Dry eyes (or dry eye syndrome) is a very common condition. It occurs when there is not enough moisture on the surface of the eyes, either because the eyes do not produce enough tears or because the tears have an improper chemical composition. A film of tears is spread over the eye with each blink of the eye. There are 3 layers to the tear film and an abnormality in any or all of the layers can lead to dry eye symptoms. The first layer is oily layer produced by oil glands (meibomian glands) in the eyelid. Its main purpose is to smooth the tear surface and reduce evaporation of tears. The middle layer is a watery layer that makes up most of what we ordinarily think of as tears. This layer, produced by the lacrimal gland, cleanses the eye and washed away irritants or foreign particles. The inner layer consists of mucus produced by the conjunctiva. The mucus allows the watery layer to spread evenly over the surface of the eye and help the tears stick to the eye.

Dry eyes increase with age and affects women more commonly than men, especially after menopause. It can also result from eyelid or blinking problems, climate (low humidity, wind, dust, air conditioning, heating), injury, and various health problems (arthritis, Sjogren's syndrome, diabetes). A variety of common medications - prescription and over-the-counter - can cause dry eye by reducing tear secretion. These include diuretics, beta-blockers, antihistamines, sleeping pills, medications for "nerves", and pain relievers. The preservatives in certain eye drops, including artificial tears, can also worsen dry eye symptoms. Contact lens wearing increases tear evaporation thereby decreasing eye moisture. Dry eye is the number one reason why people stop wearing contact lenses. Prolonged focusing of the eyes, such as with reading, computer use and driving on long trips, also contribute to dry eye symptoms because a person does not blink as often when doing these activities.

Symptoms of dry eye include:
  • Stinging or burning of eyes
  • Scratchiness
  • Stringy mucus in or around the eyes
  • Redness
  • Excessive eye irritation from smoke or wind
  • Excess tearing
  • Difficulty wearing contact lenses
  • Blurred vision that sometimes clears with blinking
Excess tearing from "dry eye" may sound illogical, but if the composition of the tear layers is abnormal, the eye becomes irritated, sending back a reflex message to the lacrimal gland to send down a large volume of tears at once. The reflex message is "shut off" when the dry eye condition is treated, and the eye no longer feels irritated. Severe dry eye can damage eye tissue, scar the cornea, and impair vision.

Treatment of Dry Eyes
Dry eye is not preventable, but it can be controlled before harm is done to your eyes. Regular eye exams can detect dry eye early even before symptoms become noticeable. Treatment for dry eye can take many forms:
  • Increasing the humidity at home or work can help.
  • Frequent use of artificial tears or lubricating ointments often relieve symptoms. If these need to be used more than twice a day, preservative free preparations are indicated to avoid worsening the dryness from the preservatives in the tears/ointments.
  • Tiny stoppers, called "punctum plugs," may be placed in the opening of tear outflow channels located on the inner corner of the eyelids. These keep the tears that one does make in the eye longer. Implantation is done in the office and only takes a few seconds. These drainage channels can also be permanently surgically closed in severe dry eye.
  • Nutritional support can improve tear production and tear composition. Recent studies seem to indicate that omega 3 fatty acids and fish oil may improve the symptoms of dry eyes as well as having other health benefits.
  • A newer modality is the use of a prescription eye drop called Restasis, which reduces inflammation in the lacrimal gland and the tears that occurs with dry eyes, thereby improving tear production and composition. Over 90% of patients placed on Restasis in our practice have noticed an improvement in their symptoms.
  • Sometimes topical steroid drops may be used short-term to suppress inflammation as well.
  • If the lipid layer of the tear film is abnormal, hot compresses to aid in flow of the oily layer, treatment of blepharitis (inflammation of the eyelids), and doxycycline (an oral antibiotic that thins the oily secretions and thereby enhances drainage) may be required in the treatment of dry eye.
  • Newer materials in certain brands of contact lenses may decrease dry eye symptoms in contact lens wearers and allow more comfortable and longer wear time of the contact lenses.

Pleasant Valley Ophthalmology    11825 Hinson Road, Suite 103    Little Rock, AR 72212-3404
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