Dry Eyes Evaluation and Treatment
What is Dry Eye?
Dry eye is a condition in which the eyes have inadequate lubrication and moisture. In other words, the eyes lack normal tears.
What are Tears?
The “Tear Film” is a combination of water, oil, and mucous-like secretions that coat the eyeball. These secretions are constantly being produced, but you may only notice “tears” in your eyes when something irritates or stimulates your eyes, triggering the release of large amounts of tears. The watery component of the tear film is produced by the main tear gland which sits beneath the outer upper eyelid. Tears then wash over the surface of the eye and then drain out through the tear duct, which has an opening on the inner upper and lower eyelids.
What are Symptoms of Dry Eyes?
- Burning and Light Sensitivity
- Gritty/Sandy Feeling Redness
- Itching of Eyes (itching may be caused by allergies as well)
- Sticky Secretions (if the tear film lacks water it is mostly comprised of mucus & oil)
- Excess Tearing (yes, tearing can be a sign of dryness!) Often, tearing is the only symptom of dry eyes. What actually occurs is that the eyes become so dry and irritated that they intermittently pour out tears.
What Causes Dry Eye?
Most of the time, the tear gland stops producing a normal amount of tears for unknown reasons. Some health conditions are associated with Dry Eye, such as rheumatoid arthritis, Sjogren’s disease, and other conditions involving malfunctions of the body’s immune system. In these cases, there is often abnormal inflammation of the tear glands causing them to produce less tears. Many medications can cause a decline in tear production as well; these include medications for depression, antihistamines, and diuretics.
What Factors Contribute to Dry Eye?
- Fans/Air Blowing (ceiling fans in bedroom, air ducts in car, windy conditions)
- Prolonged Reading or Computer Use
- Contact Lenses (the contacts absorb moisture, taking tears away from the eyes)
- Laser Eye Surgery (LASIK)
- Abnormal Eyelid Closure (after strokes, injuries, eyelid surgeries)
- Medications (prescription and over the counter)
- Dehydration (may be worsened by medications, caffeine intake)
How is Dry Eye Treated?
1. Modify Contributing Factors: Put a humidifier in your bedroom, turn off fans, avoid certain medications, limit contact lens use.
2. Use Artificial Tears: Numerous available brands over the counter, all very similar but somewhat different. In general, there are thin vs. thick drops, and those with or without preservatives. Thick or “gel” drops coat the eye better, but tend to blur vision (many prefer to use gel drops or an actual eye ointment at bedtime). Preservative free drops come in individual vials, are more expensive, but are gentler on the eye. These are preferred if you have a sensitivity to eye drop preservatives or if you need to use the drops more than 4 or 5 times a day (which may lead to irritation from the preservatives). The drops can be used as little as once or twice a day to as often as every hour, depending on your symptoms. People often develop a preference for a particular brand. Ask us for samples (and coupons!).
3. Supplements: There are nutritional supplements available in drug and health food stores designed to treat Dry Eye. These are primarily combinations of omega-3s, fish oil, flaxseed oil, and Vitamin E.
4. Punctal Plugs: Plugs can easily be placed in the eyelid openings to the tear duct (the “puncta”) to keep tears from draining out of the eye.
5. Prescription Medicines: There are prescription medicines designed to treat dry eye as well.