Dry Eye Syndrome

Many people suffer from Dry Eye Syndrome but most have never heard of the problems. People typically self-diagnose their symptoms as “allergy related” especially since early in the disease process symptoms may not be persistant every day but may be bothersome some days but not others.

The tears are a complicated system containing an outer oily layer, a middle watery layer, and an inner mucous layer. An inbalance in any of these layers can cause the tear film to dehydrate and start the complex called Dry Eye Syndrome.

The effects of dry eye vary from person to person, but the most common symptoms experienced are as follows:

• irritated, scratchy, dry eyes
• feeling of something in the eye
• eye redness (many times friends and co-workers think they are abusing drugs or alcohol due to the severe eye redness)
• fluctuating vision
• excessive watering due to reflex tearing that kicks in when the eye gets dry (Yes this is the ironic part of the disease!!!)

Dry eye is most often the result of the natural aging process. More than 75% of people age 65 and older are affected by dry eyes. Women are more commonly affected particularly during menopause, due to the hormonal changes occurring throughout the body. In addition to age, dry eye can result from any of the following conditions:

• reduced blinking (associated with computer use)
• certain medications such as antihistamines for allergies (Claritin, Zyrtec, Benedryl), hormone therapy (Premarin, birth control), and antidepressants (Zoloft, Paxil, Prozac)
• environmental factors such as dry climate and exposure to wind
• pregnancy
• smoking
• general health problems such as diabetes, acne rosacea, arthritis, Sjogrens syndrome
• contact lens wear
• refractive surgery – LASIK

Excessive dry eye can damage eye tissues and cause excessive redness. Currently there is no cure for Dry Eye Syndrome but there a variety of ways to manage the condition.

Life Style influences: stop smoking, limit caffeine intake, keep hydrated with drinking water throughout the day

Environmental influences: using a humidifier at home or work, avoiding wind and dust, and trying to blink more frequently when reading or focusing for an extended period of time may reduce the effects of dry eyes.

The first line of treatment is usually the use of artificial tears or lubricant eye drops and supplements such as Omega 3 Essential Fatty Acids. Instilling the drops several times a day or as needed can help people who have mild dryness. Lubricating ointments are also available and can be applied to the eyes at night to help maintain moisture during sleep. The drawback of this therapy is that the effects of artificial tears are generally short lived, and some people have to use the drops frequently throughout the day to remain comfortable. In this case, the use of drops or ointment is too inconvenient and unacceptable to some people. Drops such as Visine and Clear eyes are not very effective in treating the condition and patients usually waste money and delay getting professional help since they think the symptoms will go away.

Vitamins can help maintain an adequate tear film. Omega 3 fatty acids support proper tear secretion and tear film health. I recommend Omega Max which is manufactured by Amerisciences and is the Omega 3 used by NASA for the astronauts, The gel tablets are made from cold water fish such as cod, mackerel, and salmon. The fish oil is very high quality free of any heavy metal contaminants. Plus the capsule is designed to dissolve in your intestine instead of the stomach which avoids the “fishy burps”. It takes about 2 -3 months of treatment before any improvement is noted.

Prescription medications such as Restasis and topical steroid drops (e.g. Lotemax, FML) are required to reduce the inflammation and increase tear production by the tear glands.

A technique called punctal occlusion may reduce or even eliminate the need for lubricating eye drops or ointment. The tears naturally drain out of the eye into the nasal passages through openings in the eyelid called puncta. The puncta are located toward the inner corner of the eye, and there is one punctum on each of the upper and lower eyelids. Medical grade collagen or silicone plugs may be inserted in the puncta to inhibit drainage and keep the tears in contact with the eye for a longer period of time. Usually, punctal plugs are applied to only the lower punctum, but in some cases all four puncta may be blocked. Punctal occlusion is a fairly simple, painless procedure and can be performed in an eye doctors office. In addition, the plugs may be removed at any time if excessive tearing is produced. In addition to the above treatments, researchers are investigating some alternative treatments with medications that are in the experimental phase now and may be approved in the near future. Although dry eye is a chronic syndrome and cannot be cured, the current treatments and lifestyle changes do bring relief for the millions of Americans suffering with the symptoms of dryness. Consult your eye care professional for the latest treatment options appropriate for you.