What is Dry Eye?
Dry eye syndrome (DES) is a very common disorder.
It was originally thought that there was a deficiency of tears at the ocular surface. Recently however, investigations have shown that DES is much more complex than previously thought and that “tear film dysfunction syndrome” might more accurately describe the condition.
DES can be broken down into two basic etiologic classifications: insufficient tear production or increased evaporation of tears from the eye surface.
The tear film is made up of 3 layers: lipid, aqueous and mucin.
Individuals with dry eye syndrome can be deficient in any of these basic factors.
- Lipid tear deficiency is caused by blepharitis or Meibomian gland dysfunction. This leads to an abnormal increase in the evaporation of the tears from the surface of the eye.
- Mucin deficiency is usually caused by conditions such as vitamin A deficiency,chemical injury, and Stevens-Johnson syndrome. Produced by goblet cells,mucin promotes even distribution of the aqueous tears over the surface of the eye.
- Aqueous tear deficiency occurs when their is insufficient tear production. It can be caused by medications, contact lens wear, increasing age, hormonal changes, Sjogren’s syndrome and other autoimmune diseases.
When there is either a decrease in the quantity and/or quality of natural tears, dry eye occurs. Most dry eye results when there is an increase in tear evaporation or a decrease in tear production. Some people can have more than one mechanism affected.
Some symptoms of dry eye are listed below:
- Burning or stinging
- Blurred vision that improves with blinking
- Excessive tearing
- Increased discomfort after prolonged reading or computer use
- Tiredness of the eyes
- Irritation/ Itching
What Causes Dry Eye?
There are many factors that contribute to dry eye and often times people may have several causes. Some of the factors that contribute to dry eye include:
- Increasing age
- Certain diseases, like Sjogrens, rheumatoid arthritis, lupus, diabetes and thyroid
- Low humidity environments such as dry, windy conditions, hot or cold climates, indoor heating or air conditioning
- Hormonal changes experienced during pregnancy as well as peri and post menopause.
- Medications such as antihistamines, antidepressants, oral contraceptives and some heart medications
- Blepharitis as well as rosacea of the face.
- Irritants such as smoke or dust
- Infrequent or incomplete blinking as well as incomplete lid closure at night while sleeping
- Eye surgery
- Glaucoma drops
How Does the Doctor Test for Dry Eyes?
There are a variety of tests that the doctor may perform that help quantify tear quantity as well as tear evaporation and tear quality. A complete medical and ocular history as well as medications taken by the patient are very important components to the diagnosis. Many times, a patient has a multitude of factors that may be contributing to their dry eye problem.
Recently, Solinsky EyeCare has acquired the TearLab Osmolarity System which is the latest technology in diagnosing dry eye disease. The TearLab Osmolarity System is designed to measure the amount of salt (osmolarity), in a patient’s tears. Best of all it only needs a very tiny sample and it only takes 20 seconds to calculate the osmolarity. Once the doctor receives that number, they can then begin to prescribe a dry eye treatment that is just right for you.
What Are Some of the Ways to Help Relieve and Treat Dry Eye Syndrome?
The treatment is tailored to each patient based on severity of symptoms, clinical signs, and the mechanism(s) contributing to their eye problem. The treatment can range from occasional use of artificial tears for someone who has very infrequent and mild dry eyes to prescription drops called RestasisTM that help reduce inflammation to the ocular surface. Punctal plugs may be placed in the tear duct to help conserve tears by delaying outflow. Oral medications may be prescribed to improve tear quality affected by rosacea. Some nutritional supplements such as flaxseed and alpha omega fish oil have been advocated to have some benefit in reducing inflammation and help to restore the tear film.
Management of the tear film dysfunction and ocular surface disease has the objective of promoting the health of the ocular surface and is tailored to the individual patient. Lifestyle changes, artificial tears and topical eye ointments can also help patients with mild DES. Patients with moderate to severe DES may benefit from medical treatment with immunomodulators or anti-inflammatory agents. Call our office for an appointment today! 860-233-2020.