Product profile

Menopause and dry eye disease

Easing the burden

By Meena Puar BSc (Hons), MCOptom, FBCLA

Approximately 61 per cent of perimenopausal and menopausal women are affected by dry eye disease (DED). In fact, women over 50 are nearly twice as likely to experience the condition compared to men of the same age1 . Are we delivering the best service for these women, and do they know it? Are we making the most of this valuable patient base? Is this an opportunity for growth in your practice?

SHARING KNOWLEDGE AND EXPERIENCES This summer, Théa spent time successfully engaging with this patient group, raising awareness of the link between DED and the benefits of visiting a optometrist. Our press event saw patients together with a panel of experts, including Sarah Farrant and Francesca Marchetti, sharing their knowledge and experiences, resulting in an array of media coverage.

Having never experienced any eye problems to suddenly suffering with “bizarre” watery, gritty and irritated eyes, 53-year-old Margaret recounted her fairly typical and frustrating journey. This involved trying home remedies at first, being told it was hayfever, visiting her GP and pharmacy, and finally seeking help from a local optometrist. She told the audience that as well as physical symptoms, there were mental challenges of living with DED: “There’s not a day that goes by where you are not dealing with it,” she said. “It’s a very debilitating condition.”

Margaret went on to say that living with DED had made her very aware of the key role that optometrists play: “You take your eyes for granted until something happens. You don’t appreciate what they mean to you.” With the help of her optometrist, Margaret was diagnosed with DED and

Helping women to manage their symptoms

blepharitis and is now successfully managing her conditions with Théa Blepha cleansing products and preservative-free dry eye drops.

Having Margaret share her own experience was really valuable. Even as an experienced optometrist, it made me think again about how we can better serve these women in practice. Adopting a simple approach of letting patients know you are open to discussions, and offering straightforward daily routines to manage the condition, will really benefit both patient and business.

For many women, going through the menopause can make them feel in a constant state of premenstrual syndrome. Alongside the feelings of irritability, sadness, and lack of motivation, comes additional symptoms like hot flushes, night sweats, weight gain and mood swings. A symptom that may be lesser known to these patients but all too familiar to us in practice is dry eye. Understanding the correlation between the menopause and dry eye can assist us in helping our patients.

JOINING UP THE DOTS The tear film has three components: the outer lipid layer, which is secreted by the meibomian glands, the aqueous layer secreted primarily by the lacrimal gland, and the inner mucin layer secreted by the goblet and epithelial cells of the conjunctiva. The meibomian glands are modified sebaceous glands, which produce and secrete lipids to promote stability of the tear film and reduce evaporation of the aqueous layer.

The production of all three layers is influenced by the sex steroid hormones – androgen, oestrogen and progesterone. The meibomian glands and lacrimal glands have oestrogen and androgen receptor sites that stimulate secretion.

During menopause, the production of these sex steroid hormones is reduced, which can lead to tear film imbalance.

The reduction in androgen can impact the quality and quantity of lipids produced by the meibomian glands, and the reduction in oestrogen and progesterone, may suppress the sebaceous glands which can, in turn, lead to a reduced lipid production. This disruption to the tear film can then start a cascade of events, including inflammation and the appearance of ocular surface disease including DED.

When we include time spent on screens, wearing contact lenses for long periods of time, cigarette smoke exposure, heating, air-conditioning as well as certain medications and other chronic conditions, it really is a recipe for the onset of those ›

Figure 1: Warm the eyes with the Bepha Eye Bag

‘bizarre’ symptoms of DED so well explained by Margaret.

Symptoms of DED include pain, blurring of vision, foreign body sensations, redness, tired eyes, excessive watering, photophobia, and dryness. Despite some people suffering with DED, more than a third of people are unaware of the symptoms2 meaning that lots may be suffering needlessly. Whilst DED can be effectively managed, if left untreated it can lead to serious infections and ocular surface damage.

TREATMENTS Luckily, there are treatments and simple lifestyle adjustments that can help manage DED symptoms. Théa has a range of clinically proven products that help patients adopt a systematic approach to good eyecare with a simple warm, cleanse, hydrate and nourish routine. Empowering your staff to discuss the options a can really make a difference. We can support you and your staff to confidently communicate the benefits and treatment options you offer.

STEP 1: WARM AND CLEANSE Step 1 of the routine is to warm and cleanse the eyes and eyelids with the Blepha range. Starting with warming, the Blepha Eyebag (Figure 1) provides rapid ocular comfort, relieving symptoms of meibomian gland dysfunction (85 per cent of dry eye is caused by this), blepharitis, stye and chalazion in just 14 days3 .

The Blepha Eyebag is a reusable warm compress that works by emitting heat that helps to soften the oily secretions in the eyelids, aiding the release of natural oils to maintain tear film and ocular comfort4,5 .

Developed and recommended by ophthalmologists6, the Blepha Eyebag is made with silk and cotton, and is natural, convenient, easy to use and can be reheated up to 200 times. Its handmade design, notably its flax (linseed) filling, is free from additives and plastics.

Next is Blephaclean to remove any allergens, debris or make-up from the eyelids due to allergy or infection. Due to the micellar action, it is highly tolerated making it suitable for the most delicate skin, which is particularly welcomed by women who suffer with skin complaints whilst going through the menopause. It is clinically proven to reduce symptoms of blepharitis after 21 days of twice daily use7 .

STEP 2: HYDRATE Step 2 is to provide dry eye symptom relief with Thealoz Duo or Zaspray (Figure 2 and 3). Around one fifth of people suffer with DED and this can be caused by hormonal changes. Thealoz Duo offers immediate relief for all dry eye patients as it hydrates, lubricates and uniquely protects the surface of the eye – as well as increasing the tear film thickness and improving tear film stability.

It’s paramount that patients are encouraged to opt for a preservative-free eye drop. Products containing preservatives have a risk of toxicity, which can damage the surface of the eyes, leading to inflammation9. Théa’s unique dry eye range is 100 per cent preservative-free and lasts for up to three months.

Thealoz Duo is a premium preservativefree drop delivered in the patented ABAK bottle: easy to squeeze for those experiencing dexterity issues.

The menopause can also be a direct cause of heightened sensitivities due to hormone levels and the immune system being intricately connected. So, when hormone levels fluctuate, the immune system can be thrown into chaos. Théa has something to suit everyone with our newest addition to the dry eye range – Zaspray.

Zaspray is a three-in-one solution to relieve itchy and dry eyes, especially caused by allergies. It is specifically designed to hydrate, lubricate, and soothe the eyes with its unique formula made up of hyaluronic acid and Per-Lip complex with perilla seed. The spray mechanism also makes it easy to use and convenient for those who struggle with drops, have dexterity or coordination issues10 .

STEP 3: NOURISH Step 3 is to support eye health and vision with Nutrof Total. Théa has discovered that only four per cent of people eat enough of the recommended foods to support eye health. Nutrof Total offers a clinicallysupported formulation delivered in a once-daily soft gel capsule, shown to be easier to swallow than tablets. Containing vitamin D in line with government guidance, Nutrof Total can help combat deficiency, whilst supporting women’s eyes during age-related changes. Nutrof Total includes vitamin D and omega 3, which can also help combat dry eye symptoms.

IN CONCLUSION Supporting women as they go through the menopause may just be a key to growing your relationship with this group of patients – and growing your business in independent practice.

Figure 3: Zapsray: a new three-in-one solution

For references, please email alex.france@theapharma.com

Meena Puar is professional education lead in optometry for Théa UK.

To find out more about the full Théa product range and support for your practice, telephone 0345 521 1290 or visit www.thea-pharmaceuticals.co.uk ■