What you Should Know About Dry Eyes/Ocular Surface Disease

What is dry eye syndrome?
Dry eyes are one of the most common eye complaints; in fact over 10 million Americans suffer from dry eyes. There are several types of dry eyes because tears are made up of several different components. In addition to water, normal tears also have oils, protein, and mucous. Each of these is important to a healthy tear film that will adequately lubricate the eye. If you lack any one or combination of these components you may suffer from dry eyes, which can lead to irritation and even inflammation.

If you have dry eye you may experience sandy-gritty irritation or burning in your eyes that generally gets worse as the day goes on. The irritation and inflammation can stimulate further tear production, called reflex tearing. Reflex tearing differs from normal tearing in that it is primarily of just a watery nature, lacking some of the other critical components. These tears typically do not coat the eye well and may cause an eye that runs—like water off a duck’s back—still leaving dry patches on the eye.

Why do people develop dry eyes?
Dry eyes may develop for any number of reasons. Certain medical conditions can be associated with these ocular findings, including arthritis, thyroid, and others. Chemical changes brought on by menopause or hormone replacement therapy can be a factor. Dry eyes can be a side effect of several systemic medications. Sometimes eye injury or previous eye surgery may contribute. When possible, addressing the root cause may also prove beneficial in dry eye management.

How are dry eyes treated?
Replacement of the missing tear components through the use of artificial tears helps not only to adequately lubricate the eye, but also to reduce the irritation and thereby reduce your own tearing. Artificial tears, gel, or ointment work much like hand or skin cream, in that once the dryness is already present it takes several applications for symptoms to completely go away. It also works much better as preventative therapy; you should use them on a regular basis to prevent the dryness from returning.

Artificial tears (or ocular lubricants) are available over-the-counter (OTC), without a prescription. There are many different brands, each with slight differences in their ingredients. Sometimes these drops have ingredients—like strong preservatives—that may aggravate the problem, so remember that not all tear brands are alike. Consult your eye doctor before purchasing any over- the-counter drops.

We prefer the use of tears with special gentle preservatives, or even no preservatives, which are safer to use when applied several times each day. We recommend starting at 6-8 times a day or more, and then backing down to a maintenance dose once you start to notice some relief. Sometimes thicker tear drops or even tear gels may be used to better coat the eye and help natural tears stick to the eye better.

For more severe cases, other treatments are available besides artificial tears to manage dry eyes. New prescription medications can help reduce the inflammation caused by dryness and even help stimulate natural tear production. Other oral medications and supplements can help your body make a better quality of tears naturally. Omega-3 fatty acids found in flax seed and fish oils are one of the more common supplements.

We may also recommend closure of the tear drainage system to help keep the tears you do produce in your eyes longer. Just like damming up a river, it stops the current and allows the moisture to pool up where it is needed, in this case on the surface of the eye. This can be accomplished with the use of special “punctal” plugs, which are applied painlessly in the office. These plugs may be short acting and designed to dissolve after a few days to see if this treatment would be helpful. Or, they may be more permanent plugs, used for long-term therapy. Often a cautery treatment is used instead of the plugs to seal off the tear drain permanently. Sometimes lifestyle modification and additional treatments may be indicated when dry eyes are more severe, and our doctors will be happy to explain these if they should pertain to you.

Dry eyes can be an uncomfortable and chronic problem to deal with. Please remember that successful treatment requires your assistance in following your doctor’s orders.