Dry Eye Disease

 

If your eyes sting, itch or burn, you may be experiencing the common signs of “dry eye.” A feeling of something foreign within the eye or general discomfort may also signal dry eye.

What is dry eye?
Dry eye describes eyes that do not produce enough tears. The natural tears that your eyes produce are composed of three layers:

  • The outer oily layer, which prevents or slows evaporation of the tear film;
  • The middle watery layer; which moisturizes and nourishes the front surface of the eye;
  • The inner mucus layer, which helps maintain a stable tear film.

Dry eye may occur because the volume of tears produced is inadequate (we all produce fewer tears as we get older, and in some cases this can lead to dry eye symptoms). It may result because the composition of the tears has changed so that they are unstable and evaporate more quickly.

What causes dry eye?
Dry eye symptoms can result from the normal aging process. Exposure to environmental conditions, as well as medications, such as antihistamines, oral contraceptives or anti-depressants, can contribute to the symptoms of dry eye. Or, dry eye can result from chemical or thermal burns to the eye. Dry eye may also be symptomatic of general health problems or other diseases. For example, people with arthritis are more prone to dry eye.

Will dry eye harm my eyes?
If untreated, it can. Excessive dry eye can damage tissue and possibly scar the cornea at the front of your eye, impairing vision. Dry eye can make contact lens wear more difficult since tears may be inadequate to keep the lenses wet and lubricated. This can lead to irritation and a greater chance of eye infection. Therefore, it is important to follow the recommended treatment plan.

How is it diagnosed?
During the examination, you will be asked about your general health, use of medications, and work and home environments to determine factors, which may be contributing to dry eye symptoms. This information will help decide whether to perform specific dry eye tests.

To test for dry eye, diagnostic instruments that allow a highly magnified view of your eyes or small strips of paper or thread and special dyes to assess the quantity and quality of the tears may also be used.

How is it treated?

Dry eye cannot be cured, but your eyes’ sensitivity can be lessened and measures taken so your eyes remain healthy. The most frequent method of treatment is the use of artificial tears or tear substitutes. For more severe dry eye, ointment can be used, especially at bedtime. In some cases, small plugs may be inserted in the corner of the eyelids to slow drainage and loss of tears.

To keep dry eye symptoms in check, you and your optometrist need to work together. If you have increased dryness or redness that is not relieved by the prescribed treatment, let us know as soon as possible.

Managing Dry Eyes
Dryness of the eyes can be caused by systemic disease such as thyroid disease, rheumatoid arthritis, or Sjogren’s Syndrome. It can also be caused by some blood pressure medications, birth control pills, and many other medications. Many times we simply do not know why a patient’s eyes do not secrete an adequate amount of tears.

One thing is for sure, it is definitely more of a problem in the dry Southwest climate. In this environment, tear glands have to work over-time to keep up with evaporation.

 

Dryness of the eyes can cause burning, itching, a sandy sensation, blurred vision, and contact lens discomfort.

Most of the time we can not remove the actual cause of the dryness, but we can manage the problem. Eye drops to keep your eyes moist can be used several times a day. Drops that DO NOT constrict blood vessels to make your eyes look less red are preferable. If eye drops alone do not relieve your symptoms, a procedure called punctal occlusion my be utilized.

Tears normally exit the eye through a small hole (punctum)in the upper and lower eyelids. From there, tears go through a canal and into your nose. Punctal occlusion is accomplished by placing plugs into these puncti so that your tears may not escape. Dissolvable plugs are tried first as a trial. If relief of symptoms is achieved, non-dissolvable plugs are inserted. These can be removed at any time without surgery. This procedure is done in our office and is painless. Because Dry Eye Syndrome is a medical problem, your medical insurance will usually pay for the procedure.

A new eye medication, Restasis, is being utilized to actually treat the gland that is not making enough tears in those suffering from autoimmune disease, such as rheumatoid arthritis. It is a twice-a-day eyedrop that can improve tear-gland function in about 4 weeks.

What is dry eye syndrome?

Your tears function to protect the eyes and keep them lubricated and comfortable. Dry Eye Syndrome (DES) is the decline of the quantity and/or quality of the tears produced. It is caused when the tear glands in the upper and lower eyelids do not produce enough tears, or they don’t produce the right kind of tears. This phenomenon causes the eyes to feel irritated, scratchy, burning, red, and uncomfortable. Dry Eye Syndrome is the most common of all eye disorders, affecting approximately 20% of our population.

The complexity of tears
Your eyes are moistened by two different types of tears: lubricating tears and reflex tears. Lubricating tears are produced continuously to moisturize the eye and contain natural infection-fighting antibiotics. Reflex tears are produced in response to sudden irritation (smoke, onions, foreign particles), injury, or emotion. Ironically, the irritation from dry eyes can trigger reflex tears, which flood the eye. But because reflex tears do not have the proper lubricating composition, the discomfort persists. Thus, “watery eyes” can actually be a symptom of DES.