Angeles Vision Clinic

Dry Eye

Dry Eye

and its Treatment

This site covers dry eye, its symptoms, causes, treatment and problems associated with it. Discussions on puntual occlusion, Sjogren’s syndrome, and new dry eye nutritional supplements.

What is Dry Eye?

Dry eye with Rose Bengal Stain

Dry Eye is actually a collection of symptoms that make up an eye condition that stems from an imbalance in the quantity or quality of tears. These symptoms include dry, red, gritty, and even watery eyes. Often, Dry Eye sufferers report the feeling of something foreign within the eye or eye strain. Some people do not produce enough tears to keep the eye comfortable.

The moisture level in the eye is maintained by the balance of tear production and tear loss through drainage and evaporation. When this balance is not sustained, dry spots appear on the surface of the eye and cause irritation.

Tears are produced by two different methods. One method produces tears at a slow, steady rate and is responsible for normal eye lubrication. The other method produces large quantities of tears in response to eye irritation or emotions.

Tears that lubricate are constantly produced by a healthy eye. Excessive tears occur when the eye is irritated by a foreign body or when a person cries.

What are the symptoms of Dry Eye?

The usual symptoms include:

  • Stinging or burning eyes
  • Scratchiness
  • Stringy mucus in or around the eyes
  • Eye irritation from smoke or wind
  • Excess tearing
  • Difficulty wearing contact lenses

Excess tearing from “dry eye” sounds illogical, but if the tears responsible for maintenance lubrication do not keep the eye wet enough, the eye becomes irritated. When the eye is irritated, the lachrymal gland produces a large volume of tears which overwhelms the tear drainage system. These excess tears then overflow from your eye.

What is the Tear Film?
Tears bathe and lubricate the eyes. Each time you blink, new tears are formed in the several glands located around each eye. A healthy tear film consists of a delicate balance of three layers:

The tear film consists of three layers:

  • An oily layer
  • A watery layer
  • A layer of mucus

The oily layer, produced by the meibomian glands forms the outermost surface of the tear film. Its main purpose is to smooth the tear surface and reduce evaporation of tears.

The middle watery layer consists of 98% water, and cleanses the front surface of the eye this is what most of us ordinarily think of as tears. This layer, produced by the lachrymal gland, cleanses the eye and washes away foreign particles or irritants.

The inner layer consists of mucus produced by the conjunctiva. Mucus allows the watery layer to spread evenly over the surface of the eye and helps the eye remain wet. Without mucus, tears would not adhere to the eye.

What Causes Dry Eye?
Tear production normally decreases as we age. Although dry eye can occur in both men and women at any age, women are most often affected. This is especially true after menopause.

Dry eye can also be associated with arthritis and accompanied by a dry mouth. People with dry eyes, dry mouth and arthritis are said to have Sjogren’s syndrome.

A wide variety of common medication, prescription and over the counter, can cause dry eye by reducing tear secretion. Be sure to tell your eye care provider the names of all the medication you are taking, especially if you are using:

  • Diuretics
  • Beta blocker
  • Antihistamines
  • Sleeping pills
  • Medication for “nerves”
  • Pain relievers

Since the above medication is often necessary, the dry eye condition may have to be tolerated or treated with “artificial tears.”

People with dry eye are often more prone to the toxic side effects of eye medication, including artificial tears. For example, the preservatives in certain eye drops and artificial tear preparations can irritate the eye. Special preservative-free artificial tears may be required.
How is Dry Eye diagnosed?
Your eye care provider is usually able to diagnose dry eye by examining the eyes. Sometimes tests that measure tear production may be necessary. One test, called the Schirmer tear test, involves placing filter-paper strips under the lower eyelids to measure the rate of tear production under various conditions. Another uses a diagnostic drop (fluorescein or Rose Bengal) to look for certain staining patterns.
How are Dry Eyes Treated?
Depending on the causes, Dry Eye Syndrome can be treated as a temporary problem or a lifelong disease requiring long-term treatment. Either way, tears must be conserved or replaced in order to provide relief.

Adding tears
Artificial tears are probably the most common forms of treatment for Dry Eye Syndrome. Eye drops are similar to your own tears. They lubricate the eyes and help maintain moisture. Artificial tears are available without a prescription. There are many brands on the market, so you may want to try several to find the one you like best.

Preservative-free eye drops are available if you are sensitive to the preservatives in artificial tears. If you need to use artificial tears more than every two hours, preservative-free brands may be better for you. Solid artificial tear inserts that are placed inside the lower lid on a daily basis and gradually release lubricants may be beneficial to some people.

You can use the tears as often as necessary, once or twice a day or as often as several times an hour.

Conserving the tears
In cases of persistent Dry Eye symptoms, permanent, reversible closure of the tear duct or punctal occlusion, may be the best solution. Punctal occlusion allows you to retain your own, natural tears without the bother or expense of constantly replacing the tear film with artificial tears.

Punctal Occlusion
In cases of persistent Dry Eye symptoms, permanent, reversible closure of the tear duct or punctal occlusion, may be the best solution. Punctal occlusion allows you to retain your own, natural tears without the bother or expense of constantly replacing the tear film with artificial tears.

Tears drain out of the eye through a small channel into the nose (that is why your nose runs when you cry). Your eye care provider may close these channels either temporarily or permanently. The closure conserves your own tears and makes artificial tears last longer.

Punctal occlusion acts very much like a stopper in a sink. When the punctal opening is closed, tears stay on the eye longer. There are three basic methods of tear duct closure:

  • Cautery – Reversible? No.
  • Lasers – Reversible? No.
  • Punctal Plugs – Reversible? Yes!

What are Punctal Plugs?
Punctal Plugs are the least invasive of the long-term solutions to Dry Eye Syndrome. A small, soft silicone plug, about the size of a sesame seed, is non-surgically inserted into the natural punctal opening. The entire procedure can be performed in your Eye Care Professional’s office within a few minutes. Many patients report immediate relief from Dry Eye symptoms. Although silicone plugs are considered a permanent treatment for Dry Eye, your doctor can easily monitor and remove them if necessary.

Nutritional Supplements to combat Dry Eye:

New Drugs with possibilities

  • Oral Salagan (Pilocarpine) has been been reported to help by increasing lacrimation, the ability of your body to produce fluids.
  • Cyclosporine eye drops have been show to be effective in eyes that are dry secondary to collagen vascular diseases such as Rheumatoid arthritis, Sojourns syndrome and keratoconjunctivitis sicca. A commercial drop will be on the market in the near future. At the present time a some compounding pharmacists can formulate them.