dry eyes

 
 

dry eyes

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Dry Eye Defined

Dry Eye Syndrome is a type of Ocular Surface Disease.  It is a condition in which there is a chronic lack of sufficient tears to lubricate and nourish the eye.  Tears are required for maintaining the health of the front surface of the eye and consistently clear vision.  Inflammation may occur along with dry eye. People who suffer from dry eye either experience low tear production, poor quality tears or a combination of both.  Thorough evaluation as to the nature of your dry eye by your eye doctor is an important step toward optimizing eye health, comfort and vision.  

What Are Tears?

Tears are created by the lacrimal gland and are necessary for overall eye health and vision.  Tears are composed of three major components:

1.The outer lipid/oily layer produced by the meibomian glands

2.The middle watery/lacrimal layer produced by the lacrimal glands

3.The inner mucus/mucin layer produced by the goblet cells

The tears are made of proteins, electrolytes and vitamins that are critical in maintaining eye health and preventing infection.  Each layer of the tear film serves a critical purpose.  Tear lipids prevent evaporation and increase lubrication while mucins help anchor the tears to the ocular surface. Tears are constantly produced to bathe, nourish and protect the front surface of the eye.  Dry eye results when one or more of the tear layers are not adequately produced.

Types of Dry Eye

Aqueous Tear-Deficient Dry Eye

A disorder in which the lacrimal glands fail to produce enough of the watery, middle layer component of the tear film to maintain a healthy eye surface.

Evaporative Dry Eye

A disorder characterized by inflammation of the meibomian glands, failing to produce the lipid/oily part of the tear film that slows evaporation and keeps the tears stable.

Symptoms of Dry Eye

Dry eye can either be a temporary or chronic condition.  Dry eye is a common condition and in most cases, chronic and progressive.  Dry eye can range from subtle irritation to inflammation of the tissues of the eye.  Symptoms of dry eye include:

Persistent dryness

Sandy/gritty/scratchy feeling

Foreign body sensation

Burning or stinging sensation

Redness

Pain/discomfort

Episodes of excess tearing

Episodes of blurred vision

Heavy eyelids or eye fatigue

Discomfort with contact lenses

Decreased tolerance of reading, working on the computer or any activity that requires sustained visual attention

Causes and Risk Factors of Dry Eye

Age

Dry eye is a natural part of the aging process.

Gender

Women are far more likely to exhibit signs and symptoms of dry eye secondary to hormonal changes associated with pregnancy and menopause.  Hormonal changes associated with oral contraceptives and hormone replacement therapy also contribute to dry eye.

Medications

Specific medications may reduce tear production including antihistamines, nasal decongestants, certain blood pressure medications, medications used to treat Parkinson’s disease, antidepressants and oral contraceptives.

Medical Conditions

Certain systemic conditions increase the likelihood of dry eyes including lupus, rheumatoid arthritis, diabetes, thyroid disorder, rosacea and Sjogren’s syndrome

Medical Eye Conditions

Skin diseases on or around the eyelids, diseases of the glands of the eyelids, such as meibomian gland dysfunction, and chemical/thermal burns that scar the membrane lining the eyelids and covering the eye can cause the development of dry eye.

Environmental Conditions

Dry eye symptoms can be triggered by environmental factors including smoke, dust, wind and dry climates as well as air conditioning and heating.  There are situations that require focused attention and lead to a failure to blink regularly, such as time spent staring at the computer, watching television and reading a book.  Dry eye can also occur from exposure in which the eyelids do not close completely during sleep.

Loss of Sensation of the Cornea

It can be a result of long term contact lens use, refractive eye surgery (such as LASIK) and certain chronic inflammations and infections of the front of the eye.

Diagnosing Dry Eye

Patient History

A thorough history must be gathered including the nature and severity of symptoms, overall eye and health history, medications taken and any environmental factors that could be contributing to the dry eye problem.

External Examination of the Eye

Evaluation of the lid structure and blink dynamics play an important role in understanding the nature of the dry eye.

Evaluation of the Eye Lids and Cornea

Utilizing bright lights and high magnification, careful evaluation of the meibomian glands and the front surface of the eye must be performed.  

Measurement of the Quality and Quantity of the Tears

Abnormalities must be quantified and qualified using special testing specifically designed to understand the nature and severity of the dry eye.  Special dyes may be instilled in the eyes to better observe tear flow and to highlight any changes to the outer surface of the eye.

Treatment of Dry Eye

Depending on the causes and severity of dry eye, various approaches may be utilized to relieve the symptoms.  Dry eye can be a chronic and progressive condition.  Proper management of your dry eye can keep your eyes healthy, more comfortable and preserve your vision.  

The first priority is to determine if a disease is the underlying cause of the dry eye condition.  If that is the case, that underlying condition must be treated.

Hydration

Simply drinking more water sometimes reduces the symptoms of dry eye syndrome.  Women require approximately 90 ounces of water while men require approximately 125 ounces of water per day.  Experts agree that 20 percent of the water your body needs comes from the food you eat while the remaining 80 percent originates from the fluids you drink.  The best choices for beverages are water, 100 percent fruit and vegetable juices and milk.

Medications

There are a number of medications, such as oral contraceptives, certain high blood pressure medications, that contribute to the development of dry eye.  It is important to consult your eye doctor as well as your primary care doctor to pinpoint possible causes and discuss your options.  

Supplements

This is an article about the use of nutraceutical supplements on dry eye.

Diet and Exercise

A balanced life in diet and physical activity can have an amazing impact on your overall eye health.  Research has identified essential nutrients that can protect your eyes-keep them healthy, improve the quality of your vision and reduce your risk of certain eye conditions.  Key elements include:

Lutein+Zeaxanthin as found in green, leafy vegetables, corn and eggs

Vitamin C as found in citrus fruits

Vitamin E as found in nuts and sweet potatoes

Zinc as found in mild and red meats

Eyelid Diseases (Including Blepharitis, Meibomian Gland Dysfunction, Rosacea)

Proper treatment of the underlying eyelid disease is key to relieving the symptoms of dry eye.  This may include short term use of antibiotics and/or steroids as well as long term implementation of warm compresses, lid massage and eyelid scrubs with specific cleansers.

Adding Tears

Mild cases of dry eye can be managed with over-the-counter artificial tears, gels and ointments.  There are many types of artificial tears available.  In order to optimize the benefits of artificial tear use, it is important to consult with your eye doctor to confirm the best choice for your type of dry eye.

Conserving Tears

Another approach is to keep your natural tears in your eyes for longer by blocking the tear ducts through which the tears normally drain.  The ducts can be blocked by tiny collage or silicone plugs that can be easily inserted, and removed, as needed.  

Increasing Tear Production

Cyclosporin, known as Restasis, is the only topical anti-inflammatory prescription medication available to treat dry eye.  Restasis helps your body produce more tears by reducing inflammation associated with dry eye.  It is designed to gradually increase tear production, decrease corneal damage and reduce symptoms of dry eye.  The benefits of cyclosporine are through its long term use.  

Nutraceutical Supplements

Not all choices in nutraceutical supplements are created equal.  Depending on how the supplement was formulated, your body may not be able to reap the benefits.  It is important to discuss your choice in supplements with your doctor.

Amniotic Tissue Graft

A revolutionary development in the treatment of moderate to severe dry eye, the amniotic tissue graft offers a natural therapeutic approach to promote a healthy ocular surface.  This tissue has healing properties that aid in ocular surface repair by reducing inflammation and help damaged eye surfaces heal.  Eyes treated with an amniotic tissue graft heal more quickly, experience less discomfort and have less overall scarring.  

Contact Lens Associated Dry Eye

It may be as simple as switching brands and/or lens cleaning solutions.  Good communication, persistence and patience between you and your eye care practitioner can make a world of difference in your contact lens comfort.  Don’t settle for the comfort of what you think is “normal.”  

If you are dealing with dry eyes, contact our optometrist in the Rockville, Maryland and Washington, DC area who can help provide you with the treatment you need.