Our office is an accredited Dry Eye Center and can help you understand and treat your dry eyes. The term “dry eye” can be a little confusing, since one of the most common symptoms may be excessive watering or tearing! It makes more sense, though, when you learn that the eye makes two different types of tears.
The first type, called lubricating tears, is produced slowly and steadily throughout the day. Lubricating tears contain a precise balance of mucous, water, oil, nutrient proteins, and antibodies that nourish and protect the front surface of the eye.
The second type of tear, called a reflex tear, does not have as much lubricating value. Reflex tears serve as a kind of emergency response to flood the eye when it is suddenly irritated or injured. Reflex tears might occur when you get something in your eye, when you’re cutting onions, when you cry, or when you accidentally scratch your eye. Still another cause of reflex tearing is irritation of the eye from lack of lubricating tears. The eye sends a distress signal through the nervous system for more lubrication. In response, the eye is flooded with emergency tears. However, these tears are mostly water and do not have the lubricating qualities or the rich composition of normal tears. They will wash debris away, but they will not coat the eye surface properly. The reflex tears gush out in such large quantities that the tear drainage system can’t handle them all and they spill out onto your cheek. If your eye is not producing enough lubricating tears, you have dry eye syndrome.
Dry eye is frequently under diagnosed. The symptoms often develop subtly and are often overlooked until the problem is severe. Dry eye affects women much more frequently than men. Typical symptoms include:
- Watery eyes
- The feeling of sand or grit in your eyes
- A burning or stinging sensation, worsened by heated rooms or air conditioning
- Vision that becomes blurred after periods of reading, watching TV, or using a computer
- Discomfort & irritation
- Sensitivity to light
- Feeling of foreign body in eye
- Aging can result in less oil production in the glands of the eyelids. Oil keeps tears from evaporating off the eye. Reduced oil production allows tears to evaporate too quickly, leaving the eye dry.
- Diseases including Sjogren’s Syndrome, rheumatoid arthritis, Parkinson’s and diabetes.
- Hormonal changes, particularly after menopause.
- Prescription medications, including some high blood pressure medications, antihistamines, diuretics, antidepressants, anti-anxiety pills, sleeping pills and pain medications. Over-the-counter medications including some cold and allergy products, motion sickness remedies, and sleep aids can also cause dry eye.
- Hot dry or windy conditions: High altitude, air-conditioning and smoke can also cause dry eye.
- Reading, using a computer or watching TV.
- Some types of eye surgery, including LASIK can aggravate dry eye.
- 70% of dry eye disease is caused by evaporative or lipid deficiency (also known as Meibomian Gland Dysfunction).
Our office measures the tear osmolarity by utilizing the TearLab Osmolarity System. With this system we can now measure the severity of your dry eyes and also evaluate your progress on treatment. Our cornea specialists will also check for dry eye by examining your eyes with a bio-microscope, measuring your rate of tear production and checking the amount of time it takes for tears to evaporate between blinks. The doctor can also check for pinpoint scratches on the front surface of the eye caused by dryness using special diagnostic dyes such as fluorescein, Rose Bengal, or Lissamine Green.
Dry eyes can be exacerbated by smoky environments, dust and air conditioning, and by our natural tendency to reduce our blink rate when concentrating. Purposefully blinking, especially during computer use and resting tired eyes are basic steps that can be taken to minimize discomfort. Rubbing the eyes can irritate them further and should be avoided. Conditions such as blepharitis can often coexist and treating this disease is essential to improving dry eye. Using a humidifier, especially in the winter, can also help by adding moisture to the dry indoor air.
For mild and moderate cases, supplemental lubrication is the most important part of treatment. Application of artificial tears at least 4 to 6 times per day can provide temporary relief. Our artificial tear of choice is Oasis tears. Unlike other drops, these contain glycerin, a natural compound designed to moisturize and protect the ocular surface of the eye and are free of toxic polymers. Most importantly, these tears contain a chemical called hyaluronate to allow the drop to remain longer in the tear film, giving longer-lasting lubrication and comfort. With each blink of the eye, it re-lubricates to provide prolonged relief.
Artificial Tear Ointments
Lubricating tear ointments such as Tears Again can be used during the day, but they generally are used at bedtime due to poor vision after application. Application requires pulling down the eyelid and applying a small amount inside. Depending on the severity of the condition, it may be applied from every hour to just at bedtime.
Consumption of dark fleshed fish containing dietary omega-3 fatty acids is associated with a decreased incidence of dry eye syndrome. Alternatively, dietary supplements of Ocular Essential capsules can be taken daily to provide the recommended intake necessary to relieve dry eye. The recommended dosage is 3 capsules per day.
Topical cyclosporine A is an immunosuppressant that decreases surface inflammation. Usually, 1 drop of Restasis is instilled in each eye twice a day, 12 hours apart. It should not be used during eye infections. Side effects may include a burning sensation or redness. In order to minimize these side effects, a mild steroid drop, such as Lotemax is prescribed when beginning Restasis treatment. The effects of Restasis on dry eyes do not occur immediately, but an overall relief in dry eye symptoms is most often achieved at 3 to 6 months after the start of Restasis treatment.
In each eye, there are little openings that drain tears into the tear ducts called puncta. There are methods to partially or completely close the tear ducts. This blocks the flow of tears into the nose, and thus more tears are available to the eyes. Punctal plugs are inserted into the puncta to block tear drainage, mainly for people who have not found dry eye relief with eye drops. They are reserved for people with moderate or severe dry eye when other medical treatment has not been adequate.
Punctal plug insertion is a painless procedure. Sometimes temporary punctal plugs are placed initially, where a plug that will dissolve quickly is inserted into the tear drain of the lower eyelid. This can be done to determine whether permanent plugs can provide an adequate supply of tears.
If temporary plugging of the tear drains works well, then silicone plugs may be used later on. The plugs will hold tears around the eyes as long as they are in place. They can be removed easily if needed. Rarely, the plugs may come out spontaneously or migrate down the tear drain. Many patients find that the plugs improve comfort and reduce the need for artificial tears.
If punctal plugs are effective; however, they keep falling out surgical cauterization of puncta can be performed. This shrinks the drainage area, and thus closes the tear duct.
In Office Treatment
The Doctors at Ophthalmology Associates are utilizing Lipiview and LipiFlow to help in diagnosing and treating evaporative dry eye disease. This technology (www.tearscience.com) is one of our most remarkable resources to help people suffering from dry eyes due to rapid evaporation of the tear film layer. To find out whether you can benefit from the LipiFlow treatment, please complete our Dry Eye Self Evaluation Test.
Dry eye syndrome usually is a chronic progressive disease, and its prognosis varies depending upon the severity of the condition. Some patients with dry eyes have such severe blurring or irritation that it can may interfere with their ability to work or drive. People sometimes feel their vision blurs with use, or have severe irritation to the point that they have trouble keeping their eyes open and may not be able to work or drive. Most patients have mild-to-moderate cases and can be treated symptomatically with lubricants, which provide an adequate relief of symptoms. Our doctors can determine the severity of your dry eyes and whether alternative forms of treatment are needed.