Treatments for Aqueous Deficiency Dry Eye

The tear film is made up of 3 layers: an oily layer, a watery layer (called the Aqueous Layer) and a mucin layer. Deficiencies in the watery, Aqueous Layer can be caused by a variety of different reasons: medicines, auto-immune syndromes or LASER surgery (See causes of Aqueous deficiencies).

Eye Drops can alleviate some symptoms of Dry Eye

Deficiencies in the watery layer can lead to symptoms such as burning, grittiness and reduction in quality of vision as the cornea becomes dessicated (dried out).

While not all types of dry eye are helped by frequent use of artificial tear drops, we have found that many of our clients with aqueous deficiencent Dry Eye find eye drops help alleviate symptoms. In this case, drops should be used at least hourly.

Punctal plugs clinically proven to reduce symptons 

For aqueous deficient dry eye, the use of punctal plugs is our most commonly recommended treatment at the Dry Eye Centre. Punctal plugs can be used to block the puncta where the tears drain away. Clinical studies have shown that punctal plugs reduce symptoms and also decrease inflammation in aqueous deficient dry eye (footnote 1). 

There are two puncta in each eye, one on the top lid and one on the bottom lid, both near to the nose (see picture above). Punctal plugs are inserted and block these holes and prevent the tears from draining away.

Prescription Medicines can increase aqueous production in Dry Eye

In cases where drops and punctal plugs do not help, we often prescribe a cyclosporine drop called Ikervis. Ikervis has been shown to increase the amount of aqueous production. Probably by inhibiting a particular part of the immune system and hence reducing inflammation.

Scleral Contact lenses can be used to retain moisture

In severe cases where the cornea has become desssicated from dryness we often use scleral contact lenses to protect the ocular surface from the dryness. Scleral lenses are fitted so that they have a gap between the lens and the eye – this gap is filled with saline providing lubrication and protection to the cornea.

In conclusion, there are many different ways and combinations to treat Dry Eye. At the Dry Eye Centre, we evaluate each patient and craft a treatment program that is unique to your needs.

Please contact us if you would like to book in for an assessment and evaluation.

1 -April 2016 Effects of Punctal Occlusion on Clinical Signs and Symptoms and on Tear Cytokine Levels in Patients with Dry Eye

Causes of Aqueous Deficiencies in Dry Eye

The aqueous is the watery layer of the tears. It is produced in the lacrimal glands.

Deficiencies in aqueous production can be caused by:

• Auto-immune disorders, such as Sjogrens
• Medicines for blood pressure, anti-depressants, hormone replacement therapy
• LASER surgery
• Medicines for Acne, such as Roaccutane

Deficiencies in the watery layer lead to symptoms such as burning, grittiness and reduction in quality of vision as the cornea becomes dessicated (dry).

Here at the Dry Eye Centre, we diagnose aqueous deficiency using the Schirmer's test. In this test a small strip of paper is inserted under the bottom lid. The paper is left for 5 minutes and at the end of the test the length of the paper that has become wet from absorbing the tears is measured. A measurement less than 10mm is considered abnormally low. 

At the Dry Eye Centre, we try to understand the cause(s) of patient dry eye and aim to treat not only the symptoms of Dry Eye but also the cause of Dry Eye, where possible. We are happy to work with your GP or Consultant to develop a comprehensive medical approach that works for you.