What is Dry Eye?


In medical terms, Dry Eye is lovingly known as "KERATOCONJUNCTIVITIS SICCA".
The tear film consists of 3 layers: A superficial lipid (oily) layer which decreases evaporation, a middle aqueous layer which contributes 90% of the tear film, and a deep mucin layer which facilitates spreading of the tears over the cornea.

Keratoconjunctivitis sicca (KCS) occurs whenever there is decreased production of tears or increased evaporation or break-up of the tear film. Usually the problem arises as a decrease in aqueous tear production which may occur as a result of toxic or inflammatory degeneration of the lacrimal glands (certain drugs, viruses, etc have been incriminated), damage to the innervation of the lacrimal glands, or chronic conjunctivitis. In many cases no specific cause can be identified. When the aqueous tear production decreases, mixing of the oily and mucin layers occurs producing a thick, yellowish, ropy discharge which clings to the eye. Drying of the cornea produces irritation which results in vascularization, pigmentation, and scarring of the cornea.

 

How do you treat Dry Eye?


Treatment for KCS involves 3 essential components:

(1) Stimulation of tear production.
Tear production is best stimulated by the topical administration to the eyes. Usually 4-6 weeks (sometimes longer) is required for tear production to improve. Usually treatment must be continued for life to maintain tear production, but it is possible in some cases to reduce usage. This is especially true if KCS is detected early before severe drying is present.

(2) Control of ocular inflammation and infection through the topical application of an antibiotic-steroid preparation. Occasionally antibiotics may be given orally.

(3) Tear replacement until return of normal tear secretion.

 

Can Watery Eyes Be a Symptom of Dry Eye?


Yes. As odd as it sounds, many Dry Eye sufferers experience ‘wet eyes’ due to the tear glands overproducing watery or reflex tears to compensate for a lack of a balanced tear film.

 

Can reading & TV or computer viewing cause Dry Eye?


During reading and TV or computer viewing, the rate of eyelids blinking reduces significantly, especially in dryer climates. This causes the tear film to evaporate leading to dryness of the eyes. This may happen in some people, especially more when they are tired, or have spent long hours watching TV or computers. Computer Users tend to blink much less frequently (about 7 times per minute vs. a normal rate of around 22 times/minute). This leads to increased evaporation along with the fatigue and eye strain associated with staring at a computer monitor. Ideally, computer users should take short breaks about every 20 minutes to reduce this factor. Also, adjusting the monitor so that it is below eye level will allow the upper lid to be positioned lower and cover more of the eye’s surface, again to reduce evaporation.
 

What else can cause Dry Eye?


Climatic conditions is a very significant contributor to Dry Eye.

Blepharitis can often cause Dry Eye symptoms due to inflammation of the eye lid margins, which is caused by a bacterial infection (Staphylococci). This condition can compromise the quality of the tear film causing tears to evaporate more quickly. The bacteria produce waste material that can cause a mild toxic reaction leading to chronic red, irritated eyes. Click Blepharitis for treatment.

LASIK surgery temporarily disrupts the ocular surface/lacrimal gland unit. This condition usually eventually clears up.

Diseases that may be associated with Dry Eyes include Rheumatoid Arthritis, Diabetes (especially when the blood sugar is up), Asthma, Thyroid disease (lower lid does not move when blinking), Lupus, and possibly Glaucoma.

Age - Tear volume decreases as much as 60% by age 65 from that at age 18. Dry Eye Syndrome affects 75% of people over age 65.

Hormonal changes for women can cause decreased tear production brought on by pregnancy, lactation, menstruation, and post menopause.

Other including too much coffee drinking, smoking, wearing contact lenses, air-conditioning or heat.

Dust, Pollen, and Tobacco - When tear production decreases, dust and pollen stay in the eye longer and are more likely to stimulate an allergic response. In addition, anything that makes an eye more irritated, including Dry Eye, will make an eye more sensitive to environmental irritants such as tobacco smoke.

 

What are the warning signs and how is it detected?


People with Dry Eye have sandy-gritty irritation or burning in their eyes. Initially people may have symptoms only after particularly long days, or when driving, or with contact lens wear, or when exposed to extremely dry environments such as that seen in airplane cabins.

Eventually symptoms become more consistent, and if someone has sandy-gritty irritation or burning that gets worse as the day goes on, and if they have had these symptoms for more than a few days, Dry Eye should be ruled out by an eye doctor.

We will review your history and examine your eyes to make sure you do not have any other problems, and determine the cause for your Dry Eyes.

 

Can Dry Eye syndrome come and go?


Dry Eye syndrome does not truly come and go, but in the early stages of the condition, or with mild Dry Eye, you may only have symptoms after long days, or with environmental conditions that decrease your blink rate (i.e. computer use) or under conditions that increase evaporation from your tear film (i.e. wind, dry air, etc.). Some patients may notice discomfort only when they wear their contact lenses. Some people may develop symptoms only when they are dehydrated--just like your mouth becomes dry, your eyes can become dry in this way.

What if I don't treat Dry Eye. Can I loose sight?


If untreated, Dry Eye can progress to a more irritable, troublesome condition called chronic conjunctivitis. It can cause considerable trouble, and Dry Eye can lead to loss of sight due to corneal scarring, so delaying treatment is not recommended.

Is there treatment for corneal scarring caused by Dry Eye?


When patients experience corneal scarring from Dry Eye, sight may be restored by corneal transplants. However, the original cause of the scarring should be addressed to prevent a recurrence of vision loss. Research and development of human corneal skin grafts to repair severe corneal damage are of great interest to us at Adlington Eye Center.

What can I do to prevent or control Dry Eye syndrome?


Have annual eye exams.
See us immediately if you notice Dry Eye symptoms or any decline in your vision.