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I am evaluating a number of in-practice/clinic professional treatments that may improve or replace, at least in part, home treatments, in much the same way as the treatments from your dental hygienist improve dental hygiene:



This where absorbable Intracanalicular Implants, which are microscopic plugs or implants that reduce tear flow out through the lacrimal ducts, and so retain more tears on the ocular surface, are placed in the tear ducts. The tear ducts drain tears from the eye down into the nasal pages and the back of the throat.


For dry eye patients who have difficulties producing enough tears, known as aqueous deficient dry eye, they can be particularly helpful.


One of the pathways tear loss is reduced, retaining more moisture on the eyes surface. It may mean less frequent application of drops during the day and more eye comfort on waking.
I only use absorbable Intracanicular Implants for patients nowadays, avoiding potential plug loss and discomfort, these absorb over a period of time, sometimes up to six months, rather like absorbable sutures. Implantation is painless and they are not visible to the naked eye.





Dermatologists have been using Low Level Light Therapy (LLLT) since 1987 to heal and rejuvenate tissue. Ophthalmology has been using this technology since 1999 when they started treating glaucoma via Selective Laser Trabeculoplasty (SLT), which does not cut or burn the trabecular meshwork, but simply stimulates it, increasing cellular metabolism for aqueous drainage.

Now derived from decades of use in treating gum disease this simple, innovative and professional system is used to treat many of the conditions that adversely affect the ocular surface - using Light Modulation® / LLLT technology.

Photobiomodulation treatment
Photobiomodulation treatment


Photobiomodulation is an innovative technology that stimulates mitochondria contained in the cells. Light modulation® triggers biochemical and biophysical reactions that encourages cells to create a better protein synthesis.

What are the benifits? Lower and upper eyelids treatment: 100% of the eyes’s Meibomian glands. Direct treatment of meibomian glands The LED matrix triggers eyelid endogenous heat and ATP production. This patented technology encourages removal of gland blockage, allows lipids to flow to complete tear composition. Improved lipid presence avoids fast evaporation of tears. Please contact Andrew D Price by emailing This email address is being protected from spambots. You need JavaScript enabled to view it.  for an initial discussion on if, following an initial assessment, you may be suitable for photobiomodulation, this is provided in the practice you attend.





Every six months or so, we make an appointment with our dentist to have a deep cleaning of our teeth. We know the importance of dental hygiene because we brush our teeth daily. Even with daily brushing, a tough film of bacteria develops on our teeth, requiring routine cleaning to maintain our oral health.
Our ocular health is no less critical, but many of us do not perform daily lid hygiene, and even fewer schedule a visit with our eye care specialists to deep clean our eyelids thoroughly every 6 months. Washing our face is insufficient to remove the daily buildup on our eyelid margin. Our lashes hide the lid margin, and the orbital bones glide our hands and fingers away from our eyelids while washing our face.

The gradual accumulation of oil, bacteria, Demodex mites, and debris generates inflammation along our eyelid margins that not only damages the eyelid itself but also seeps onto the ocular surface with every blink to cause collateral damage on the conjunctiva and cornea. Chronic inflammation causes blurriness, grittiness, dryness, and redness – hallmarks of dry eye syndrome. Beyond the symptoms are anatomic changes to our eyes. Our eyelid margin becomes vascularized and irregular, which can cause mechanical damage to the cornea and inflammatory changes on the cornea that can be seen as punctate epitheliopathy, Staphylococcal marginal disease, and even ulcers. The lacrimal punctum constricts, leading to decreased tear drainage and increased accumulation of inflammation on the ocular surface. Each successive injury to our eyelids potentiates the next cycle of injury.


Okra-based products with an in-practice treatment use a polysaccharide complex derived from fresh okra to control inflammation, reduce biofilm, and kill any Demodex mites.

Like our teeth, even daily eyelid hygiene cannot remove the tough biofilm plaque that develops over time. We offer a type of eyelid debridement procedure called ZEST. This procedure uses a patented gel derived from fresh okra and specially-made soft applicators to cleanse the eyelids without pain or trauma. The ZEST treatment differs from other in-office deep lid cleaning procedures because it dramatically and instantly improves dry eye symptoms from almost any cause, from Demodex to meibomian gland disease (MGD). 

Click here for ZEST Treatment video


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Dry/Watery Eye FAQs

Eye makeup and skin care used in and around the eyes is a potential source of irritation, inflammation, infection, allergy and possibly adverse permanant changes to eye health. As just one example out of many aspects of eye cosmetics Amy Gallant Sullivan, Creator of 'Èyes Are The Story' highlights eyelash extensions; "eyelash extensions aren’t always pretty, lash extensions can cause irritation, conjunctivitis, keratitis, and even severe allergic reactions. False eyelashes can promote the risk of bacterial & fungal infection. Eyelash extensions can even cause eyelash loss! Watch the video for more information on lash extension.


You will find the Eyes Are The Story web site here.

Kathyrn Chidwick BSc(Hons) Ophthalmic Dispensing, in a recent article in Re:View the ABDO College journal, discussed the possible contamination and infections from ocular cosmetics. Her critical research analysis found studies that revealed high contamination of ocular cosmetic products being used by patients with potential sight-threatning bacteria and fungi. It is strongly advisable for ocular cosmetics not to be shared or used past their expiry date. 

The same research analysis found studies showing eye liner can destabilise the tear film and block the vital meibomian glands in the eye lid. Many skin-care products contain retinoids, these may cause or excerbate meibomian gland dysfunction. 

Alllergic reactions to the multitude of chemicals found in ocular cosmetics have been known for many years, even leading to a dermatitis condition on the eye lids, from the ocular cosmetics themselves, or hair products. 

The complete article can be found in the December 2021 issue of Re:View  .


Always apply makeup outside the lash line and apply mascara from the tips rather than the roots of the lashes, preferably to the top lashes only.

Never apply eye makeup over the oil glands that line the very edge of your upper and lower lids, just inside the eyelash line. These are the glands that secrete oils to keep the eye lubricated. If you need to use an eye drop, apply it 15-30 minutes before putting on your makeup.


It is a must to remove makeup before bed. Sleeping with eye makeup on can lead to clogging of the oil producing glands and eye infections. Try a gel based product that is oil and paraben free. Avoid getting the makeup remover into the eyes as this may irritate them further.
Avoid mineral oil, sodium lauryl sulfate, and diazolidinyl urea. While they work well to remove makeup, they are known to cause irritation to the eyes.
A gentle lid scrub with baby shampoo on a clean cotton pad or soft cloth or a store bought lid scrub can help remove excess makeup and unclog the eye’s oil glands.

Makeup Hygiene

Keeping makeup applicators clean is critical to keep infection at bay. Make sure to sharpen your makeup pencils before application to remove the top coat of bacteria. Also, wash makeup brushes as well as using a brush cover to keep them clean. Avoid using store samples, but if you must make sure to use a fresh applicator.
Do not use the same applicator on different parts of the face. For example, do not use the same pencil on your lips and your eyes.
Avoid sharing makeup with anyone else and using makeup past its expiration date. As a rule of thumb, dispose of your eye makeup every three to six months. You can keep a marker in your makeup kit to note the date the makeup was opened.
Do not use any type of eye makeup if you have an eye infection and see your optometrist right away. If you do develop an infection, throw away all your eye makeup and buy a new set to start with after your optometrist OKs you wearing it again.
Always wash your hands before applying makeup and avoid using saliva to assist in putting your makeup on as this could lead to an eye infection.

Makeup Type

The tiny particles in glitter and powder based shadows and foundation can get into and aggravate the eyes. Instead sparingly use cream shadows, highlighters and foundations.
Use a thickening mascara instead of lash-lengthening or waterproof ones as they are less likely to flake and get into the eyes.
Stick with hypoallergenic brands to avoid excess irritation. Avoid makeup with arsenic, beryllium, cadmium, carmine, lead, nickel, selenium, and thallium.

Find Alternatives

A plastic eyelash curler is a great alternative to mascara. (The metal in regular eyelash curlers can cause irritation and dryness around the eye).
You might also get away with less eyelid makeup if you concentrate on your eyebrows instead.

If you suffer from severe and chronic dry eye and are intolerant of eye makeup try highlighting other aspects of you face, such as your lips and cheeks, which allows you to highlight your natural beauty without ever touching your eyes.

Eyelash extensions

These have grown in popularity due to beauty trends favoring the appearance of more robust eyelashes and eyebrows. Eyelash extensions are synthetic fibers (e.g. polyester) that are applied on the natural lashes using glue that may contain chemicals such as formaldehyde, lead, and benzoic acid.  Allergic reactions to eyelash glue can be serious as well as associated complications including keratoconjunctivits, contact dermatis and blepharitis, conjunctival and corneal erosion, subconjunctival hemorrhage. To prevent complications arising from eyelash extensions, both the patients and the beauty industry should learn the potential complications of the procedure and the ingredients of the glue and lash removers should be strictly regulated and monitored.


Yes, it is possible. Many general health conditions have a role in dry eye and/or blepharitis. At your Dry Eye Assessment we will want to know about your general health and health conditions/treatments you have had in the past. We believe it is simply not possible to address your dry eye condition and best help you without knowing this information. Just as one example, rheumatoid arthritis or other types of inflammatory disease are a risk factor in dry eye disease, so if that is the case we would want to manage it specifically, another good reason why self-treatment with self-selected eye drops is not advised.

Yes, it is possible. Many general and eye medications and the conditions they are taken for can exacerbate the general condition called dry eye. At your Dry Eye Assessment we will want to know your medications, food supplements and ask about your diet, do you eat oily fish for instance. We believe it is simply not possible to address your dry eye condition and best help you without knowing this information. Importantly we very rarely advocate a medication change but rather work with your medication prescriber to manage your dry eye condition, certainly you should not change medication in any way without consulting your doctor or pharmacist.

On an allied point there are available specific dry eye food supplements with evidence of effectiveness available, but these are contra-indicated if you are taking certain medications or other food supplements, we will advise you at your Dry Eye Assessments. 

As in the ‘hot flannels’ question, this advice, although well meaning, is not based on any evidence of its effectiveness. In fact there is evidence that it can adversely affect vital glands on the eye surface that contribute to good quality tears. It also has a detergent effect, which actually beaks up the tear film. Its use has never been proposed by the manufacturers of such a product, and recently a well-known global producer of ‘baby shampoo’ officially wrote to an UK ophthalmologist strongly supporting his advice against its use. 


If this was the question in 1975, perhaps so, if only because we didn’t understand the complexity of the eye lids or the tears then and we had nothing better. This approach was neither safe (risk of it being too hot and/or very unhygienic) or effective (the required heat is not maintained for nowhere near long enough). In 2020, with our much better understanding of the ocular surface, lids and tears we know much better. Heat application alone is not usually sufficient to help one of the types of dry eye (the type of dry eye needs to identified correctly) most Eye Care Professionals, who understand dry eye/blepharitis would not advocate their use.

Yes, most glaucoma drops have preservatives within them to protect against contamination. Very often the continued application of these very necessary drops, with their preservatives, to the eye can cause eye surface inflammation and irritation.
Many of the same age group of patients using glaucoma drops are predisposed to dry eye, these two factors (preservatives and dry eye) often mean the eye is not comfortable.
The answer is NOT to stop using the glaucoma drops, they are vital, it may well be, after a specific Dry Eye Assessment, the dry eye and effects of the glaucoma drops can be managed better, leading to the eyes being more comfortable and, evidence has shown, the glaucoma drops being more effective.

Although a few specific dry eye drops have very sophisticated formulations, even they don’t have ability to stay on the eye’s surface for many hours. Most dry eye drops, with more basic components, will have only have an effect for one or two hours.
The answer, in many cases, following a specific Dry Eye Assessment and diagnosis (there are different types of dry eye) is to treat the eye’s surface in addition to the use of very particular drops. Once the particular cause is identified in the exam, targeted therapy can be advised, sometimes aided by in-practice treatment. The very good news is that this approach gives me, and more importantly, my patients a 95% success rate!