Revive Eye Spa: our dry eye clinic

What is dry eye?

Every blink spreads a thin film of tears across the front of the eye. The film has three layers: a sticky base that holds it to the surface, a watery middle that carries oxygen and nutrients, and a thin oily top layer that stops it evaporating. Dry eye is what happens when that film is not being made in enough quantity, or is not good enough quality to last between blinks.

The most common cause by far is a shortage of the oily layer. The oil comes from tiny glands along the edge of the eyelids called meibomian glands. When they become blocked or inflamed, tears evaporate too quickly and the surface dries out between blinks. Less often, the watery layer itself is in short supply. Many people have a mixture of both.

What makes it worse

• Screens and reading, because we blink less than half as often when we concentrate
• Central heating, air conditioning, wind and long-haul flights
• Contact lens wear
• Getting older, and hormonal changes around the menopause
• Some medicines, including antihistamines and some blood pressure tablets
• Blepharitis, rosacea and some autoimmune conditions
• Eye surgery, including laser vision correction
• CPAP machines and sleeping with the eyes slightly open

What happens at a Revive Eye Spa assessment

We call it a spa because the appointment is unhurried and the treatments are gentle, but it is a clinic first. Everything we recommend follows from what we find.

1. We listen. When it started, what makes it worse, what you have tried, and a short questionnaire so we can measure improvement later.
2. We examine the tear film under the slit lamp with special dyes, timing how long it lasts between blinks and looking for dry patches on the surface of the eye.
3. We examine the eyelids and the meibomian glands, and gently express them to see what the oil is like.
4. We check for blepharitis, allergy, lid position and anything else that could be contributing.
5. You leave with a written plan, and a review date so we can see whether it is working.

Treatment, step by step

The basics at home

Warm compresses to soften blocked oil, followed by gentle lid massage. Lid cleaning with a proper lid wipe or foam rather than baby shampoo, which strips the natural oils. Blink breaks from screens. A humidifier in a dry office. These sound simple, and done properly they resolve a surprising share of cases.

Drops, gels and ointments

There are dozens of lubricants and most people have tried the wrong one. We match the drop to your tear film: lighter watery drops for a shortage of tears, oily or liposomal drops when evaporation is the problem, gels and night ointments for morning grittiness, and preservative-free formulations for anyone using drops more than a few times a day or wearing contact lenses.

Punctal plugs

Tears drain away through two tiny openings in the inner corner of each eyelid. If your eyes are not making enough tears, closing those drains keeps your own tears on the eye for longer. We start with a temporary dissolving plug to see how much it helps. If it does, a tiny silicone plug can be placed in the same way, painlessly, in a couple of minutes at the practice. They are reversible and often let people cut down on drops altogether.

Beyond the basics

Where there is inflammation or infection, prescription drops or a short course of tablets may be needed, which we arrange through the practice or with your GP. If your dry eye needs treatments we do not offer, such as intense pulsed light, or if we find a condition that needs a hospital opinion, we refer you and explain why.

Assessment and treatment fees: to be confirmed by the practice.