Dry Eye
Dry Eye Syndrome
Tears are a complex mixture of water, salts, oils, and proteins that help the surface of the eye remain smooth and uniform. Tears also wash away foreign material,such as allergens or bacteria, that may be harmful to the eye. Dry Eye Syndrome(DES) occurs when your natural tears are not able to adequately lubricate,coat, and protect the surface of your eyes. There can be many reasons for insufficient tears. In some cases, you may not produce enough tears or the tears that are being produced are of a poor quality so they evaporate more easily and do not cling to the surface of the eye properly. Age, hormonal imbalance, autoimmune disease, eyelid problems, medications, and environmental factors can directly cause or aggravate DES.
Dry Eye Symptoms and Signs
Common
symptoms and signs of DES include:
Usually affects both eyes, but one eye may be affected more
Eye discomfort, such as stinging, burning or a scratchy sensation
Eye redness and/or eyelid redness
Blurry vision or fluctuating vision
Tearing
Eye fatigue after reading for a period of time
Light sensitivity, including glare or starbursts around lights
Irritation from smoke or wind blowing into the eyes
Waking up with stringy material in the corner of the eyes
Uncomfortable contact lenses, especially towards end of day
Eye infections, including from contact lens wear
Scarring of the cornea (front clear window of the eye) in advanced cases
When dry eye symptoms affect vision or eye comfort, a detailed examination by your eye doctor can lead to treatment to improve or control these symptoms.
symptoms and signs of DES include:
When dry eye symptoms affect vision or eye comfort, a detailed examination by your eye doctor can lead to treatment to improve or control these symptoms.
Composition of Tears
Tears consist of a mixture of water, oil, and mucus. Problems with any of these components may lead to DES.
Aqueous layer: The main component of tears is water mixed with salts, enzymes, and proteins. A complex mixture of water, salts or electrolytes, proteins, oils or lipids, mucin, and other molecules that interact to maintain a uniform tear film.This is produced by the lacrimal gland, which is
located underneath the outer aspect of the upper eyelid. If the lacrimal
gland becomes inflamed, its cells may no longer function normally and
produce less aqueous.
Mucous layer: Special (goblet) cells on the white
of the eye (conjunctiva) produce mucus, a thick, white material that coats
the superficial cells the eye and helps bind the aqueous layer of tears to
the surface cells.
- Oil layer: Fatty oils, or lipids, are secreted by small (meibomian) glands on the edge of the eyelid, near the eyelashes.
Causes of Decreased Tear Production
Causes of Increased Tear Evaporation:
Medications Associated with Dry Eye Syndrome
Some basic questions you may want to discuss with your doctor include
Diagnostic Tests for Dry Eye Syndrome
Measuring the volume and quality of your tears.
Schirmer test. A filter strip with millimeter marking is placed on the lower eyelid. Tears flow onto this blotting
paper for 5 minutes, measuring the amount of tears asorbed during this interval. The normal range is from 10 – 20 mm in 5 minutes.
Dye Test. Various liquid dye eye drops can be applied to the surface of the eye. Areas that have a good coating of tears will dilute the dye. The dye will accumulate in drier regions because the tears are not adequate to
rinse away the dye.,
Fluorescein (green) dry accumulates on the inferior portion of the eye as there are insufficient tears to wash away the dye.
Treatment of DES
For most people with mild dry eyes symptoms, treatment involves over-the-counter eye drops and other simple remedies, such as wearing sunglasses when outside or drinking more water. Keeping the eyelid area clean and opening pores of tear
glands in the eyelid are important for every dry eye patient. This can be done by cleansing the eyelash region (lid scrub) and applying heat and moisture (hot compress). If your dry eyes symptoms are persistent and more serious, there are a number of medical and surgical treatment options that can be of benefit.
Treating the underlying cause of dry eyes
Your doctor will work to determine what’s causing your dry eyes. In some cases these situations can be reversed. For instance, if a medication is causing your dry eyes, your doctor may recommend a different medication that doesn’t cause that side effect. If your symptoms are worse with computer work, then taking breaks during the work day may be helpful. If you have an eyelid condition, such as a condition that makes it difficult to close your eye completely when you blink, your doctor may refer you to an eye surgeon who specializes in plastic surgery of the eyelids. If your signs and symptoms suggest an autoimmune condition,
such as rheumatoid arthritis or Sjogren’s syndrome, your doctor may refer you to a rheumatologist for evaluation.
Environmental Modification
If you experience dry eyes, pay attention to the situations that are most likely to cause your symptoms. Then find ways to avoid those situations in order to prevent your dry eyes symptoms. For instance:
Avoid air blowing in your eyes. Don’t direct hair dryers, car heaters, air conditioners or fans toward your eyes.
Wear glasses on windy days and goggles while swimming. The wraparound style of glasses may help reduce the effects of the wind. Goggles protect your eyes from chemicals in pool water that can dry your eyes.
Add moisture to the air. In winter, a humidifier can add moisture to dry indoor air.
Consider eyeglass shields to protect your eyes. Safety shields can be added to the tops and sides of eyeglasses to block wind and dry air from getting to your eyes. Ask about shields where you buy your eyeglasses.
Take eye breaks during long tasks. If you’re reading or doing another task that requires visual concentration, take
periodic eye breaks. Close your eyes for a few minutes. Or blink repeatedly for a few seconds to help spread your tears evenly over your eye.
Position your computer screen below eye level. If your computer screen is above eye level, you’ll open your eyes wider to
view the screen. Position your computer screen below eye level. This may help slow the evaporation of your tears between eye blinks.
Stop smoking and avoid smoke. Ask your doctor for help devising a quit-smoking strategy that’s most likely to work for you.
Lubricants
Eyelid Health
For people with eyelid inflammation (blepharitis) and other conditions that block the flow of oil to the eye, regular eyelid washing may help. Your doctor may recommend that you do this daily, even when you do not have dry eyes symptoms. stopping this daily routine may cause your dry eyes to return.
Hot Washcloth. Wet a clean cloth with hot water. Hold the cloth over your eyes for five minutes. Re-wet the cloth with hot water when it cools. Gently rub the washcloth over your eyelids to loosen any debris. While this can be helpful and soothing, it is difficult to maintain an adequate amount of heat for a sufficient amount of time.
Mild Soap Cleanser to Eyelid. Baby shampoo or other lid cleansers may be recommended by your doctor. Put the soap on your clean fingertips and gently massage your closed eyes near the base of your eyelashes. Rinse the soap completely
away. Pre-moistened lid cleansing pads are also commercially available.
Omega-3 Fatty Acid Supplements
Some preliminary research has suggested that omega-3 fatty acids could help relieve dry eyes symptoms. These fatty acids, found in fish and vegetable oils, are thought to reduce inflammation in the body, including in the eyes and eyelids. Omega-3 fatty acids are available in foods (salmon, tuna, flaxseed, walnuts) and in supplements.
Medications
Office Treatment of DES
Closure of the Tear Drain: Punctal Plugs. Normally tears drain through a canal in the inner corner of each eyelid into the sinuses and nose. This is why tears don’t normally spill down the cheek. Tiny silicone plugs or surgical cautery can
be used to block the tear drain, allowing the tears to remain in contact with the eyes longer. Plug insertion is an easy, reversible procedure that can be performed in the examination room and is usually covered by medical
insurance.
Bandage Contact Lens. If the eye is too dry, a soft, clear bandage contact lens can be applied to protect the surface of the eye. Similarly, eye goggles can be worn at night time.



