I’ve been receiving hospital treatment for a severe dry eye condition for many years. This has been managed successfully by inserting plugs into my tear ducts and using eye drops. About six years ago, I also developed a sensitivity to sunlight. A hospital specialist has suggested heated eye pads and lutein supplements. I have tried both but my light sensitivity hasn’t improved.
Mrs P. Tomkins, Hampshire.
The treatment you’ve had is standard for severe dry eyes. Typically the condition is the result of a blockage in the meibomian glands, which produce an oil that forms the outer layer of tears and helps lubricate the eyes.
This is usually age-related – as we get older, the number of these glands declines and their oil becomes thicker and waxier, contributing to dry eyes. Bacteria can flourish there, causing inflammation (and sore, red eyelids).
In more severe cases such as yours, patients can have tiny plugs placed into the tear ducts to stop the tear fluid draining out, reducing dryness.
In your longer letter you mention Ikervis drops: these work by suppressing the inflammation. The other two eye drops you’re using – Clinitas and Xailin – are lubricants that help ease the symptoms, as the Ikervis takes time to work.
The light sensitivity (or photophobia) you describe is probably part of the dry eye syndrome – tears protect the surface of the eye, and with less of this protection, the nerves are more exposed and reactive. I suspect your specialist’s suggestion to use heated eye pads is to tackle the underlying cause of the dry eyes. Heat can ‘soften’ the oil to help release it.
While you can buy special eye pads from any chemist, a warm compress (such as a flannel) or a microwaveable seed-filled eye mask are also good options – using one of these for ten minutes once or twice daily can help.
As for lutein supplements, these are not intended to treat dry eye – rather, they can help protect the macula, the area at the back of the eye that’s responsible for sharp, detailed vision.
Eye drop brands, such as Clinitas and Xailin, are lubricants that help ease the symptoms of severe dry eyes
I’m 77 and recently experienced a strange ‘surging’ feeling from my stomach to my head while watching TV. Hospital tests found my blood pressure was high – but everything else was normal. What caused it?
Anne Scott, via email.
This must have been frightening, and your longer letter contains several vital clues to a possible cause.
You mention having had two transient ischaemic attacks (TIAs), or ‘mini strokes’, in 2014 and 2018. A TIA is a temporary interruption of blood flow to the brain that causes stroke-like symptoms but no lasting damage. It does indicate an increased risk of a full stroke later, however.
At the time, tests showed you had high cholesterol so you were prescribed a statin and clopidogrel – a blood thinner to lower the risk of stroke.
After this recent episode you had a CT scan of your head and an electrocardiogram (ECG), which checks the electrical activity of the heart to look for abnormal rhythms. Both were normal.
Even so, and despite the reassurance you were given by doctors in A&E, I think it’s hard to rule out another TIA – especially as your blood pressure was raised at the time.
The other likely explanation is a heart-rhythm problem. I’d suggest asking your GP about being referred for longer ECG monitoring – ideally for seven days.
This would involve wearing a monitor at home and is more likely to detect any intermittent rhythm problems that may have been missed during the spot-check in A&E.
In my view… A lifetime of useless health secretaries
So we have a new Health Secretary, Yvette Cooper – the 26th since I became a doctor. I can dimly recall a few good decisions, but most introduced changes that damaged patient care.
Kenneth Clarke (in post 1988-1990) was the worst, his actions reverberating to this day.
In hospitals, the loss of the traditional ‘firm’, where a consultant led a team of junior colleagues, was the biggest disaster in healthcare, undermining training.
The introduction of an ‘internal market’ comes a close second: GPs were given budgets to purchase care by entering into contracts with hospitals, supposedly choosing better value and saving money as the hospitals had to compete.
This did not increase choice as promised – you could refer to a hospital only if your practice had a contract with it. So your decision was based not on the consultant having the right experience and wisdom, but on funding and economy.
We also ended up with a vast infrastructure to create and monitor contracts, diverting funds away from patient care.
Those same administrators remained after the dissolution of the internal market, an army of managers who ultimately took over healthcare decisions from the doctors and nurses. A disaster.
