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Dry Eye Syndrome
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Dry eye syndrome is a very common and frustrating disorder suffered by over 10 million Americans. It is very prevalent in this part of the country as we have an abundance of dry weather and wind aggravating the problem. A healthy tear film is necessary for a normally functioning eye. The tear film has 3 main components:
Aqueous component: Made mostly of water. It lubricates the eye, delivers oxygen and nutrients to the ocular surface, and washes away allergens, debris, and keeps the ocular surface clean. Oily component: Oils secreted from glands in the eyelid called meibomian glands. The oil rests on top of the aqueous layer like oil on water preventing the tears from evaporating and stabilizing the tear film.
Mucous component: Mucous secreted from glands within the eyelid and conjunctiva (the clear skin covering the white part of the eye). This layer is sticky and allows the tears to adhere to the ocular surface. This layer is usually normal except in rare systemic diseases or certain chemical injuries to the eyes. A deficiency in any of these three components can lead to dry eye problems.
Dry eye symptoms: burning, itching, chronic red eye, foreign body sensation (a feeling similar to having sand in the eyes), intermittent blurry vision and excessive tearing. Tearing can be triggered by emotion or irritation such as from getting something in your eyes. This reflexive tearing contains only the watery component and does little to soothe the eye as these tears are lacking the other components. They evaporate quickly and run down the face since they don’t stick to the ocular surface.
Intermittent blurry vision is typically aggravated during visually tasking activities such as reading, working on the computer, watching TV or driving. During these activities, our blink rate decreases allowing the eyes to dry out. Those who suffer from dry eyes may notice clear vision when they initiate these activities, but their vision becomes progressively more blurry. The vision can temporarily be cleared by blinking because that replenishes tears to the dry ocular surface. Unfortunately, blinking doesn’t always work and you are forced to discontinue that activity.
Causes of Dry Eyes: There are many causes of dry eye. As we get older, our bodies produce less oil affecting our tear film. Hot, dry, windy climates, smoking, and contact lens wear can also cause or aggravate dry eyes. Certain medications, thyroid conditions, vitamin A deficiency, and diseases such as Parkinson’s and Sjogren’s can cause dryness. Women frequently experience problems with dry eyes as they enter menopause because of hormonal changes.
Diagnosis of dry eyes can usually be done by history of symptoms, but it can be confirmed by simple office tests. The physician can evaluate tear production, evaporation time, and quality using special drops and tests.
Treatment options for dry eyes are many, but the patient must realize that dry eyes are a chronic problem and persistent treatment will be necessary.
Artificial Tears: Over the counter eye drops can help supplement the aqueous component of tears. Most brands are equally efficacious if used at least 3-4 times a day. Try to avoid those that claim to be “redness-relievers” as those are great at temporarily eliminating the redness, but they do not address the dry eyes and the redness will then return. Do not stop using tears once your eyes start to feel better. For those with severely dry eyes, consider trying lubricating gels as they tend to provide longer relief. Also, lubricating ointments can be used overnight.
Punctal Plugs: The upper and lower eyelids have a drainage system that drains tears from the ocular surface to the nose. If you are deficient in tear production, you want the tears you make and the artificial tears you place on your eyes to stay on the eyes as long as possible. By placing a silicone plug into the opening of the system, the punctum, the tear drainage can be significantly slowed allowing them to nourish the ocular surface. This minor procedure can easily and painlessly be performed in the office during your examination and is usually covered by insurance.
Warm Compress & Lid Scrub: Many patients have chronic inflammation of the eyelids leading to oil gland dysfunction and debris formation on the lashes. By doing this procedure at home at least once a day, the oil component of the tear film can be greatly improved.
Procedure: Run very hot water over a wash cloth and wring it out. Place the wash cloth over your closed eye for 1-2 minutes. This can be repeated a couple of times. Then, wrap the moist wash cloth around your finger and rub or massage your upper and lower eyelid to remove the debris from the lashes and to compress the oil glands in the eyelid, expressing the oil from them. Some like to use a mild soap like baby shampoo or commercially available eyelid scrubbing pads to aid in this process and that works well. Some have proposed putting uncooked rice in a sock and warming it in the microwave to use as the warm compress and that seems to stay warm longer. Any of these methods are acceptable.
Prescription Medications for Dry Eye: Restasis is a medication that works at the source of dry eyes. Inflammation of the tear secreting glands causes decreased production of the aqueous component of tears as well as making the tears that are produced not very healthy. Restasis is used twice a day to reduce the inflammation thus increasing the amount and the quality of the tears. It needs to be used for at least 3 months to evaluate for effectiveness, and, if working well, may need to be continued long term.
Azasite is a relatively new medication that has two functions. Chronically inflamed eyelids tend to harbor more bacteria and the antibiotic activity of Azasite helps clear the unwanted bacteria. Also, Azasite has anti-inflammatory action that helps decrease the inflammation of the oil secreting glands thus improving the production and flow of oil from the eyelids. It is used once a day at night for the first 1-2 months and then has shown to be effective with a maintenance dose thereafter.
Meibomian Gland Probing: A new method of relieving the obstruction to the flow of oil from the meibomian glands has recently been shown to offer marked relief of symptoms. This technique, developed by Dr. Steven L. Maskin of Tampa, Florida, involves an in-office treatment using tiny stainless steel probes measuring 1-2mm in length to break up adhesions and fibrotic bands within the duct of the glands. This scarring forms from chronic eyelid inflammation. Because the duct openings are extremely small, and there are 20-30 ducts in each eyelid, this treatment takes some time to perform. The eyelid is numbed using a liquid gel anesthetic before the treatment and is performed in the usual eye examination chair. Benefits reported by patients who have had this procedure performed include less foreign body sensation, decreased burning and irritation, less need for artificial tears, and improved vision among others.
If you are suffering any of these symptoms listed above, try using artificial tears four times a day for a couple of weeks. If you don’t see any improvement, you may benefit from a formal dry eye evaluation by your eye care specialist.