Information - Dry Eye Syndrome

Tears are essential for good eye health and comfort as well as keeping the eye moist; tears keep the eye comfortable by cleaning it out. The thin film of tears that coats the eye isn’t just water, it’s a fluid produced by glands near the eye. The eye may not produce enough tears, or the quality is poor and the tears either don’t spread well or they evaporate too quickly. Dry eyes, also known as “keratoconjunctivitis sicca” are a common complaint, with about 10 people in 100 seeking treatment. The dryness and irritation stimulates the production of an excess amount of the watery layer of the tear film which has a poor lubricating quality as it lacks the oil and mucus.

Layer 1 – Oily Layer

The outer layer is an oily film, made in the tiny oil glands that run along the inner eyelid. This layer smooths and seals the tear surface and helps reduce evaporation of tears. Abnormalities lead to excessive evaporation of the watery layer, causing dry eyes.

Layer 2 – Watery Layer

The gland under the upper eyelid produces the middle watery layer which is the thickest, keeping the eye moist and cleaning it out. It supplies the cornea with oxygen and other nutrients and any problems within this layer are the most common cause of dry eyes. Inflammation of the glands is often the reason for reduced production of the water.

Layer 3 – Mucus Layer

The thin, inner layer is made up of mucus produced by cells in the lining which helps the tear film spread evenly over the surface of the eye. Tears spread over the eye with every blink so excess tears drain away through two ducts in the corner of the eye near the nose.

Signs and Symptoms

·        Persistent dryness.

·        Burning.

·        Eye discomfort.

·        Blurred vision.

·        Sensitivity to bright light.

·        Eye soreness.

·        Scratchy feeling in the eye(s).

Treatment

Dry eye syndrome is a long-lasting condition and it comes and goes at various times. It cannot be cured by the symptoms can be well managed. Moisture replacement using artificial tears is a successful treatment that consists of lubricating eye drops. Some eye medications irritate their eyes so find a product that is preservative-free. Also, some drops are thicker than others and may give long-lasting relief.

To help ease symptoms of dry eye:

·        Take regular breaks to rest your eyes.

·        Drink lots of water to keep the body hydrated.

·        Consult your optometrist about changing medications if they appear to be causing side effects.

·        Wear sunglasses outside – wrap-around glasses help by keeping out dust and wind.

·        Avoid environments that contribute to dryness.

·        Special glasses known as moisture chambers can be worn.

·        Some nutritional supplements are thought to help improve the quality of tears and lessen symptoms.

·        Avoid rubbing your eyes – this worsens the irritation.

·        Use a cold washcloth compress or ice pack over your eyes to stop or sooth itching.

Treatment of Mild Symptoms

Using artificial tears on a regular basis may relieve mild symptoms. They are typically used up to 4 times a day but may be used more often, as needed. Vision is blurred briefly after using ointment. Many patients prefer gel products because they have a prolonged action. Hot compresses and eyelid massage can be helpful, especially if you have eyelid problems.

Treatment of Moderate Symptoms

Moderate symptoms are treated with preservative-free artificial tears at least 4 times a day. In some cases, application may be hourly, or even several times an hour. Lubricating ointment is used at bedtime.

·        Punctual Occlusion

A tiny plug is inserted into the puncta, a small drain in the inner corner of the upper and lower eyelids of both eyes. Each plug prevents the tears from draining away too quickly, thereby keeping moisture in the eye.  Patients aren’t aware of the plugs and they may be temporary or permanent. If they’re made of collagen, the effect is temporary because the plugs dissolve after a period of time. However, if the plugs are silicone, they are permanent but can be removed.

Treatment of Severe Symptoms

Severe symptoms are treated with preservative-free artificial tears and lubricating ointment at night. Antibiotics may also be needed. If the eyelids won’t close completely, a procedure called latrael tarsorrhaphy may be done where the outside of the upper and lower eyelids are sewn together to make closing of the eye easier.

Causes of Dry Eye Syndrome

In Australia and New Zealand, about 1 in 10 adults have the condition at some point in their lives. Dry eye syndrome is more common in mature women possibly due to hormonal changes as it occurs more frequently after menopause.

These are some factors that may contribute to the development of dry eye syndrome:

·        Some medications that may decrease tear production such as antihistamines, antidepressants, sleeping pills, diuretics, certain blood pressure medications, medications for Parkinson’s disease and birth control pills.

·        Living in a dry, dusty or windy climate.

·        Air conditioning or heating systems that cause low humidity in the air

·        A condition that interferes with normal blinking.

·        Decreased blinking when working in front of a computer screen, watching television or reading.

·        Certain medical conditions which may make it difficult to close the eyelids completely.

·        Autoimmune diseases where the immune system produces antibodies that attack healthy tissues, in this, the eye’s moisture-producing glands.

·        Age.

·        A deficiency or dysfunction of tear-producing glands.

·        Long-term contact lens wear.

·        Smoking.

·        Chemical burns or fumes to the eye.

·        Vision correction surgery or other eye procedures.

·        Malposition of the lower lids.

·        Vitamin A deficiency.

Diagnosis

Your optometrist will ask about your symptoms and your medical history, and will carefully examine your eyes. Your optometrist checks the cornea to see if it is damaged and to determine the extent of dryness. The examination may include tests to determine the cause of the dryness. A thin strip of filter paper is placed under the lower eyelid and is removed after a few minutes to measure the amount of moisture. Special drops containing a dye may also be placed in the eyes to make the tear film easier to see. If autoimmune disease is suspected as a possible cause of dry eye syndrome, blood tests may be done.

Dry Eyes and Contact Lens Wear

Dry eyes are a common complaint among contact lens wearers. Contact lens intolerance can be a symptom of dry eyes, but long-term contact lens wear is also thought to cause or aggravate dry eye because:

·        The lens absorbs and disrupts the tear film, causing protein deposits to form on the lens.

·        The lens rubs against the conjunctiva.

Your optometrist may suggest that you change to a different type of lens or reduce daily wearing time. Your optometrist will also check that the lens fit correctly. If the dryness is mild, rewetting drops may be used.

Vision Correction Surgery

Dry eyes can affect healing after vision correction surgery. If you are considering this surgery, dry eye syndrome first needs to be treated successfully to ensure the best outcome.

Follow-Up and Prognosis

If you have mild symptoms, you may only need annual check-ups. If symptoms are severe or are not responding to treatment, you may need more frequent check-ups. In rare cases, severe dry eye syndrome can lead to an increased risk of serious infection of the cornea. Over time, further complications may lead to loss of vision, or even the eye itself, but this is rare. The incidence of dry eye increases in polluted atmospheres. The growing use of computers, video games and other related technology is contributing to the problem.

Medical History

Your optometrist needs to know your complete medical history to plan the best treatment. Your optometrist needs to know about:

·        Any allergy or bad reaction to antibiotics, or other medicines.

·        Recent or long-term illness, including infections, and any previous surgery.

As some medicines can cause dry eye, be sure to tell your optometrist the names of all medicines you are taking or have been taking.

Report to your Optometrist

Contact your optometrist if you develop any of the following:

·        Problems with vision.

·        Severe pain in either eye.

·        Feel the treatment isn’t working.

·        Any adverse reaction to the medication.

·        Any concerns you have regarding the condition or your treatment.