Why massaging eyelids helps relieve dry eyes 

I’ve been diagnosed with dry eyes, and have been using drops and warm eye pads for two weeks. But it’s still very uncomfortable. Can you suggest any other remedy?

Jayne Cole, Southampton.

As many as one in four of us has dry eyes, but plenty may not realise it, as the symptoms that cause it can be confusing: largely because, paradoxically, dry eyes stream with tears at times.

These tears are the eye’s way of compensating for the dryness.

Normally, there’s a film of tears that’s spread across the surface of the eye every time we blink. This provides a protective covering, enabling the eyelids to open and close comfortably. It also has healing properties.

The tear film is made up of a mucous inner layer, a watery middle layer and an oily outer layer that prevents the watery layer from evaporating too quickly.

However, for a variety of reasons, such as age or hormonal changes related to the menopause, for example, the meibomian glands that line the eyelid and produce the oily secretions become less productive — and any oil they do produce becomes less effective.

As many as one in four of us has dry eyes, but plenty may not realise it

As many as one in four of us has dry eyes, but plenty may not realise it

This means the watery layer is left unprotected, so it evaporates or is shed as tears, leaving the eye feeling dry, gritty and sore.

Using lubricating eye drops will help. You say in your longer letter that you’re using sodium hyaluronate, but this treats the symptom and is not a cure.

The best results come from meticulous, regular lid hygiene. This involves applying heat to the eyelids to soften sticky oil secretions that may be clogging up the outlets from the meibomian glands. Do this for four to five minutes.

You’ll also need to apply a little pressure to the area, by massaging along the lid margin with a cotton wool bud. Wipe along the outside edge of each eyelid after the heat treatment — three to four strokes along each lower lid. It works even better if you dip the cotton bud in baby shampoo.

The best way to apply heat is with a hot compress — for example, a flannel squeezed out after soaking in hot water. You can also purchase an eye compress containing wheat, which is warmed in a microwave (be careful to follow the instructions).

I have also experimented with an eye wand, a vibrating eyelid warming device. These are readily available online, though they can cost in the region of £60.

If you get into the habit of using the compresses and massaging daily, you may then find that the lubricant eye drops are only required occasionally.

One other consideration is that extended use of laptops and other screens seems to lead to a reduction in blinking, and this interferes with the normal spread of tear film across the eyes. So make sure you have a screen break every hour if this applies to you.

I hope this regimen will lead to improvement within weeks.

During a visit to A&E with a cracked rib, I was told my heart rate was a little high. I have since been checking my pulse at rest and it is 80 beats per minute (bpm), which surprises me. I take a brisk 30-minute walk daily and a 30-minute hill walk weekly, with no discomfort. Do I need medication to reduce my pulse?

Paul Jones, by email.

I believe there’s no need for concern about this. You say in your longer letter that you take doxazosin, prescribed for high blood pressure.

This is a drug called an alpha adrenoceptor antagonist. A known and harmless side-effect of these drugs is reflex tachycardia, where the heart beats faster.

There is no harm in having a slightly raised heart rate: you’re still within the normal range of 60 to 100 bpm.

What matters is that your blood pressure is normal and you are symptom-free with no breathlessness when you exercise, indicating that your heart function is good.

Rest assured, you don’t need to be worried.

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