfort when wearing contact lenses.

Excessive tearing from “dry eye” may sound illogical, but is actually the eye’s response to discomfort. If the tears responsible for maintaining lubrication do not keep the eye wet enough, the eye becomes irritated. Eye irritation prompts the gland that makes tears (called the lacrimal glands) to release a large volume of tears, overwhelming the tear drainage system. These excess tears then overflow from your eye.

When you blink, a film of tears spreads over the eye making the surface of the eye smooth and clear. Without this tear film, clear vision would not be possible. The tear film consists of three layers:

• An oily layer
• A watery layer
• A layer of mucus

The oily layer, produced by the meibomian glands (oil glands), forms the outermost surface of the tear film. Its main purpose is to smoothen the tear surface and reduce evaporation of tears. The middle watery layer makes up most of what we ordinarily think of as tears. This layer, produced by the lacrimal glands in the eyelids, cleans the eye and washes away foreign particles or irritants.

The inner layer consists of mucus produced by the conjunctiva. Mucus allows the watery layer to spread evenly over the surface of the eye and helps the eye remain moist. Without the mucus, tears would not stick to the eye.

Dry eye may develop due to

• Inflammatory disease, such as allergies, autoimmune diseases such as Rheumatoid Arthritis, Sjogren’s syndrome
• Environmental conditions such as allergens, cigarette smoke, dry climate, high temperature, air pollution), excessive computer use
• Hormonal imbalance, such as perimenopausal and post-menopausal women and patients under hormone replacement therapy
• Contact lens wear.
• Systemic disorders, such as diabetes mellitus, deficiency of vitamin D, vitamin A and thyroid disease
• Previous eye surgery or long-term use of medications which create hypersensitivity or toxicity in the eye
• Many systemic medications, such as diuretics, antihistamines, antidepressants, psychotropics, cholesterol lowering agents, beta-blockers and oral contraceptives

As dry eyes may be associated with a variety of causes, it is important to perform a comprehensive evaluation before proceeding to treatment. At Arohi Eye Hospital, systematic step wise examination leads to the diagnosis of dry eyes, and the severity of it.

1. Thorough History: A careful and thorough history is obtained with particular attention to diabetes, thyroid disease, connective tissue disorders, contact lens wear, previous ocular surgery and relevant drug history. Taking a thorough history helps us to identify when and how your dry eye started. It may also help us to reach the diagnosis.
2. Ocular Surface Disease Index (OSDI) questionnaire: This questionnaire is used in assessing patients with dry eye symptoms which helps to quantify the symptoms and eradicate the severity of the disease.
3. Slit Lamp Examination: A careful slit lamp biomicroscopic examination (a high magnification microscopic examination) is done to look for any abnormalities in the front part of the eye. This is where we look at the ocular surface and diagnose meibomian gland dysfunction, blepharitis or any other lid abnormalities.
4. Break-up time test (TBUT): Tear film stability can be assessed with the fluorescein tear break-up time test (TBUT). TBUT less than 17 seconds is indicative of evaporative dry eye.
5. Schirmer test: Another clinical method for assessing the severity of dry eye is ocular surface dye staining and the Schirmer test. Schirmer test measures aqueous tear (the watery part of the eye) production. It involves placing filter-paper strips under the lower eyelid to measure the rate of tear production
6. Meibography: This is a no touch, fast infrared imaging to see whether the meibomian glands (structure producing oily layer of tear film) are structurally normal, dilated, shortened or atrophied. With this advanced testing we can also grade the level of meibomian gland dysfunction