DRY EYE DISEASE
Dry Eye Disease (DED) is a chronic condition characterized by inflammation of the surface of the eye. Besides the expected symptom of “dryness” of the eyes, it often causes excess tearing, and in fact, the most common complaint of a patient with DED is that their eyes water too much. This can be explained by noting that a tear that is not oily, does not wet the front of the eye very well. If your brain perceives that your eyes are dry, and your eyelids produce a tear film that is poorly formed, you will often tear more than normal, trying to wet the eye with inadequate tears. Hence, the excessive tearing complaint. Cold weather, wind and other environmental factors all may play a role in worsening the symptoms. Concentrating for extended periods of time, for example, when working on a computer or driving long distances, exacerbates the problem by reducing your blink rate, often times by up to 50%, worsening the symptomology.
Another form of DED is due to a lack of tear volume. Although less common of a cause, it results in similar symptoms.
Symptoms of DED include dryness, burning, grittiness, itching and/or redness. Treatment includes OTC artificial tears, gel lubricants, ointments, punctual occlusion, Rx eyedrops such as Xiidra, Cequa and Restasis, Amniotic Membrane allograft and minimal topical steroid use.
Without treatment, chronic dry eye can lead to chronic and often severe irritation and reduced vision. If you are experiencing symptoms of dry eye, mild or severe, it is important to see your eye doctor who can help you effectively manage your dry eye condition.
What causes dry eye?
The risk of dry eye increases as we age and women are more susceptible. Other factors that contribute to dry eye can include long term contact lens use and refractive procedures, such as LASIK, which can lead to decreased tear production. Sometimes dry eye occurs when the balance of the different components that make up the tear film becomes offset.
Your tear film is very thin, very complicated, but critical to eye health. It has multiple layers, but in simple terms, there is a mucous layer that helps it stay in contact with the ocular surface, a fluid layer with many chemical components for eye health stabilization, and an oily layer that keeps the tear film from evaporating too quickly between blinks. Of course, a decreased blink rate worsens the condition. Any disruption of any of the three layers, causes a breakdown of the fluid layer protecting the ocular surface. Damage to the epithelial cells is inevitable when the condition is not treated properly.
A wide variety of common medications, both prescription and over-the-counter, can cause dry eye by reducing tear secretion. Be sure to tell your eye doctor the names of all of the medications that you are taking.
Symptoms & Diagnosis
Dry eye symptoms can include:
Excessive tearing
Stinging or burning
Scratchiness
Grittiness
Itching
Stringy mucus in or around the eyes
Lack of tear volume
Contact lens discomfort
Careful examination of the ocular surface, tear film, conjunctiva and eyelids is necessary to properly diagnose Dry Eye Disease, and any associated causes. A clear discussion of symptoms, how they feel, affects on vision and time of day, all help point to the cause of DED.
Treatment
Although there is no cure for dry eye, treatment can effectively keep symptoms under control. Treating dry eye sooner rather than later can help preserve the health of the eye and slow down any further progression of the disease.
Treatment usually involves some type of artificial tear drops sold over the counter. Typically, the better ones have an oil additive that helps replace a deficient oily tear layer. In some situation when multiple uses a day are required, a preservative free option may work best. Artificial tears help dilute the typical excessively salty tear composition.
Another alternative to help keep your eyes lubricated is to conserve your own tears. Normally, your tears drain out of the eye through a small channel in each eyelid. Dr. Massengale can perform a procedure to temporarily close the channels with removable punctual plugs. With this method, plugs are inserted into the drainage system and reduces the tear exiting from the eye.
LipiFlow
Oils produced by the eye’s meibomian glands seal in and prevent evaporation of your tear film. If your dry eye is caused by problems with these glands, Dr. Massengale may recommend a new procedure called LipiFlow. Performed in the doctor’s office, this procedure delivers warm pulsations to the eyelids, opening up the oil glands and helping them to secrete oils normally.
What You Can Do at Home
To minimize the evaporation of tears, avoid exposure to dust, cigarette smoke, other irritating pollutants, and try to avoid the wind. You could also try these remedies:
Apply a warm compress to your eyes - A warm compress will help improve the secretion of mebum (oil) from your eyelid glands.
Use a cold-mist humidifier - Use a humidifier daily at home and at your workplace to keep the air moist.
Avoid sleeping with a fan on your face - Fans that circulate air are fine, but when directed at your face, it can facilitate the evaporation of your tear film. This is especially the case for those who don’t naturally close their lids completely when they sleep. Dr. Massengale can prescribe an ointment to use in the evening that helps with incomplete eyelid closure.
Blink more - Blinking spreads tears evenly over the surface of your eye. When you watch TV, drive or stare at a computer screen, you typically blink half as often as normal. Taking breaks from these activities and trying to blink more often can be helpful.
Increase your omega-3 fatty acid intake - This is probably the most important step to take for any cause of DED. Studies show that consistently eating foods rich in omega-3 fats, such as salmon and other fatty fish, and certain nuts and seeds such as walnuts, flaxseeds, or chia seeds help improve dry eye. You should consider taking a fish oil supplement daily, with a minimum of 2 grams daily. Make sure that regardless of what the front of advertises as total Omega 3’s, that the ingredient label shows that there is ample DHA and EPA so that you are getting at least 2 grams daily. Also important, is to make sure the form you are taking is stated as “Triglyceride” form. The “Ethyl Ester” form is cheaper in cost, but not nearly as effective.