Dry eye and ocular surface disease evaluation and treatment

Dry eye syndrome is a chronic lack of sufficient moisture in the eye. Its consequences range from subtle but constant irritation to inflammation of the front tissues of the eye.

Dry Eye Syndrome Symptoms and Signs

• A stinging, burning or scratchy sensation in your eyes
• A sense of sand in your eyes
• Stringy mucus in or around your eyes
• Increased eye irritation from smoke or wind
• Eye fatigue after short periods of reading or working at the computer
• Sensitivity to light
• Difficulty wearing contact lenses
• Blurred vision, often worsening at the end of the day
• Excessive tearing can sometimes be the result of irritation initially triggered by dryness

Risk factors for Chronic Dry Eye (CDE) include:

1. Hormonal changes (related to aging and menopause)
2. Medicines
   • Diuretics, drugs commonly used to treat high blood pressure
   • Antihistamines and decongestants
   • Sleeping pills
   • Birth control pills
   • Tricyclic antidepressants
   • Isotretinoin-type drugs for treatment of acne
   • Opiate-based pain relievers such as morphine
3. Autoimmune disease (eg., Sjogren's Syndrome)
4. Contact lens wear
5. Smoking or second hand smoke

What Causes Dry Eyes?

Tears bathe the eye, washing out dust and debris and keeping the eye moist. They also contain enzymes that neutralize the microorganisms that colonize the eye. Tears are essential for good eye health. Tears are composed of three layers: the outer, oily, lipid layer; the middle, watery layer; and the inner, mucin layer. Each layer is produced by a different part of the eye, so a problem with any of those sources can result in dry eyes.There are 4 main categories of dry eye syndrome:

1. the eye doesn't produce enough tears
2. the tears have a chemical composition that causes them to evaporate too quickly
3. the eyelids do not close properly to protect the eye surface
4. there are irregularities on the eye surface that disrupt tears and create local dryness

Dry eye syndrome has several causes. It occurs as a part of the natural aging process, especially during menopause; as a side effect of many medications, such as antihistamines, antidepressants, certain blood pressure medicines, Parkinson's medications, and birth control pills; or because you live in a dry, dusty or windy climate. Air conditioning and heating systems can dry the air in your home or office and, in turn, your eyes. Another cause is insufficient blinking, such as when you're staring at a computer screen all day.

Treatment for Dry Eyes

Dry eye syndrome is an ongoing condition that may not be cured (depends on the cause, but the accompanying dryness, scratchiness and burning can be managed.

We start with artificial tears, which are lubricating eye drops that may alleviate the dry, scratching feeling. Tears that are preservative-free are less irritating to the eye surface.

Closing the opening of the tear drain in the eyelid with special inserts called punctal plugs is another option. This works like closing a sink drain with stopper. These special plugs trap the tears on the eye, keeping it moist. Once inserted, you will not feel these tiny plugs. This may be done on a temporary basis with a silicone plug or the ducts can be permanently closed with a procedure performed in our office.

Restasis (cyclosporin) eye drops go one step further: they help your eyes to increase tear production and are useful in patients who have an inflammation component to their dry eye.

If the problem is environmental, you can wear sunglasses when outdoors, to reduce exposure to sun, wind, and dust. You may want to try the kind that has a seal at the sides, to keep wind and dust from getting to your eyes. Indoors, an air cleaner can filter out dust and other particles from the air, while a humidifier adds moisture to air that's too dry because of air conditioning or heating. Taking breaks from computer work to moisturize your eyes during the day can also help.