Many of our patients report that they have dry, irritated, itchy, or uncomfortable eyes. A large percentage of them suffer from Dry Eye Syndrome. The patient who has Dry Eye Syndrome is no longer producing the quantity and quality of tears that he or she once produced. In fact, the progressive decrease in tear quantity and quality begins at about age 10 and continues throughout our lifetimes. If we live in a humid climate with an abundance of moisture in the air (such as in Hawaii or Florida), we are able to tolerate dry eyes. If we live in an arid environment with no moisture in the air (such as Southern California), our eyes will likely develop symptoms of Dry Eye Syndrome. The average Southern California female begins to use artificial tear drops at age 40, the average male at 50. Many require drops at a much earlier age.

In order for the eyes to be comfortable, they must be kept moist with tears. The lacrimal glands work to produce the tears we need. The eyelids then sweep the tears across the cornea each time we blink. A punctum, or drain hole, is located on the eyelid margin of each of the four eyelids near the inner corner. A canal runs from each of the four punctum into the tear bladder. The tear bladder empties into the nose. This is why the nose runs when the eye tears.

If you have dry eyes you may put drops in your eyes, but as quickly as you put a drop in, it can potentially run down the drain too quickly. The tears we produce must stay in the eye long enough to be spread over the cornea to keep it moist. For this reason, we have established a deliberate step-by-step regimen for management of Dry Eye Syndrome.

Punctal Occlusion with Punctal Plugs

Punctal plugs may be thought of as stoppers such as you would place in the bottom of a sink. Placing a punctal plug assures that whatever tears produced or placed in the eye (in the sink) will stay there longer, rather than immediately run into the puncta (down the drain).

Step One: Placement of Dissolving Collagen Plugs in the Lower Puncta

Collagen punctal plugs are a trial therapy, not a treatment. They are made to dissolve rapidly. Placing collagen plugs takes approximately 30 seconds and is entirely painless The patient will return to the office two weeks after the placement of the plugs and advise the physician as to whether the eyes were too wet for several days and then the plugs dissolved, or whether in fact, there was no change. If there is no change, then non-dissolving silicone plugs may be safely and comfortably placed.

Step Two: Placement of Non-Dissolving Silicone Plugs in the Lower Puncta

If no tearing or wet eyes followed the placement of the dissolving plugs, non-dissolving silicone plugs may be inserted. These plugs will stay in place and will keep the tears in the eye.

Step Three: Placement of Dissolving Collagen Plugs in the Upper Puncta

If there is continued evidence of Dry Eye Syndrome under the microscope after placement of lower non-dissolving silicone plugs, the process may be repeated for the upper puncta, beginning with the placement of dissolving collagen plugs.

Step Four: Placement of Non-Dissolving Silicone Plugs in the Upper Puncta

If there is no tearing after placement of upper dissolving collagen plugs, non-dissolving silicone plugs may be placed in the upper puncta.

Step Five: Possible Permanent Closure of the Puncta

If non-dissolving silicone plugs are appropriate for you for dry eye management, you may opt to have the puncta closed permanently rather than wearing non-dissolving silicone plugs.

Dry Eyes is a very common problem and is routinely and simply addressed, according to the above regimen. Keep in mind that if you have heavy or droopy eyelids and are considering surgery to correct the droopy eyelids, the elevation and removal of extra weight from the eyelids may result in the eyes being more open. This will allow you to see better and improve your appearance. It will also potentially allow for greater evaporation of tears, since the eyes are more open and therefore more exposed to air. For this reason, we may recommend Dry Eye treatment, based on the microscopic diagnosis of Dry Eye, even if you are presently asymptomatic.

If you think you may have Dry Eye, we invite you to call today to schedule an ophthalmic evaluation.
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