Dry Eyes or Dry Eye Syndrome affects millions of people worldwide. While many people associate the thought of dry eyes with various symptoms of ocular discomfort such as dryness, grittiness or burning, most people do not realize that in order to have normal vision, it is critical to have a sufficient quantity of healthy tears on the surface of the eye at all times.

Dry eye is an eye condition in which there is a deficiency of the tear film due to either an insufficient production of one’s own natural tears or an excessive evaporation of tears. In either case alone, or in situations where both problems are present, there is a resulting lack of tear film quantity and often a loss of tear film quality. This then causes the eye surface to become compromised.

Insufficient Tear Production

There are a number of factors that can cause you not to produce a sufficient quantity of tears. Certain systemic conditions such as Sjorgren’s Syndrome or autoimmune connective tissue diseases such as Rheumatoid Arthritis and Lupus Erythematosis may decrease the quantity of tears that you produce. Patients with Sjorgren’s Syndrome not only have dry eyes but also may have dry mouth and arthritis as well. Any disease or inflammation of the tear gland, called the lacrimal gland, will also cause patients to produce to few tears to maintain a normal and healthy tear film. These may include factors such as long term contact lens wear, past eye infections, certain allergies and even vitamin deficiencies.

Excessive Evaporation of Tears

There are a number of factors that can cause your tears to evaporate too quickly. This can include environmental factors such as being exposed to forced hot air heat at home or at work, dry climates in general, air travel, reduced blinking from contact lens wear, reduced blinking from looking at a computer screen or reading for long periods of time, air pollution or even just blowing your hair dry.

Your tears may evaporate to quickly if you suffer from ever low-grade eyelid inflammation. Within your eyelids are tiny tubular glands called Meibomian Glands. Any inflammation of the eyelids such as from blepharitis of any type or ocular rosacea can cause the Meibomian Glands to stop secreting their oily film. This oily film is required as an outer layer of the tear film to prevent evaporation. Without it, you will almost certainly experience quick evaporation of tears and dry eyes. This is especially noteworthy for perimenopausal women as it is believed that 75% of women in this age group have some presence of facial rosacea. This along with the general hormonal changes occurring during this time, make perimenopausal woman particularly susceptible to dry eyes.

Finally, your tear film may evaporate too quickly if the tears are not properly spread and replenished over the surface of the eye because of inadequate eyelid movement This may be due to improper or incomplete closure of your eyes during sleep, certain eye “bulging” conditions that may be related to thyroid problems, or a loss of tone or shape of the eyelids so that they turn in or turn out.

Dry Eye Diagnosis and Treatment

During a dry eye examination and consultation, our experts are able to evaluate your tear production. We will also use specially formulated eye drops that contain dyes to help investigate the functioning of the various layers of the tear film as well as the underlying surface of the eye. Based on our findings we will be able to make a proper diagnosis as to the particular cause of your dry eye syndrome and prescribe the necessary tear substitutes, eye drops and/or other options to help restore your tear film back to normal and make you more comfortable.

The specific treatment options that our experts may prescribe will really depend on the likely cause and the severity of your dry eyes. For those patients with mild to moderate dry eyes the first course of treatment may be to use unpreserved artificial tears. Depending on the nature of your tear film deficiency, the doctor may have you use a specific type of artificial tear that has different characteristics in terms of salt content and viscosity. Follow these instructions carefully. In addition, we may advise you on environmental factors that need to be modified. Sometimes, if the oily layer of the tear film is deficient, they may suggest that you increase your consumption of oily fish or even take flax seed oil as a dietary supplement. Most likely you will be asked to drink plenty of water.

If these approaches do not work, our Ophthalmologists may suggest the insertion of tiny punctual plugs that will slow down or even stop the drainage of tears from the eye. These plugs are easily and comfortably placed in the lacrimal puncta in the eyelids. Initially you may have a temporary dissolving plug put in place to see if your signs and symptoms are actually responsive to this treatment. If the results are good, it may be necessary to place a more permanent type of plug in the lacrimal puncta to affect a long-term solution.

For patients with moderate to severe dry eyes where you may already be using artificial tears and already have punctual plugs without relief, the prescription of Restasis eye drops in addition to the other treatments can often help alleviate your symptoms. Restasis works by suppressing a type of inflammatory cell from entering the Lacrimal Gland and thus allows the lacrimal gland to function more effectively so that you can actually make more of your own natural tears.

Occasionally there are some cases that may not respond to the above sequence of treatment options because of some underlying low-grade inflammatory or infectious process. In these cases it may be necessary to also prescribe an oral antibiotic such as a tetracycline or and anti-inflammatory eye drop such as a corticosteroid eye drop.

As you can see, the diagnosis and treatment of dry eyes is complex and requires patience and persistence on the part of the physicians and the patient. With careful diagnosis and a systematic therapeutic approach, sufferers of dry eye syndrome can most often experience considerable improvement.

Our Ophthalmologists will use every necessary diagnostic procedure to help identify the source of your dry eyes and offer you the best possible solution. Please feel free to ask us about a dry eye consultation.