| Dry Eye Syndrome is a very common condition caused
by either decreased tear production or increased tear evaporation.
The tear film has multiple layers and is produced by numerous different
glands located in the tissues around the eye. If one or all of these
components is produced in decreased levels, tears tend to evaporate
faster than normal, leaving the eye in a relatively tear-deficient
state. |
The tear film both lubricates the cornea and conjuctiva
and provides a smooth even surface through which light can be
focused into the eye. The absence of an adequate tear film can
lead to slight blurring of vision, as well as a gritty sensation
as the cornea rubs against the inside of the eyelid during blinking.
As the corneal surface dries out, reflex tearing occurs to protect
the corneal surface from breaking down. This is why tearing can
be associated with dry eyes.
Low-grade inflammation often accompanies dryness, which in turn
leads to an additional decrease in tear production. Medications
to combat inflammation are sometimes required in the treatment
of dry eye.
Environment can often play a significant role, especially in
dry climates. Activities like reading and computer use can also
aggravate dry eyes due to the fact that blinking is often reduced
during these activities. Some systemic diseases (i.e. Rheumatoid
arthritis, Sjögren’s Syndrome) can also cause dry eyes.
A complete eye exam by an ophthalmologist is recommended.
Treatment of dry eye can include:
- Replacement of artificial tears.
Many brands of artificial tears are available over-the-counter
(Refresh, Systane, Genteal, Theratears, etc.) including many
generics. Initially, tears should be done 4-5 times a day and
can be tapered to meet your eye’s needs. In some cases,
tears may be required more frequently. If you require tears
more frequently than 5 times a day, you may need to switch to
preservative-free artificial tears, as the preservatives in
eyedrops can irritate the eye if used too frequently.
- Medications to fight inflammation. Restasis
twice a day is an effective and safe long-term treatment for
dry eyes. It is a mild immune modulator that blocks the inflammatory
pathway that leads to decreased tear production. However, daily
use for 2-3 months is needed before the full effect of the medication
is realized. Topical steroids are also used for short-term treatment
of dry eyes, but are not recommended for long-term use due to
potential side effects (cataracts, glaucoma) that can occur.
- Punctal occlusion. There
are openings on both the upper and lower eyelid through which
tears drain away from the eye and into the nose. Small silicone
plugs can be placed into the lower openings to prevent premature
drainage of the tears. These can be placed in the office during
your visit. Over time, the punctal plugs may fall out; however,
due to their small size and location, most patients are unaware
of their presence. Permanent punctal occlusion may also be done
in severe cases.
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