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Dry Eye Syndrome

Dry eye, a common eye problem, can be caused by a lack of tear production or rapid evaporation. Tears normally keep the eyes moistened and lubricated. However, stinging, burning, dryness, and redness will result if tears are not sufficient to keep the eyes wet and comfortable. While discomfort is the primary result of dry eyes, infection and corneal scarring may occur if left untreated.

What is tear film?

The tear film, which constantly covers the eye, is made up of three layers. The oily outer layer reduces evaporation of the tears. The watery middle layer cleanses the eye and washes away foreign particles or irritants. The inner layer consists of mucous which coats the surface evenly and allows the tears to adhere to the surface of the eye.

Tear Production

Tears flow into the eye from two separate glands. The lacrimal glands, which are located above the eye, produce watery tears to moisten the eye. These tears also serve as “crying tears” which are released in response to injury and emotion. The tarsal glands, parallel strands of glands located within the inner surfaces of the eyelids, contribute to the tear film which constantly moistens and lubricates the eye. The tear film is spread over the eye by blinking, keeping the surface of the eye smooth and optically clear. Tears also protect the eye from infections, since they contain a substance called lysozyme that acts as an antibacterial agent. Tears drain from the through two small openings called the upper and lower puncta. From the puncta the tears drain through the tear sac and out into the nasal passages through the nasolacrimal duct. 

What are the symptoms of dry eyes?

People with dry eyes often complain that their eyes feel gritty, itchy, and dry. Other common symptoms include burning, stinging, redness, stringy mucous, and sensitivity to light. Some people may experience their eyelids sticking together in the morning. People with dry eyes may also have difficulty wearing contact lenses, which normally float on top of the tear film. If not enough tear film is produced, irritation and redness may limit the amount of contact lens use. Surprisingly, watering of the eyes is also a symptom of dry eyes, as excess tears are produced in response to irritation. However, these excess tears are “crying tears” which consists mostly of water. The excess tears lack the oil necessary to keep them from evaporating, and, therefore, do not function to lubricate the eye.

What causes dry eyes?

Normally, tear production decreases with age, leaving the delicate eye tissues exposed to the irritation effects of the environment and pollution. Dry eyes are more common with contact lens wearers and women, especially during change of life or pregnancy. Dry eyes often occur in people with arthritis. Medications and Vitamin A deficiency may also cause dry eyes by reducing tear secretion. In addition, environmental factors such as sun, wind, pollution, dry air from heating or air conditioning and smoke contribute to the occurrence of dry eye. Finally, abnormal eyelid location may cause dry eyes.

Dry Eye Treatment Options

Treatment of dry eye syndrome varies based on the medical condition.

People who suffer from dry eyes can take steps to prevent the evaporation of tears. Using a humidifier to add moisture to the air and avoiding smoke, wind and other irritating conditions may provide relief.

Artificial Tears
Over the counter eye drops or artificial tears and ointments help to alleviate mild symptoms of dry eye. Some people who are sensitive to preservatives require special preservative free artificial tears. An ointment at bedtime may be required in more severe cases.

Dietary Supplements
A natural relief for some patients suffering from dry eye is to eat foods containing vitamins A, C and E and omega 3 fatty acids which are found in fish and flax seeds.

Restasis® is a prescription eye drop that will sustain your body’s ability to produce natural tears more effectively than over the counter drops.

Punctal Plugs
In some cases, the punctum may be temporarily narrowed or blocked to keep the tears from draining out of the eye quickly. A tiny puntal plug, about the size of a grain of rice, is painlessly placed in the tear drainage canals. The plugs permit only a small percentage of tears to pass into the punctum, thus building up a layer of tears on the surface of the eye. The plugs dissolve over about 3-6 months.

Permanent Punctal Occlusion
The punctum can also be be narrowed or blocked using surgical techniques or lasers. This procedure can ususally be performed in the office and is painless, as a local anesthetic is administered before the treatment. Although it is impossible to reopen the punctum once it has been closed, the need to do so is rare.

If you are suffering from dry eyes or other eye discomforts, schedule an appointment today. Left untreated dry eye can lead to other more serious conditions including corneal ulcers, infection, and conjunctivitis.


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