Dry eye related discomfort is the most common ailment treated by optometrists. Here are common symptoms:
- Dryness, redness, itchiness, blurred vision, stinging sensation
- excess watering/tearing, a foreign body sensation
- sandy/gritty sensation, contact Lens intolerance
- light sensitivity, excess mucous, burning sensation
Dry eye syndrome, often referred to as keratitis sicca or keratoconjunctivitis sicca, is caused by insufficient and/or poor quality of tears.
There are three main components to human tears. The bulk of human tears are produced by the lacrimal gland. The oily component of tears is produced by the meibomian glands and the third component, the goblet cells, keeps all of the components mixed up. When one of the parts of this mixture becomes unbalanced, patients become symptomatic. There are numerous reasons as to why these glands may not be doing their part.
Inflammation of the lacrimal gland is the most common cause of insufficient tear volume. Meibomian gland dysfunction, inflammation of the glands at the eyelid margin, contributes to poor tear quality. Medications frequently cause ocular dryness. The medications most commonly causing dry eyes are antihistamines, oral contraceptives and decongestants. Hormonal changes also contribute to insufficient and poor quality of tears.
Who is at Risk for Dry Eye Syndrome?
Dry eye syndrome is very common. It is estimated that between 13% and 35% of the general population experiences dry eyes, resulting in up to 96 million affected individuals in the United States. The incidence of dry eye syndrome is higher, however in those over age 40 and women.
Some systemic disorders such as Sjögren syndrome, rheumatoid arthritis, and acne rosacea make a person more likely to experience ocular dryness.
Refractive surgery procedures such as PRK, LASIK and LASEK disrupt the neural feedback loop and are common causes of dry eyes. Poor tear quality can cause both decreased visual acuity and discomfort for refractive surgery patients and needs to be addressed during all phases of their care.
Patients often report that their eyes do not seem to be dry until they wear contact lenses. Contact lenses don’t cause the dryness, however a patient with dry eyes will experience discomfort because their eyes can’t support the presence of the contact lens. Typically, soft contact lenses are 30 to 70% water. Contact lenses essentially work like a sponge in the eye, and a patient with borderline dry eye symptoms is often contact lens intolerant.
Contact lenses rely on our eyes to produce enough tears to hydrate the contact lenses and allow them to float on a cushion of tears. If there are not enough tears to both hydrate the lens and lubricate the eye, then the patient experiences contact lens intolerance. Often a contact lens intolerant patient can wear contact lenses for a few hours, but their wearing time decreases when in the presence of smoke, air conditioning, wind low humidity, etc.
Dry eye syndrome is diagnosed in the office by considering the clinical presentation, patient’s complaints and diagnostic testing. Determining the cause of the dryness whether it is insufficient tear production, poor tear quality or a systemic disease is critical in improving your comfort.
The following are the most developed forms of dry eye treatment:
Artificial tears containing active ingredients such as carboxymethylcellulose, hydroxypropyl methylcellulose, glycerin, castor oil, polyethylene glycol or polyvinyl alcohol are used in mild cases of dry eyes. Not all artificial tear brands work the same or work in all patients. More severe cases require additional treatment. If you find yourself using your artificial tears three or more times a day you should use a preservative free tear. Most patients find that artificial tears do help, however the affect is only temporary, lasting only 10-15 minutes.
In our experience, significant dry eye relief is achieved with Punctal occlusion. The puncta are the small opening found on the edge of the upper and lower eyelids next to the nose. Tears drain out of the eye through the puncta into the nose, this is why your nose runs when you cry. If you aren’t producing enough tears, then you don’t want the tears that you are producing to be drained away. Punctal occlusion is painless and performed in the office, taking only a couple of minutes.
Omega-3 fatty acids, found in oily fish are very beneficial. Most western diets almost never provide enough omega-3 fatty acids to provide a therapeutic benefit, therefore dietary supplementation is almost always required.
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