Dry Eye Syndrome
Dry Eye Syndrome is a pervasive issue in society. With appropriate evaluation and treatment, people can be quite comfortable.
Dry Eye Syndrome
Dry eye syndrome is one of the most common problems affecting the general population and can cause problems that range in severity from mildly irritating to debilitating. Dry eye syndrome is a general term that describes the state of the front of the eye in response to a breakdown in the natural layer of tears that coats the front of the eye, called the tear film. Normally, this layer of tears is a stable, homogenous layer that not only provides the cornea and conjunctiva a healthy buffer from damage were it constantly exposed to the air, but this interface between the tear film and the air is also responsible for a significant amount of the focusing power of the eye. When the tear film becomes unhealthy, it breaks down in different places on the cornea and conjunctiva, leading not only to symptoms of irritation, but also to unstable and intermittently changing vision.
While there are numerous different symptoms one can experience, prominent amongst these symptoms is tearing; naturally, a patient may wonder why their eye can be “dry” despite producing plenty of tears. This is because the unhealthy tear film and the irritation that comes from it stimulates the brain to produce a wave or reflex of tears to help counteract the irritation. However, this reflex tearing is simply insufficient to correct the overall problem. For this reason, dry eye syndrome could more appropriately be termed “Tear Film Dysfunction.” Other symptoms of dry eye syndrome or tear film dysfunction include:
- Scratchy or foreign-body sensation
- Frequent blinking
- Mattering or caking of the eyelashes (usually worse upon waking)
- Blurry or fluctuating vision (made worse when reading, watching television, driving, or playing video games)
- Eye pain and/or headache
- Decreased hormones associated with aging
- Thyroid eye conditions
- Eyelid inflammation (blepharitis)
- Medication/supplement use, including psychiatric medicines, OTC cold medicines, anti-histamines, beta-blockers, pain relievers, sleeping pills, diuretics and oral contraceptives
- Sjogren's syndrome (dry mucus membranes throughout body)
- Other autoimmune disorders including Lupus and/or Rheumatoid Arthritis
- Chemical splashes / injuries to the eyes
- Eye surgery
- Environmental (dusty, windy, hot/dry)
- Contact lens use
- Neurologic conditions, including stroke, Bell's palsy, Parkinson's
- Inflammatory eye conditions, including Herpes virus infections and uveitis / iritis
- Vitamin A deficiency (rare in US)
Sometimes there are obvious signs of dry eye syndrome / tear film dysfunction that you, acquaintances or even your primary care doctor may notice that may prompt you to seek treatment. However, if you have any symptoms indicative of this but there don’t seem to be obvious signs of it, that doesn’t mean you don’t suffer from it. In fact, most people with dry eye syndrome / tear film dysfunction have signs of it which are not even obvious on a general, screening eye exam. For this reason, if dry eye syndrome / tear film dysfunction is suspected by you or your primary care doctor, a thorough, targeted evaluation for dry eye syndrome by your eye MD doctor is frequently necessary to uncover the diagnosis. Depending on your particular constellation of signs, symptoms, history and comorbidities, your doctor may order tests ranging from Shirmer tear test to blood tests to check for systemic disease.
An individual with dry eye syndrome / tear film dysfunction may, in fact, have more than one cause acting simultaneously to produce the symptoms. This is actually the case for many persons who suffer from dry eye syndrome. For this reason, many persons who undergo casual evaluations and/or treatment attempts of dry eye syndrome without investigating for and treating all the possible causes can end up becoming frustrated, have persistent symptoms that can worsen, and may jump from doctor to doctor to seek relief.
Depending on the causes, there are numerous treatments for dry eye syndrome / tear film dysfunction, but the more common treatment modalities include:
- Artificial tears (preferably ones without a redness-reliever component in them)
- Longer acting agents such as artificial tear gel and ointments and lacrisert
- Tear conserving interventions such as punctal plugs
- Warm compresses
- Eyelash scrubs
- Prescription medicines to encourage tear-production such as Restasis
- Topical ophthalmic steroids are helpful in controlling the inflammatory aspect of the disease.
- Oral flaxseed oil or fish oil supplements 2000mg/day has also been found to be useful in alleviating symptoms and decreasing the frequency of topical agents.
Prognosis / Follow up
Most people with dry eye syndrome who keep up with their regimen as prescribed by their eye doctor are able to have their symptoms controlled, allowing them to function either symptom-free or with minimal difficulty. Because of the nature of the causes of dry eye syndrome, most people do not get “cured” of their problem, but with regular maintenance can function as though they are cured. However, even the patient who is well-controlled on maintenance therapy can have break-through episodes and require a visit to their eye doctor, in addition to regularly scheduled visits (which is usually once to twice per year).
To learn more about dry eyes, please log on to http://www.geteyesmart.org/eyesmart/diseases/dry-eye.cfm