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Dry Eye Disease and Treatment

Dry eye syndrome (DES) is a chronic condition that develops when your eyes do not produce and maintain enough tears to keep the eye’s surface lubricated resulting in multiple symptoms that range from person to person. This can be due to a reduction in tear production or increased tear evaporation from a lack of lipid in the tears that stem from oil glands in the eyelids. The effects can range from minor dryness and discomfort to pain, blurred vision, and frequent infections. This has become the number one problem that patients have with their eyes.

Symptoms of Dry Eye Disease

Symptoms of dry eye syndrome can vary depending on the severity of the condition but can include:

• Dry, scratchy eyes
• Burning or stinging
• Irritation
• Watery eyes
• Blurred vision
• Pain
• Foreign body sensation
• Tired eyes, especially after extended time doing near tasks

The main function of tears is to maintain the health of the cornea of your eye by washing away foreign matter and ensuring that the surface of your eye remains moist, smooth and clear. Tears also rinse away dust particles from your eyes and contain enzymes that protect your eyes from bacteria that can cause infections. Dry eyes are a condition that develops when the amount of tears produced or the quality of the tears are not sufficient to maintain the moisture balance in your eye. This can result in that scratchy sensation, a continuous feeling of dryness, stinging and a sensation of a foreign body in your eye. Ironically in an effort to fight off the condition, dry eyes can cause you to produce excessive tears, which is why some people experience watery eyes.

Causes of Dry Eye Disease

Dry eyes can occur naturally as a result of aging or hormonal changes, typically in women who are pregnant, taking oral contraceptives or going through menopause. In fact, women over 50 have a 50% greater risk of dry eye disease than men do of the same age. It can also result from taking certain medications that reduce tear production such as antihistamines, blood pressure medications and antidepressants. Environmental factors can also play a role in drying out the eyes and DED is common in areas where the climate is dry, dusty and windy. Home air conditioners or heating systems and excessive time spent staring at a computer or television screen can also dry out eyes and exacerbate symptoms due to the lack of blinking while staring at our screens.

Individuals that suffer from certain medical conditions such as diabetes, blepharitis, lupus, arthritis and thyroid problems are more vulnerable to developing DED. Other causes can be due to eye surgery including LASIK, certain conditions in which the eyelids don’t close properly or extended contact lens use.

Diagnosis of Dry Eye Disease

Typically, dry eye disease can be diagnosed through a comprehensive eye exam and a description of your symptoms. On some occasions the eye doctor might decide to do a test that measures how quickly your tears evaporate from the surface of your eye. By instilling a simple dye called fluorescein (much like food coloring) the doctor is able to watch and count how long it takes the tears to start to break up after they’ve asked you to hold your eyes open after a blink. This is called TBUT or a Tear Break Up Time test. A low TBUT generally indicates a lipid (akaoil) deficiency in the tears resulting from oil glands in the eyelids not functioning properly. This leads to what is called, evaporative dry eye. 86% of dry eyes have an evaporative component. In another type of test, called a Schirmer test, a strip of filter paper is placed under the lid of the eye and you will be asked to close your eye for five minutes. Following the test, the amount of moisture on the strip will be measured. Schirmer tests are performed less frequently than a TBUT test.

As mentioned, evaporative dry eyes are a result of poor lipid or oil, in the tear film because of poor meibomian function. The meibomian gland are exceedingly small oil glands in the edges of our eyelids. With a normal blink of the eye, these glands are gently squeezed and minute droplet of meibum or lipid oil, is released into the tear pool along the lower lid. Then the upper lid pulls up the tear over the front part of the eye, the cornea. This coats the surface with a smooth, slippery surface so that you can see your best, have your eyes feel their best and have them look their best. Very often these glands do not function properly because they are blocked up or the meibum oil is not of a good consistency. This can occur because of excess bacteria on the lids which can produce a biofilm that covers the openings along the eyelid margin. Other problems such as blepharitis or ocular rosacea can also block these glands. Overall, the underlying cause creates an inflammatory response in the eye and the meibomian glands and treatments have to deal with this inflammation or the meibomian glands will atrophy and die, leading to more permanent dry eye problems.

Proper blinking is an important factor in the issue of dry eye disease. As stated before, a proper blink spreads tears upon the cornea. Behaviorists have measured the effect of staring at something has on our blink rate. Most people blink between 50-60% less while staring at something. This lack of blinking often makes dry eyes get worse. It is usually not possible to tell one’s self to blink more but you can take time and be intentional with your blinking. There are blinking exercises that can help to release the oils from the meibomian glands.

Treatment for Dry Eyes

There are many treatment options for dry eyes which are highly dependent upon the cause and severity of the condition. Over the counter tear lubricants can give temporary relief of dry eye symptoms but do nothing for the underlying inflammatory problem.

As stated earlier, most dry eyes are from excessive evaporation of the tears because of poor meibomian gland dysfunction.

To treat evaporative dry eye, you must do four things to improve. First, you must treat the inflammation process. This is a modern diet problem. Most of our modern diet is poor in proper omega 3’s. For instance, much of the fish we eat is farm grown. To reverse this, a special omega 3 formula fish oil is helpful. Not any fish oil will help you. You need a fish oil that is high in the EPA component as opposed to the DHA in the oil. There is a product by the PRN company that has a patented formula that works very well. Second, you must deal with the overgrowth of bacteria on the lids. This can be accomplished with a product called Hyclear. It is an over the counter spray that is used nightly. Third, you must open the blocked meibomian glands. TearCare, (watch the video below), is a short office procedure that warms the lids so that the hardened meibum can be released. And lastly, one can purposely do blink exercises daily to improve the meibum flow. These treatments will help the eye to re-establish homeostasis and the dry eyes will see better, feel better and look better!

TearCare Animated Video from Sight Sciences on Vimeo.

Occasionally, prescriptive medicines such as Restasis, Xiidra, or Cequa are used to treat the evaporative dry eye as well. These medicines are used daily.

For the tear insufficiency dry eye patients, treatment includes punctal plugs which keep more of the eye’s natural tears in the eye and OTC tear lubricants. There are systemic health problems that can cause the reduced production of tears. Certain blood tests can help identify these problems.

As with all disease, being proactive with diet and exercise so we have a healthy body is always helpful. Stay hydrated, we live in Florida and the heat can be overwhelming.

Dry eye disease will not have a permanent effect on your vision, but there is no reason to endure dry, itchy, and uncomfortable eyes, especially since there are so many treatment options to increase moisture and comfort. It is also important to realize that this is a chronic disease that needs consistent treatment. Your doctor will work with you to create a long-term strategy to keep your eyes as comfortable as possible.