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Do you have dry eyes or watering eyes?

Want some help?
At Clinica London, we have a dedicated dry eyes and watering eyes clinic, which we call the Tears Clinic because it looks after patients who have both watering and dry eyes.
I, Jane Olver, run the clinic myself with the Clinica London nurses. The reason I set it up was that in my oculoplastic clinics I noted that a lot of the patients who had symptoms of watery eyes did not have blocked drainage tear ducts, but were, in fact, suffering from dry eyes and excess reactive tearing, called hypersecretion of tears. Their eyes felt wet, but they had sore, dry eyes.
As an oculoplastic surgeon I specialised in endoscopic endonasal dacryocystorhinostomy surgery for watering eyes, and so this has naturally led me into the field of dry eyes as well because the patients were coming to see me.
Dry eye disease (DED) is variably estimated in the population as being between 15% and 40%, depending which country and population one studies. You will come across other figures, for instance 7% to 33% in another study. The exact figure does not matter, but the message that it is common, does matter.
Younger and younger people are increasingly getting dry eyes; particularly those working with computers for long hours. In the Tears Clinic, we are both diagnosing blepharitis and meibomian gland dysfunction with dry eyes and we are finding patients who have blocked or partly blocked tear ducts.
I carry out the Tear Clinic consultation by starting with listening to the patient’s concerns, symptoms, and then observing the skin of the eyelids and face to exclude dermatological conditions such as rosacea, acne, seborrhoeic dermatitis, eczema and psoriasis.
We look carefully at the lashes to see whether there is blepharitis or trichiasis and we look at the lid function in respect to the completeness of the blink, for lid wiper zone pathology and the Marxs line defect and to check there is correct lid apposition, tarsal plate pathology and fornix depth.
We then look at the meibomian glands in the eyelids, gently pressing on them to look and to see whether there is dysfunction and grade it.
We look at the meibum quality, whether it is expressible and whether there is corneal and conjunctival surface staining.
We look at the tear meniscus and we measure the tear osmolarity.
We look at the tear break up time with fluorescein drops.
If needed we then go on and do syringing, so that we can divide our patients into those who require treatment for blepharitis, meibomian gland dysfunction and dry eyes and those who may require surgery for a blocked or partially blocked nasolacrimal duct (NLD). The NLD is the tear duct draining the tears from the corner of the eye after they have collected in the lacrimal sac buried deep.
We then customise the treatment for dry eyes or watering eyes according to the findings and the level of the problem. Dry eye treatment is largely medical and watering eye treatment (where there is a blocked tear duct) is surgery to unblock it, often with an endoscopic endonasal dacryocystorhinostomy surgery, called more simply endonasal DCR.

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