Dry Eye Syndrome

Dry eye syndrome is a common condition that becomes more prevalent with age. It occurs in about 10% of patients age 30-60 and increases to 15% over age 65.

Dry eye is a disease with many causes affecting the tears and the surface of the eye, leading to eye discomfort, visual disturbance and unstable tears, with inflammation of the surface of the eye and concentrated tears (hyperosmolar). The eyes may become dry and irritated because the eyes fail to produce enough tears or because of abnormal tears associated with increased evaporation. This can cause the tears to become too concentrated (hyperosmolar) leading to inflammation that produces unstable tears which causes the tears to become more concentrated in a dry eye inflammatory circle. The tears are important for clear vision.

The tears are composed of three layers:

• Outer oily layer: produced by glands in the lid margins (meibomian glands) and reduces evaporation of tears and stabilized the tear film
• Middle water layer: produced by the lacrimal gland
• Inner mucus layer: produced by goblet cells located in the conjunctival, the thin transparent layer covering the inner surface of the eye

The tears cover the outer layer of the eye called the cornea. The tears provide nourishment to the cornea and help protect against infections.

Symptoms

Patients with dry eye may experience certain symptoms from this condition, usually affecting both eyes, which may include:

Risk Factors

Dry eye tends to affect women more than men, as the hormonal changes that take place as a result of pregnancy, menopause and oral contraceptives affect the tear film. Risk factors include:

• Sjogren’s syndrome
• Systemic lupus erythematosis and rheumatoid arthritis
• Refractive surgery (LASIK)
• Contact lens wear
• Climate: windy, dry
• Computer work

Causes

People usually begin experiencing dry eye symptoms as they age. The condition can occur at any time and can also result from the following:

• Hormonal changes with menopause
• Autoimmune disease like Systemic Lupus Erythematosis and Rheumatoid arthritis
• Long term contact use
• Refractive surgery (LASIK)
• Medications such as antihistamines, decongestants, certain blood pressure medications, antidepressants, birth control pills
• Parkinson’s disease
• Environmental conditions such as smoking, windy and dry climates
• Diseases of the glands of the eyelids (meibomian gland)
• Allergies
• Computer use and infrequent blinking
• Pregnant women
• Chemical and thermal burns of the eyes
• Diseases of the skin and the eyes

Diagnosis

Your doctor can diagnose dry eyes by evaluating your symptoms and testing the volume and quality of the tears. A Schirmer tear test involves placing blotting strips under the eyelids to measure the amount of tear production. Other tests may be performed to determine the condition of the eye surface and how long it takes to evaporate.

Our State-of-the-Art Dry Eye Center utilizes the following tests to diagnose and management your dry eye condition:

• Shirmer Test
• Tear Break-up Time
• Tear Osmolarity
• LipiScan Imaging

Treatment

A careful history and exam will determine the type of dry eye present, which may include not enough tears (aqueous deficient) or increased evaporation (evaporative). The causes are evaluated and treatment includes:

• Artificial Tears: Available over the counter, they lubricate the eye and keep it moist. For patients using artificial tears on a frequent basis, the use of preservative-free tears is recommended, because they reduce toxic or allergic reactions to the preservatives in artificial tears
• Tear Conservation: Tears drain out through the small openings on the lids, and into the nose. These openings can be closed, sometimes with punctal plugs, that limit tear drainage.
• Equipment: Reducing evaporation in dry, indoor conditions with a humidifier may help. Wraparound glasses may reduce drying in windy conditions.
• Medications: The circle of inflammation often present in dry eye can now be treated using Restasis (cyclosporine) or Xiidra (lifitegrast) drops. Steroid drops can also be used on a short time interval.
• Nutritional Supplements: Diets with omega-3 fatty acids found in oily fish and flax seeds may help with dry eye.