Dry Eye Syndrome


Dry Eye Syndrome is a collection of symptoms that result from insufficient quantity or quality of tears.  Symptoms may include dry, red, irritated eyes.  Often people suffering from dry eyes will feel a "gritty, sandy" sensation in their eyes. They may even have seemingly paradoxical watering eyes since the eyes will water or tear excessively as a reflex response to the dryness and irritation.  The cause is usually due to either a decreased production of "normal" tears or increased evaporation of tears related to poor quality of the tear film. 

 

What Causes Dry Eye Syndrome?

Several factors can contribute to dry eyes, including:

Blepharitis

Often dry eye symptoms can result from inflammation of the eye lid margins, which may be caused by a bacterial infection (Staphylococci).  This condition is called blepharitis and can compromise the quality of the tear film causing tears to evaporate more quickly. The bacteria produce waste material which can cause a mild toxic reaction leading to chronic red, irritated eyes. The first step in treating this condition is to initiate better lid hygiene. There are many ways in which to do this, but warm compresses and lid scrub are the key components.  A simple technique is to gently massage the eyelids (keep your eyes closed!) with a hand towel soaked with warm water (or keep damp cloths on towel warmers for a more even heat), as well as scrubbing the lids with diluted  baby shampoo.  By doing this 2-3 times per day initially, the bacterial growth can be controlled. When the inflammation is more severe or uncontrolled with lid hygiene only, antibiotic drops and/or ointments can be prescribed to control the infection.  Often another condition called meibomitis is also present.  Meibomitis is an inflammation of the meibomian glands, which produce lipids that make up the outer layer of the tear film.  This lipid layer is an oily layer which helps retard evaporation of the tears.  When the meibomian glands become inflamed or clogged, the tear film quality is poor.  Lid cleansing is the first line of treatment for meibonitis.  Topical or systemic antibiotics such as azithromycin, tetracycline or doxycycline may be helpful in many cases.  Special dry eye nutritional supplements including Omega 3 fish oils often improve the quality of the tear oil film and reduce inflammation of the glands, and are recommended.  It may take 4-6 weeks of consistent dosage to achieve relief, however.

Computer Use 

Computer users tend to blink much less frequently (about 7 times per minute vs. a normal rate of around 22/minute).  This leads to increased evaporation along with the fatigue and eye strain associated with staring at a computer monitor.  Ideally, computer users should take short breaks about every 20 minutes to reduce this factor.  Also, adjusting the monitor so that it is below eye level will allow the upper lid to be positioned lower and cover more of the eye's surface, again to reduce evaporation.  Trying to be more conscious of blink rate, air circulation, glare, and making a more ergonomic work area can help reduce dry eye symptoms while working at the computer.  Dry eye symptoms may also be reduced by using dry eye supplements, artificial tears; or punctal plugs to reduce tear drainage from the eyes,  which can be obtained from your eye doctor.

Medications

Some medications may also contribute to increased dry eye symptoms.  Antihistamines, blood pressure medications, oral contraceptives, ulcer medications, over-the-counter vasoconstrictors (i.e. Visine), as well as antidepressants.

Diseases

Diseases that may be associated with dry eyes include rheumatoid arthritis, diabetes, asthma, thyroid disease, lupus, and possibly glaucoma.

Age

Tear volume decreases as much as 60% by age 65 from that at age 18.  Dry Eye Syndrome affects 75% of people over age 65. 

Hormonal Changes in Women

Hormonal changes can cause decreased tear production brought on by pregnancy, lactation, menstruation, and menopause.
 
 

Dry Eye Treatment

The first line of treatment should address the CAUSE of the dry eye, rather than simply treating the symptoms with eye lubricants, the most commonly prescribed treatment.  Generally we first recommend lid hygiene using the technique described above.  If the symptoms don't improve within two weeks, supplementing with dry eye nutritional formulas such as Biotears from Biosyntrx.  They contain nutrients shown to be helpful in improving tear quality, including vitamin A precursors, and vitamins C, E, D and B6.  More importantly, in my opinion, are the included essential fatty acids, EPA, DHA and GLA, which play an important role in producing a quality tear film and reducing inflammation in the eyelids (as well as their well-documented heart and brain health benefits).   Don't get discouraged, though, It can take up to 6 weeks for this treatment to be effective.

Should these treatments be unsuccessful, then one should treat the symptoms with artificial tears.  I recommend Similasan Homeopathic eye drops for Dry Eyes.  Refresh Tears or Genteal, are products which are safe to use with contact lens wearers because the preservative in these products is dissolved once in the eye, avoiding  allergic reactions to the preservative itself.  In addition, preservative free ointments, such as Refresh PM, may be of benefit, but are usually used only before bedtime or in severe cases since vision will be somewhat blurred from the ointment.  Other topical treatments that are available include cyclosporine (which was originally approved for use in canine dry eye, and now is available under the name "Restasis"), androgens, and lipid emulsion drops. 

When artificial tears and lid hygiene don't work, the next step is to consider punctal plugs. Punctal plugs are silicone or collagen implants which block the natural drainage of tears from the eye through the punctum.  Inserting punctal plugs is a very effective option for treating dry eye syndrome, and it is a reversible procedure.   Initially most doctors insert a temporary collagen plug which dissolves after several days, so that the treatment may be evaluated before placing longer lasting collagen or silicone plugs in the eyes' tear drainage ducts.


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