Dry Eye Disease
The eye depends on the flow of tears to provide constant moisture and lubrication to maintain vision and comfort. Tears are a combination of water, oils, mucus, antibodies and special proteins. When there is an imbalance in this tear system, a person may experience dry eyes or a dysfunctional tear state.
When tears do not adequately lubricate the eye, a person may experience:
- Light sensitivity
- A gritty sensation
- A feeling of a foreign body or sand in the eye
- Blurring of vision or fluctuation of vision
Sometimes, a person with a dry eye will have excess tearing, which may seem confusing. This happens when the eye isn't getting enough lubrication. The eye sends a signal through the nervous system for more lubrication. In response, the eye is flooded with tears to try to compensate for the underlying dryness. However, these tears are mostly water and do not have the lubricating qualities or the rich composition of normal tears. They will wash debris away, but they will not coat the eye surface properly.
In addition to an imbalance in the tear-flow system of the eye, dry eyes can be caused by situations that dry out the tear film. This can be due to dry air from air conditioning, heat, ceiling fans or other environmental conditions. Other conditions that may cause dry eyes are:
- The natural aging process, especially menopause as there are androgen and estrogen receptors in the lacrimal gland.
- Side effects of certain drugs such as antihistamines, anti-depressants and birth control pills.
- Diseases that affect the ability to make tears, such as Sjogren's syndrome, rheumatoid arthritis, and collagen vascular diseases.
- Structural problems with the eye lids that don't allow them to close properly.
Though dry eyes cannot be cured, there are a number of steps that can be taken to treat them. Treatments for dry eyes may include:
Artificial tear drops and ointments. The use of artificial teardrops is the primary treatment for dry eye. Artificial teardrops are available over the counter. No one drop works for everyone, so you might have to experiment to find the drop that works for you. If you have chronic dry eye that requires you to use tears several times per day, preservative-free tears are recommended. If your eyes dry out while you sleep and are worse upon waking, you can use a thicker lubricant, such as an ointment, at night.
Punctal occlusion. Tears drain away from the eye through an opening in the upper and lower eyelids called the punctum. A silicone plug can be easily inserted into the lid in the office. This will hold tears around the eyes longer to improve lubrication. The plugs can be removed if needed. Rarely, the plugs may come out spontaneously or migrate down the tear drain. Many patients find that the plugs improve comfort and reduce the need for artificial tears.
Restasis. The FDA approved the prescription eye drop Restasis for the treatment of chronic dry eye. It is currently the only prescription eye drop that helps your eyes increase their own tear production with continued use.
Other medications. Other medications, including topical steroids, may also be beneficial in some cases.