What is Dry Eye Syndrome?

The eye depends on constant moisture and lubrication to maintain vision and comfort. Human tears, nature’s lubricant for the eye, are composed of several components secreted by specialized glands called lacrimal glands. The tears produced by these glands are made up of water for moisture, oils for lubrication, and mucus for even spreading. The mucous component also contains different types of antibodies and special proteins for resistance to infection. Dry eye syndrome or keratoconjunctivitis sicca is a condition in which the eyes do not produce enough tears or in which the components of the tears are not balanced.

What causes Dry Eye Syndrome?

The body produces both lubricating tears and emergency tears. Lubricating tears form a protective, layered coating over the cornea. When the components of the lubricating tears are out of balance, Dry Eye Syndrome can occur.

Sometimes a dry eye can lead to tears running down the cheek. At first, this may be confusing: if there are enough tears to stream down the check, how could the eye be dry? The answer lies in emergency tears; the reflex tears that are produced in response to injury, irritation, or emotion. Unfortunately, reflex tears are mostly water and do not have the lubricating qualities and additional components of normal  tears. These tears come too late. An analogy would be coming home from vacation to a brown lawn because no one turned on the sprinklers. You could water all night long, but the lawn still wouldn’t be green in the morning. Dry eyes, like brown lawns, need time and attention to regenerate.

Another aspect of the dry eye relates to the effect of air drying out the tear film. Air is the enemy of the eye and in a dry climate the eye is in constant danger of drying out. The eyelids are the eyes’ only defense against air. If you question the importance of this, just try to hold your eyelids open; most people experience severe pain within one minute of exposure to the air without protection of the eyelids. Dry eye may also be caused by aging, eyelid disorders, eyelid surgery, certain medications such as antihistamines, nasal decongestants, tranquilizers, anti-depressant drugs, lack of vitamin A or diseases including Graves’ disease, Sjogren’s syndrome, lupus and leukemia. Sometimes dry eye occurs for no apparent reason.

What are the symptoms?

Symptoms may include extreme pain, scratchy, gritty or burning sensation, the feeling of a foreign body or sand in the eye, itching, redness, excessive watering, stringy mucus and blurry vision.

How is it diagnosed?

By an ophthalmologist who will examine your eyes and ask about your symptoms, your environment, your overall health and medicines you are taking. Tests like the Schirmer test (a strip of filtered paper placed in your eye at the edge of your eyelid to test the rate of tear production) or fluorescein staining (special eyedrops that help your doctor see problems with the surface of your eyes) can be done.

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How is it treated?

There is no cure for dry eye syndrome, however, several treatment options are available that can reduce your discomfort and protect your eyes. Usually, your doctor will recommend that you use over the counter eyedrops called artificial tears during the day. The fact that several rows in the pharmacy are devoted to various brands of artificial tears is evidence of how common this problem is, particularly in arid climates. Most of these products are about the same, although some are thicker (liquid-gel formulations for example) which may be better for patients with more severe dry eyes. If one particular drop is not helping, it is sometimes worth experimenting with a different brand. Several companies make artificial tears without preservatives, and this is useful for patients who develop sensitivity to the preservatives.

Sitting in front of a computer for a long period of time may require more frequent use of artificial tears. Many patients find it helpful to keep a bottle of artificial tears in their car, at work or in their briefcase or purse.

If you have dry eyes, it is vital to use artificial tears throughout the day before the eye becomes too irritated. Once the eye becomes irritated or starts to tear, it will take longer for the eye to regenerate: remember the analogy to watering a brown lawn. In other words, a drop today will make the eye feel better tomorrow. If the eye becomes painful, it is because artificial tears were not used sooner.

If exposure during sleep is a problem due to the eyes not completely closing, thicker lubricants like ointments at night can be helpful. In most severe cases, ointment can be used during the day, although the drawback is that ointments will blur vision.

In many cases, it is important to place punctal plugs in the tear drains. This will allow the tears which are naturally produced to remain in the eye, and thus lubricate the eye longer. This is a completely painless office procedure and takes only minutes. Temporary or permanent plugs can be used to gain maximum benefit of the tears you produce. Laser treatment or surgery to permanently close off the tear drains can also be done, if appropriate.

If you suspect you have dry eyes, it is important to see an ophthalmologist to be diagnosed and treated. If you would like to schedule an ophthalmic evaluation, our professional staff would be happy to assist you.
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