Dry Eye Syndrome

Dry eye syndrome, What is dry eye syndrome

A Common Affliction

One of the more common causes of eye irritation is known as dry eye syndrome. Symptoms of dry eye are typically a sensation of regular eye irritation, burning, tearing, and sometimes-blurry vision.
 

The tear film that covers the surface of the eye is a complex three-layered structure. It is made mostly of water, but also has an inner layer of mucus, which holds the tear film to the eye surface, and an outer layer of lipids (fats) that serves to slow evaporation of tears. This tear film lubricates the eye, smoothing away irregularities for better quality vision; it washes germs and other irritating substances from the eye surface and carries important oxygen to the surface of the eye. Dry eye may also develop as a result of disease or blockage in the oil-producing glands within the eyelid.

Types of Dry Eye 

Dry eye is a label for various disorders of the tear film, which may be classified into two categories:

 

  • Decreased tear production
  • Excessive tear evaporation

 

Regardless of how, water is lost from the tear film, making it more “concentrated.” The loss draws water from the surrounding eye tissues, leading to further deterioration of the health of the eye surface. Eventually, dry, rough spots appear on the eye surface, typically affecting the quality of vision and increasing risk for eye infection and problems with contact lens use. In severe cases, permanent corneal scarring may develop.

  • HAVE DRY EYES?

    Dry eyes are estimated to affect 30 million Americans. 

  • Anatomy: Tear Layer

  • Dr. Katie Macaluso - Dry Eye Specialist

    DRY EYE SPECIALIST

    Dr. Katie Macaluso – Dr. Macaluso specifically diagnoses and treats dry eye syndrome and MGD at our Dry Eye Clinic in Leawood, KS.

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Who is at Risk for Dry Eyes?

Dry eye becomes more common with increasing age and as body hormone changes develop. Most commonly affected are postmenopausal women. Certain autoimmune conditions, such as rheumatoid arthritis and Sjögren’s syndrome, occur together with dry eyes. Medications taken by mouth are another common cause of dry eyes. In particular, several categories of drugs are more than likely to cause dry eye, including:

  • Blood pressure medications
  • Antidepressants
  • Certain medications that regulate heart rhythm irregularities
  • Decongestants
  • Antihistamines
  • Medications for Parkinson’s Disease

Rarely, there can be a genetic or hereditary cause of dry eyes. For many who have dry eyes, environmental conditions may be an important factor in worsening symptoms (construction jobs, janitorial work). Low-humidity environments, wind, central heat or air conditioning and airplane travel will likely cause dry eyes. 

Dry Eyes While Sleeping

One very common reason for dry eyes is sleep pattern problems such as snoring and sleep apnea. These can create a lack of complete eyelid closure for prolonged periods of time during sleep, which makes the corneal surface dry and speckled like sandpaper in the morning due to lack of moisture during those sleep moments of incomplete lid closure.

Dry Eye Diagnosis

Dry eye disorders can pose a challenging problem in diagnosis for physicians. Many different factors can contribute to dry eyes, and determining the cause may affect selection of the best treatment. Most important is listening carefully to a patient’s history. Patients with dry eye are typically symptomatic for at least six months, and complain of a collection of symptoms that worsen as the day goes on:

  • Sandy, gritty sensation
  • Eye redness
  • Burning or stinging
  • Dryness
  • Blurred vision
  • Foreign-body sensation
  • Contact lens intolerance

An eye exam identifies any eyelid abnormalities that may be present and contribute to symptoms of dry eye. Failing to correct eyelid problems often results in failure to relieve symptoms. A careful eye examination allows the physician to test the quality, quantity and stability of the tears and to look for irritation of the eye surface. Special dyes (colored eye drops) may reveal characteristic findings of dry eyes. Not mandatory, but helpful, is the Schirmer’s tear test, which can be done by the doctor in the office and serves to actually measure the tear film in a quantitative way.

Dry Eye Symptom Relief

For less severe cases of dry eye syndrome, there are many steps you can take to prevent and/or relieve the irritations caused by this condition:

  • Use a humidifier. Adding moisture to the air can also be helpful for the more severe cases of dry eye, too.
  • Avoid air vents or ceiling fans blowing directly on you.
  • If you frequently use a computer, position your monitor slightly below eye level so you don’t need to widen your eyes as often.
  • Take care of your health. Don’t smoke, drink a lot of water and consider taking an omega-3 supplement.
  • Plastic side shields attached to eyeglasses may help prevent rapid evaporation of tears.

Dry Eye Treatment 

Drops/Ointments 

The initial approach to treating dry eye syndrome is directed at treatment of the underlying cause. Your doctor will typically start with a special dosage of topical tear substitutes (drops, gels or ointments). Several brands include electrolytes (salts) that may help heal the damaging effects of dry or “concentrated” tears on the surface of the eye. Ointments may be very soothing but should only be used at bedtime to minimize the blurring produced.

Tear Duct Plugs

When symptoms persist despite the use of tear substitutes, temporary or permanent closure of the tear ducts may be considered (punctal plugs or thermal punctal occlusion). This very valuable approach is similar to placing a plug in the drain to help a slow-running faucet fill a kitchen sink. Each eyelid has two “drains” or tear ducts near the bridge of the nose (one on the upper eyelid and one on the lower eyelid; both near the nasal side of the eyelid).

 

Temporary plugs are available to test whether this treatment will offer relief of symptoms and are used before permanent (though removable) silicone plugs are inserted. This is done as a minor office procedure and can produce dramatic relief of dry eye symptoms. In very severe cases, it may be necessary to suture the eyelids partially together at the corners to reduce the area exposed, slowing the loss of tears to evaporation.

LipiFlow Treatment

Many dry eye cases are caused by blockage of the eyelid glands. Blinking releases an oil that protects tears and lubricates eyes. When these glands are blocked, production of the oil is hindered, causing tears to evaporate quicker and exposing the eye surface. This is known as Meibomian gland dysfunction (MGD).

 

If gland structures are healthy, blockages can be removed and proper function restored with a treatment called LipiFlow. Once the glands are producing oil, a reduction in dry eye symptoms often occurs. The treatment, which is painless and takes less than 12 minutes, involves heating the inside of the eyelids while massaging to remove gland blockages.