Dry Eye

What is dry eye?

dry eyeKeratoconjunctivitis sicca (or simply dry eyes) is an eye disease caused by decreased tear production or increased tear film evaporation.

Some people do not produce enough tears to keep the eye healthy and comfortable.

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, dryness or when a person cries.

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 lacrimal gland produces a large volume of tears that overwhelm the tear drainage system. These excess tears then overflow from your eye.

What are the symptoms of dry eye?

The usual symptoms include:

  • stinging or burning eyes
  • scratchiness
  • stringy mucus in or around the eyes
  • excessive eye irritation from smoke or wind
  • excess tearing
  • difficulty wearing contact lenses
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What Causes Dry Eyes?

Deficient tear production

Keratoconjunctivitis sicca is usually due to inadequate tear production. The aqueous tear layer is affected, resulting in aqueous tear deficiency or lacrimal hyposecretion. The lacrimal gland does not produce sufficient tears to keep the entire conjunctiva and cornea covered by a complete layer. This usually occurs in people who are otherwise healthy. Increased age is associated with decreased tearing. This is the most common type found in postmenopausal women.

Abnormal tear composition

Keratoconjunctivitis sicca can also be caused by abnormal tear composition resulting in rapid evaporation or premature destruction of the tears. When caused by rapid evaporation, it is known as evaporative dry eyes. Although the tear gland produces a sufficient amount of tears, the rate of evaporation of the tears is too quick. There is a loss of water from the tears that results in tears that are too hypertonic. As a result, the entire conjunctiva and cornea cannot be kept covered with a complete layer of tears.

Aging

Aging is one of the most common causes of dry eyes. Quite simply, our tear production decreases with age. These decreases may be caused by thermal or chemical burns, or by adenoviruses.

Eyelid Disorders

An injury or other problem with the eyes, such as bulging eyes or a drooping eyelid can also cause keratoconjunctivitis sicca. Disorders of the eyelid can impair the complex blinking motion required to spread tears.

Contact Lenses

About half of all people who wear contact lenses complain of dry eyes. This is because soft contact lenses, which float on the tear film that covers the cornea, absorb the tears in the eyes. Dry eyes may also occur after LASIK and other refractive surgeries, in which the corneal nerves are cut because the corneal nerves stimulate tear secretion. Dry eyes caused by these activities are usually resolved after several months..

Medications

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

  • diurectics
  • beta-blockers
  • antihistamines
  • sleeping pills
  • medications for "nerves"
  • pain relievers

Since these medications are often necessary, the dry eye condition may have to be tolerated or treated with "artificial tears."

How is dry eye diagnosed?

An ophthalmologist is usually able to diagnose dry eye by examining the eyes. Sometimes tests that measure tear production may be necessary.

Correcting Dry Eyes

Adding Tears

Eyedrops called artificial tears 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 eyedrops 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.

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

Other more advanced treatments may be necessary for severe dry eyes.

Medication

Inflammation occurring in response to tears film hypertonicity can be suppressed by mild topical steroids or with topical immunosuppressants.

Change In Diet

Fish consumption and omega-3 fatty acids Eating dark fleshed fish containing dietary omega-3 fatty acids is associated with a decreased incidence of dry eyes syndrome in women. Early experimental work on omega-3 shows promising results, either when used in a topical application or given orally.

Blocking tear drainage

In each eye, there are two puncta (little openings that drain tears into the tear ducts). Partially or completely closing the tear ducts blocks the flow of tears into the nose, and thus more tears are available to the eyes.

Punctal plugs

Punctal plugs are one way to block the tear drainage. For people who have not found dry eye relief with drugs, punctal plugs may help. They are reserved for people with moderate or severe dry eye when other medical treatments have not helped.

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