Dry Eye

There is actually a collection of symptoms that make up the eye condition commonly called dry eye. The condition stems from an imbalance in the quantity or quality of tears which results in symptoms including dry, red, gritty, and watery eyes. Often, those suffering with dry eye report eyestrain or the feeling of something foreign being in the eye.

The term “dry eye” can be a little confusing because one of the most common symptoms is excessive watering! It can be understood more easily when you learn that the eye makes different types of tears.

Tears function to bathe and lubricate our eyes. Each time you blink, several glands located around each eye form new tears. A healthy film of tears consists of a delicate balance of three layers:

  • Outer Lipid Layer – also known as the oily layer, it reduces evaporation of the watery layer of tears
  • Middle Aqueous Layer – also known as the watery layer, it consists of 98% water and it cleanses the front surface of the eye
  • Inner Mucin Layer – also known as the mucous layer, it stabilizes the tear film

LayeredCompositionOfTears

Lubricating tears are produced slowly and steadily throughout the day. They contain a precise balance of mucous, water, oil, nutrient proteins, and antibodies that nourish and protect the front surface of the eye.

Symptoms of Dry Eye:

  • Pain
  • Light sensitivity
  • A gritty sensation
  • A feeling of a foreign body or sand in the eye
  • Itching
  • Redness
  • Blurring of vision

Causes of Dry Eye:

Advancing age is the single most important risk factor for dry eye, though men and women of any age may experience it. Dry Eye Syndrome affects 75% of the population over the age of sixty-five years.

Hormonal changes in women brought on by lactation, menstruation, oral contraceptives, menopause, and pregnancy can cause dry eye conditions.

Several Diseases can result in side effects of dry eye; these diseases include Asthma, Cataracts, Diabetes, Glaucoma, Lupus, Rheumatoid Arthritis, and Thyroid Abnormalities.

Prescription medication including some anti-anxiety pills, anti-depressants, anti-histamines, diuretics, high blood pressure medications, pain medications, and sleeping pills.

Over-the-counter medications including some allergy and cold products, motion sickness remedies, and sleep aids can also cause dry eye.

Contact Lenses can cause dry eye which in turn is the leading cause of contact lens discomfort or intolerance. In particular, soft contacts rapidly evaporate the tears from the eye which causes irritation and protein deposits leading to infection and pain.

Environmental Conditions such as air conditioning, air pollution, dry climates, and exposure to smoke, fluorescent lights, heat, and wind can increase tear evaporation.

Computer Use by those spending hours staring at their monitors and ignoring their normal blinking process which is a vital function of tear production.

Refractive Surgery can have dry eye risks associated with the procedure. Dr. Singh consults with individuals considering refractive surgery (including RK, PRK, LASIK, LTK, PRK, and RK) regarding associated dry eye risks.

Inflammation due to an imbalance of “good” fats and “bad” fats is suggested by recent research to be a cause of dry eye.

Diagnosing Dry Eye:

Dr. Singh can perform simple in-office diagnostic tests to evaluate the quality and quantity of your tears. General health along with environmental factors and medications are considered in diagnosing dry eye. The doctor can also check for pinpoint scratches on the front surface of the eye that may have been caused by dryness. To do this, he uses special colored eye drops called fluorescein (or Rose Bengal).

Treatments for Dry Eye:

Artificial Tears, over-the-counter, preservative free, are usually the first line of treatment for dry eyes. Artificial tears lubricate the eye and ease symptoms. These products can generally be used as often as needed throughout the day; however, always read the directions and warnings.

Drops used for red eyes can often make the eyes even drier. Red eyes can be caused by numerous factors, from allergies to an eye infection. The cause and treatment can vary which is why a proper diagnosis by a qualified doctor is important.

Restasis, approved by the Food and Drug Administration in 2002, is currently the only prescription product for chronic dry eyes. This medication increases tear production, which may be reduced because of inflammation on the eye surface. Restasis is usually taken every 12 hours. It should not be used by people with any type of eye infection or hypersensitivity to any of the ingredients.

Punctal Plugs are reserved for people with moderate or severe dry eye when other medical treatment (such as the methods described above) hasn’t been adequately effective.

Each eye has four puncta which are little openings to drain tears into the tear ducts. In order to block tear drainage, punctal plugs can be inserted into the puncta. Temporary ones made of collagen are sometimes tried first to make sure that permanent ones (usually made of silicone) will not cause excessive tearing. Technological advancements in recent years have resulted in the approval of plugs that are made of thermally reactive material. When these are used, the material is inserted as a liquid into the punctum where it hardens and conforms to the individual’s drainage system. There is another option where the material starts out rigid, but subsequently becoming soft and flexible as it adapts to the individual’s punctal size after insertion.

In any of these treatment scenarios, artificial tears are still usually required after punctal plug insertion.