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Welcome to question of the day #356

Eyetools question of the day #356 

I’ve noticed that a lot of my older patients complain of gritty and watery eyes. Many of them have tried to use comfort drops but some patients can’t instil drops and other find comfort drops of no benefit. What can I do?

My clinical work involves examining people over the age of 75. I too have noticed that many of them complain of gritty and watery eyes. I have recently started to ask all the patients I see if they have gritty and/or watery eyes even if they don’t mention it in their presenting symptoms. In my experience around 30% of the people I see have gritty and/or watery eyes. Many of them have tried to use comfort drops without success for a variety of reasons.

I have started to recommend a lid wipes trial even if they are no obvious signs of blepharitis. Posterior blepharitis can be very difficult to detect. A person complaining of gritty and/or watery eye is very likely to have inefficient meibomian gland function and deserves to be informed of the potential benefits to eye comfort from the use of lid wipes.

Lid wipes are commercially available as small sterile cloths that are impregnated with artificial and natural chemicals. They are preservative, soap and fragrance free. Each cloth is individually packaged. A cloth can be used to wipe the upper and lower eye lid margins. The wiping action will remove debris and dead skin, help clear the openings of the Mebomian glands and also stimulate the Mebomian glands to produce natural oils. These natural oils flow on to the eye surface and into the tear film. This helps create an improved tear film and tears which are more likely to stay on the eye surface rather than run out of the eye on to the skin.

It is important to let patients know that symptoms will not be resolved in a few days but may take 2 to 3 weeks and for them to continue with lid wiping if their symptoms don’t resolve in a few days.

It is also important to let patients know that their eye problem is a long term one and that if their symptoms resolve and they stop using lid wipes their symptoms will return.

Several of the patients I have seen have improved eye comfort since using lid wipes and have continued to use them.

Many patients tell me that they are willing to pay the cost of lid wipes to keep their eyes comfortable and their cheeks dry.