3 Things I do not understand about dry eyes :S

[Ruvaida]

Hello,
I have a few questions that I can't find an answer for.

1. Why does sleeping increase redness and dryness of the eyes? They are closed an safe from the air and tear evaporation?

2. How do I know if my dry eyes are because if lack of tears or lack of oils? My ophthalmologist did a test for me in whuch he had put papers in my lower lids, and he said I have dry eyes. I assume I have dry eyes because of the lack od tears.
But how do I know if I also have lack of oils. What is the name of the test I should ask for?

3. I often read the warm compresses are good for dry eyes. How come? It increases redness because heat draws more blood.
Shouldn't we apply cold compresses? I've always had the impression that cold stuff soothes, that's why we apply ice to bruises. Am I right or wrong?

[bakunin]

Hi Ruvaida,

There are a lot of people with much more knowledge and experience than me to answer properly your questions.
But here we go:
Your doctor did a Schimer test on you. Supposely that test mesures your production of tears. But some doctors (i would say a reliable doctor that used to answer questions on this forum thinks Schimer test is not reliable).
A test to see if you have evaporative dry eye is called TBUT. It is made by the doctor and it is easier than Schimer testo to be made. If you have evaporative dry eye you have some problem in oil or in the mucin (or in both) layer of your tear film.
Warm compresses are good for those who have MGD, melbomian gland dysfunction - the gland in the eyelids that produces the lipid are not working well, or is blocked. The warm diminishes viscosity of the lipids, opens the ducts where the lipids go out, so it gives relief.

For what I Know many people do both compresses: warm and cold. Warm for MGD and cold against inflammation and for the reason you have exposed.

best wishes

[Ruvaida]

Thank you bakunin so much.
I googled TBUT. Actually my ophthalmologist did put an orange substance in my eyes (using a sort of small stick or q-tip, not sure) and then looked at my eyes in the watchmacallit machine (the microscope ophthalmologists use)
Is that TBUT? If not, what is that orange thing?

Thank you.

And I hope someone tells me why my eyes get really red after sleeping, is that a usual thing with all dry eyes people? Or only me?

[indrep]

Question 1.) There can be multiple reasons for this. Anterior blepharitis (inside of lids inflamed) at night means the ocular surface is in constant contact with inflamed tissue during the night. As the day goes on and tears are in contact more with the ocular surface it will typically begin to feel better. Another reason for this can be the lids are not completely closing at night and the ocular surface becomes dry damaging the cells of the cornea.

Question 2.) This one becomes a little more tricky. The paper test was for the measurement of the production of tears. Unfortunately this test is considered to not be very reliable. The test most used to measure oil insufficiency is TBUT. However it is only measuring how fast tears break up over the ocular surface. This can also be attributed to lack of mucin which holds tears on the ocular surface.

Question 3.) Warm compresses "liquify" the oils in the meibomian glands increasing their ability to be secreted onto the ocular surface. This is a bit of an issue warm vs cold. My thoughts are the warm is to get to the cause of the issue ant treat the symptom.

[Ruvaida]

Question 1.) There can be multiple reasons for this. Anterior blepharitis (inside of lids inflamed) at night means the ocular surface is in constant contact with inflamed tissue during the night. As the day goes on and tears are in contact more with the ocular surface it will typically begin to feel better. Another reason for this can be the lids are not completely closing at night and the ocular surface becomes dry damaging the cells of the cornea.

Question 2.) This one becomes a little more tricky. The paper test was for the measurement of the production of tears. Unfortunately this test is considered to not be very reliable. The test most used to measure oil insufficiency is TBUT. However it is only measuring how fast tears break up over the ocular surface. This can also be attributed to lack of mucin which holds tears on the ocular surface.

Question 3.) Warm compresses "liquify" the oils in the meibomian glands increasing their ability to be secreted onto the ocular surface. This is a bit of an issue warm vs cold. My thoughts are the warm is to get to the cause of the issue ant treat the symptom.

Thanks you so much indrep. That was really instructive. (thumbs up).

[bakunin]

Thank you bakunin so much.
I googled TBUT. Actually my ophthalmologist did put an orange substance in my eyes (using a sort of small stick or q-tip, not sure) and then looked at my eyes in the watchmacallit machine (the microscope ophthalmologists use)
Is that TBUT? If not, what is that orange thing?

Thank you.

And I hope someone tells me why my eyes get really red after sleeping, is that a usual thing with all dry eyes people? Or only me?

I think your doctor did TBUT on you. Yes, they drop a colored liquid (something between orange and brown) and after that they tell us to blink one time and don't blink anymore. They put a bluse light in our eyes and observe when the tear film breaks up. To be normal the time must be ate leats 10 sec. Bu only one of four ophtalmologist said to me the break up time in the test.