Dry Eye
DRY EYE SYNDROME
Dry eye syndrome is a common eye condition affecting millions, especially those aged 30 and older. It’s caused by insufficient tear production or poor tear quality, leading to discomfort and reduced quality of life. Fortunately, modern eye care offers improved diagnosis and treatment options.
TEARS AND THE TEAR FILM
Tears, essential for eye health, consist of three layers: the mucus layer, the aqueous layer, and the lipid layer. Each layer plays a vital role in maintaining eye moisture and optical clarity. Insufficient production or poor quality of any layer can lead to dry eye syndrome.
Tears are produced by various glands, including those in the eyelids and the lacrimal gland. Blinking spreads the tear film across the cornea, ensuring a smooth optical surface. Excess tears drain through the lacrimal puncta into the nasal passage.
Dry eye syndrome can arise from various causes, mostly environmental but including contact lens wear, which can absorb tears and proteins, leading to dry spots on the lens.
COMMON SYMPTOMS
The most common symptoms of dry eyes include dryness, itching, burning, irritation or grittiness, redness, blurry vision that gets clearer as you blink, light sensitivity and contrary to common sense….excessive tearing. These symptoms typically increase during vision related activities such as computer use, night driving, reading or watching television. They may also increase in response to environmental conditions such as wind, low humidity, airplane travel, or smoke (being in a smokey environment). Many of these symptoms of dry eyes may also be found in other eye conditions, this makes careful diagnosis especially important.
COMMON CAUSES
Environment:
Sunny, dry, or windy weather, heaters, air conditioners, and arid high altitudes increase the evaporation of tears from the surface of your eyes. In fact Phoenix, Arizona was recently recognized as the 8th “Dry Eye Hotspot” in the U.S.
Aging:
During the normal aging process, our bodies and our eyes produce gradually less and less oil. The reduction in oil in the tear film results in quicker evaporation leading to the formation of dry spots on our eyes.
Contact Lenses:
Contact Lenses are subject to dehydration or loss of their water content. As they dehydrate, they can absorb the tear film causing dry eye symptoms. In some cases, the continued drying of the contact lens surface causes it to become deposited with protein making the lenses even more uncomfortable than the dryness alone.
Medical Conditions:
Women experiencing hormonal changes (menopause), those patients suffering from thyroid disease, vitamin A deficiency, rheumatoid arthritis, lupus, psoriasis, eczema, Parkinson’s disease(or other diseases which cause decreased/insufficient blinking), acne rosacea and a number of other systemic especially autoimmune conditions may cause dry eye syndrome.
Medications:
Diuretics taken for high blood pressure, antihistamines, antidepressants, acne medications, allergy meds and many others may all produce dry eye symptoms
Eye Surgery:
Certain ocular surgeries especially blepharoplasty can lead to incomplete eyelid closure and/or alterations in tear film production and thus dry eye
DIAGNOSIS
There are several clinical examination methods that are useful for helping to diagnose and determine the severity of dry eyes. Dr. Perry may use all or some of the following tests to help make the diagnosis:
Tear Break Up Time:
A measurement made by observing the rate at which the tear film begins to evaporate and indicates the overall stability of the tear film.
Tear Staining:
A method of using special dyes to help highlight problems with the surface of the eye and the tear film quality. By placing these eye drops in the tear film the severity of the dryness can more easily be recognized.
Tear Film Height:
A measurement made with the slit lamp biomicroscope to evaluate tear volume A Schirmer Test may be performed by placing a small piece of special paper inside your lower eyelid to measure tear production.
TREATMENT
For those patients with mild to moderate dry eyes the first course of treatment usually is to use preservative free artificial tears. Depending on the nature of your tear film deficiency, Dr. Perry may have you use a specific type of artificial tear that has different characteristics in terms of salt content and viscosity. In addition, Dr. Perry may counsel you on environmental factors that need to be modified. Sometimes, if the oily layer of the tear film is deficient, he may suggest that you increase your consumption of oily fish or even take flax seed oil or omega 3 fish oil as a dietary supplement. Most likely you will be asked to drink plenty of water.
For patients with mild, moderate or severe dry eyes, who may already be using artificial tears without relief, the prescription of cyclosporine eye drops (such as restasis, xiidra or cequa) in addition to tears can often help alleviate your symptoms. Restasis works by suppressing a type of inflammatory cell from entering the Lacrimal Gland and thus allows the lacrimal gland to function more effectively so that you can actually make more of your own natural tears. A clinical study published in 2008 concluded that the use of Restasis eye drops may alleviate the signs and symptoms of dry eye during all stages of dry eye disease and especially in patients with mild forms of the problem. The study results for mildly affected patients suggest that the earlier the treatment with Restasis/cyclosporine, the better the overall treatment results.
If these approaches do not work, Dr. Perry will likely suggest the insertion of tiny punctual plugs that will slow down or even stop the drainage of tears from the eye. Dr. Perry utilizes many types of punctal plugs and will specifically cater the type of plug to each individual patient. These plugs are easily and comfortably placed in the lacrimal puncta in the eyelids. Initially you may have a temporary dissolving plug put in place to see if your signs and symptoms are actually responsive to this treatment. If the results are good, it may be necessary to place a more permanent type of plug in the lacrimal puncta to affect a long-term solution. Occasionally there are some cases that may not respond to the above sequence of treatment options because of some underlying low-grade inflammatory or infectious process. In these cases it may be necessary to also prescribe an oral antibiotic such as a tetracycline or an anti-inflammatory eye drop such as a corticosteroid eye drop.There are also additional dry eye medication options such as autologous blood serum, miebo eye drops or tyrvaya…
Other treatment options may include avoidance of certain environmental causes. 7Eye sunglasses can help with dry eyes because they keep out wind, pollen and dust with their Airlock seal; 99 percent of wearers in a study reported a decrease in overall dry eye symptoms. Also treating underlying medical conditions may help alleviate dry eye symptoms. Other medical products such as lacriserts, a tiny insert filled with a lubricating ingredient (hydroxypropyl cellulose) may be beneficial for some patients. The insert is placed just inside the lower eyelid, where it continuously releases lubrication for the eye throughout the day.
As you can see, the diagnosis and treatment of dry eyes is complex and requires patience and persistence on the part of the physician and the patient. With careful diagnosis and a systematic therapeutic approach, sufferers of dry eye syndrome can most often experience considerable improvement.