Dry Eye 

Dry Eye is a condition in which a person does not have enough quality tears to lubricate their eyes.  It may be due to an inadequate volume of tears, poor quality tears, or both. 

How do tears work?

When you blink, a film of tears spreads over the eye.  This keeps the eye's surface smooth and clear.  A quality tear film is essential for good vision.  

The oily layer is the outside of the tear film.  It makes the tear film smooth and keeps tears from evaporating  too quickly.  This layer is made in the eye's meibomian glands.

The aqueous layer or the watery layer is the middle of the tear film.  It makes up most of what we see as tears.  This layer cleans the eye, washing away foreign particles.  This layer is produced in the lacrimal glands.

 

The mucus layer is the inner layer of the tear film.  This helps spread the watery layer over the eye's suface, keeping it moist.  Without mucus, tears would not adhere to the eye.  Mucus is made by the conjunctiva, the transparent skin over the white of the eye and inside the eyelids.

 

Normally our eyes make tears constantly in order to stay moist.  If our eyes are irritated, or we cry, our eyes make a lot of tears.  But, sometimes, the eyes do not make enough tears or something affects one or more layers of the tear film. This results in Dry Eye.  

What are symptoms of dry eye?

  • Eyes sting and burn

  • A scratchy or gritty feeling like there is something in your eyes

  • Strings of mucus in or around your eyes

  • Red or irritated eyes, especially when in the wind or near smoke

  • Discomfort with contact lens wear

  • Eyes full of tears or watery eyes

What causes dry eye?

Tear production tends to decrease with age due to hormonal changes.  Both men and women get dry eye.  However, it is more common in women - especially those who have gone through menopause.

Other causes of dry eye:

  • Inflammatory and autoimmune diseases such as rheumatoid arthritis, Sjogren's syndrome, or thyroid disease

  • Blepharitis and meibomitis

  • Entropian (when eyelids turn in)

  • Ectropian (when eyelids turn out)

  • Being in smoke, wind, or a very low humidity environment

  • Lengthy computer use 

  • Long term contact lens wear

  • Having had refractive eye surgery such as LASIK

  • Certain medications such as diuretics, beta-blockers, allergy medications, sleeping pills, anxiety medication, and birth control

How is dry eye diagnosed?

The diagnosis of dry eye is often made during a routine examination by examining the eyelids and surface of the eye. There are additional tests of tear quality and tear volume that your Doctor may perform.  

How is dry eye treated?

Artificial Tears

Your doctor might suggest the use of artificial tears.   These are eye drops formulated to be like your own tears.  There are different brands and types of tears.  These vary from rather thin, watery tears for mild dry eye to gel tears for more severe dryness.  There are also oil-based tears that may be more suitable for patients that have good tear volume but have a rapid tear evaporation rate.  Preservative-free tears are available if an individual develops an allergy to preserved tears.

Tears for mild dry eye                                          Oil-based tears                                                          Gel tears                

Conserving Tears

Your doctor may suggest blocking your tear ducts.  This makes your natural tears remain in your eye longer.  Tiny silicone or gel plugs may be inserted in your tear ducts (called punctal plugs).  Some plugs dissolve over time and others are more permanent.  Either may be removed as needed.

Punctal Plug placed in the left lower lid

Increasing Tears

Your doctor may recommend a prescription medication to treat your dry eye.  These medications may help your glands produce more tears and better quality tears.  Often, these medications are recommended when artificial tears have not alleviated all your symptoms.

Currently, there are two FDA approved prescriptions for dry eye.  They are Restasis and Xiidra.  Our doctors have participated in drug trials for both of these medications and prescribe them regularly.

Dry eye prevention tips

  • Try not to use a hair dryer

  • Avoid very warm rooms

  • In the winter, add moisture to the air with a humidifier

  • Protect your eyes from wind with wrap-around sunglasses

  • Redirect fans from blowing towards your face

  • Talk to your doctor about adding omega-3 fatty acids to your diet

  • If you often wake up with dry and scratchy eyes, use a lubricating ointment or gel tear at bedtime