Dry Eye Syndrome

Over ten million Americans suffer from dry eyes. “Dry eye” is one of the most common problems treated by eye physicians. It is usually caused because of problems with the quality of the tear film lubricating the eyes.

Tears are formed in several glands around the eye. The water layer is produced in the lacrimal gland, located under the upper eyelid. Several smaller  glands in the lids make the oil and mucus layers. With each blink, the eyelids spread the tears over the eye. Excess tears flow into two tiny drainage ducts in the corner of the eye by the nose. These ducts lead to tiny canals that connect to the  nasal passage. The connection between the tear ducts and the nasal passage is the reason that crying causes a runny nose.

Three Layers of Tears

• The mucus layer coats the cornea, the eye’s clear outer window, forming a foundation so the tear film can adhere to the eye.
• The middle aqueous layer provides moisture and supplies oxygen and other important nutrients to the cornea. This layer is made of 98% water along with small amounts of salt, proteins and other compounds.
• The outer lipid layer is an oily film that seals the tear film on the eye and helps to prevent evaporation.

In addition to lubricating the eye, tears are also produced as a reflex response to outside stimulus such as an injury or emotion. However, reflex tears do little to soothe a dry eye, which is why someone with watery eyes may still complain of irritation.

Causes

Dry eye syndrome has many causes. One of the most common reasons for dryness is simply the normal  aging process. As we grow older, our bodies produce less oil (60% less at age 65 then at age 18). This is more pronounced in women, who tend to have drier skin then men. The oil deficiency also affects the tear film. Without as much oil to  seal the watery layer, the tear film evaporates much faster, leaving dry areas on the cornea.

Many other factors, such as hot, dry or windy climates, high altitudes, air-conditioning and cigarette  smoke also cause dry eyes. Many people also find their eyes  become irritated when reading or working on a computer. Stopping periodically to rest and blink keeps the eyes more comfortable.

Contact lens wearers may also suffer  from dryness because the contacts absorb the tear film, causing  proteins to form on the surface of the lens. Certain  medications, thyroid conditions, vitamin A deficiency, and diseases  such as Parkinson’s and Sjogren’s can also cause dryness. Women frequently experience problems with dry eyes as they enter  menopause because of hormonal changes.

Symptoms

• Itching
• Burning
• Irritation
• Redness
• Blurred vision that improves with  blinking
• Excessive tearing
• Increased discomfort after periods  of reading, watching TV, or working on a computer

Detection and Diagnosis

There are several methods to test for dry eyes. The doctor will first determine the underlying cause by measuring the production, evaporation rate and quality of the tear film. Special drops that highlight problems that would be otherwise invisible are  particularly helpful to diagnose the presence and extent of the dryness.

Treatment Options

When it comes to treating dry eyes, everyone’s needs are a little different.

• Artificial Tears:

Some of  these products are watery and alleviate the symptoms temporarily;  others are thicker and adhere to the eye longer. Preservative-free tears are recommended because they are the most soothing and have fewer additives that could potentially irritate. Avoid products that whiten the eyes because they do not have adequate lubricating qualities and often make the problem worse.

• Restasis™ by Allegan:

For individuals suffering with dry eyes. This new revolutionary eye drop by Allergan is medically proven to significantly reduce, if not eliminate the common symptoms of dry eye syndrome: dryness, irritation, burning, variable vision, blur and glare and foreign body sensation. This twice a day eye drop is effective in reducing the inflammatory component of this common eye complaint, thereby improving normal tear production.

Punctal Plugs:

Closing the opening of the tear drain in the eyelid with special inserts called punctal plugs is another option. This works like closing a sink drain with a stopper. These special plugs trap the tears on the eye, keeping it moist. This may be done on a temporary basis with a dissolvable collagen plug, or permanently with a silicone plug. increased discomfort after periods of reading, watching TV, or working on a computer. Many find relief simply from using artificial tears on a regular basis.

Punctal plugs are semi-permanent and can be placed in a few minutes during your office visit. They can remain in place providing comfort for years. They can come out with eye rubbing and can simply be replaced.  They don't work for every patient but some patients can't go without them, it can enhance contact lens wear.

There are also simple lifestyle  changes that can significantly improve irritation from dry eyes. For example, drinking eight to ten glasses of water each day keeps  the body hydrated and flushes impurities. Make a conscious effort to blink frequently, especially when reading or watching  television. Avoid rubbing the eyes. This only worsens the irritation.

Treating dry eye problems is important not only for comfort, but also for the health of the cornea.