Dry Eye Disease

Millions of Americans suffer from chronic dry eyes; many don’t even know they have it. They chalk up their discomfort to allergies, weather conditions or advancing age. Symptoms of dry eye disease include red eyes, burning, itching, sandy/gritty feeling, light sensitivity, watery/tearing eyes, contact lens discomfort, eye soreness and/or blurry/fluctuating vision.

Your eyes need healthy tears = a complex mixture of oil, proteins, mucous, and other components that are essential for ocular health and comfort. The tear film section does more than lubricate the ocular surface. The tear film also consists of its own immune system. So, a healthy tear film is able to protect the eye from potential ocular infections

Underlying changes to the health of the tear-producing glands can result in a change in the quantity and quality of tears you make. Even if you are able to make tears, they may not be healthy tears. Unhealthy tears can no longer provide enough nourishment or protection to the surface of the eye. Unhealthy tears can lead to damage to the eye’s surface.

WHY CAN TEARING BE A SYMPTOM OF DRY EYE DISEASE?

When the eye is irritated from dryness, the lacrimal gland produces a large volume of tears that can overwhelm the tear drainage system and overflow from your eye.

Tearing and dry eye…Oxymoron? Not really!

Many people complain of tearing, and they are subsequently diagnosed with dry eye. Why is this?

Think about this analogy: when debris, trash, an eyelash gets inside your eye or any other foreign body gets inside your eye, your eye starts to tear because your eye is trying to flush out whatever is in it. Well, when your eye is dry, a foreign body sensation is created, and a signal is sent to your eye to flush away whatever it thinks is in there.

Many times, people are unaware of their dry eye status; however, the eye itself is fully aware of the irritation. In order to alleviate the discomfort, the eye will start to tear. Unfortunately, after the eye finishes tearing, the eye is left more dry than it was. So, when artificial tear supplementation is recommended by your eye doctor, the advice should be followed!

WHAT CAUSES DRY EYE DISEASE?

Some causes of Dry Eye Disease are age, autoimmune disorders, eyelid problems, eye surgery, and/or environmental stresses. Prescription and over-the-counter medications may be the culprit, as well; such as high blood pressure medications, diuretics, beta-blockers, allergy medications, antihistamines, sleeping pills, anxiety medications or antidepressants, pain relievers, and preservatives in eye drops – OTC or Prescription i.e., glaucoma drops.

Tear production normally decreases as we age. Although dry eye can occur in both men and women at any age, women are most often affected, especially during and after after menopause. Other factors such as wind, air pollution, low humidity, air conditioning / heating, lack of sleep, too much caffeine/poor diet, use of computer terminals, prolonged reading, decreased blink rate and contact lens wear.

Mechanisms of dry eye. The core mechanisms of dry eye are driven by tear hyperosmolarity and tear film instability. The cycle of events is shown on the right of the figure. Tear hyperosmolarity causes damage to the ocular surface epithelium by activating a cascade of inflammatory events at the ocular surface and a release of inflammatory mediators into the tears. Epithelial damage involves cell death by apoptosis, a loss of goblet cells and disturbance of the mucin expression. Individual etiologies often cause dry eye by several interacting mechanisms.

SURGERY INDUCED DRY EYE

LASIK and other refractive surgeries can lead to ocular surface disease, aka dry eye syndrome. In essence, the refractive procedures disturb the corneal nerves. As a result, the innervation to the lacrimal gland is interrupted, so the signal needed for the gland to produce tears isn’t there. Consequently, the patient suffers from dry eyes temporarily and sometimes permanently. On average, it takes 6 months for functionality to return.

Dry Eye Disease Diagnosis

Your Visual Acuity will be assessed using the Snellen eye chart which measures how well each eye can see. A detailed history of your eye comfort will be obtained. During an examination at the Slit Lamp Microscope, our doctors will evaluate your ocular surface and surrounding tissues. Successful treatment of dry eye disease is dependant on correctly diagnosing the underlying cause and level of severity of the disease.

AT EFEI, WE TAKE A COMPREHENSIVE APPROACH TO TREATING THIS DEBILITATING DISEASE. WE NOT ONLY LOOK AT THE AMOUNT OF TEARS PRODUCED, BUT AT THE OVERALL HEALTH OF TEARS AND THE WAY THEY LUBRICATE THE EYE.

SCHIRMER TEST

A filter-paper strip is placed under the lower eyelid to measure the amount of tears that are produced in a given time frame.

LISSAMINE GREEN AND FLUORESCEIN DYES

These special dyes are used to show dry areas of the eye and identify underlying inflammation. They also help to access tear film quality and stability.

LID EVALUATION

Lid disease is a major contributor to unhealthy tears. If lid disease is present, it must be managed first in order to successfully treat dry eye symptoms. Examples of lid disease are: Blepharitis, Meibomitis, and Lagophthalmos (incomplete lid closure).

DRY EYE DISEASE TREATMENT OPTIONS

Treatment is based on the cause and severity of the disease ad is customized on a patient by patient basis. Treatment is targeted at supplementing the tears, conserving the tears, preventing evaporation of tears, and increasing production of tears.

Artificial Tears lubricate the eyes and help replace the natural moisture layer of the tear film. They are available without a prescription in several different variations; preserved (in a bottle) – not recommended more than 4x a day, non-preserved (in a vial) – can be used as often as necessary and ointments – used mainly at night and which may cause temporary blurred vision. Artificial tears lubricate the eye, but they lack the complex mixture of proteins, mucins, and other factors found in normal health tears and are useful for temporary relief.

Punctal plugs conserve your own tears and make artificial tears last longer on the eye so that they do not drain out of the eye through small channels into the nasal cavity.

Eye IOUX is a new treatment done in the office that helps un-plug glands in the eyelid that produce part of your natural tears.

Prescription meds such as: anti-inflammatories, Restasis

Liposome Spray-effective in patients with eyelid infections/dry eye simultaneously

Above all – dry eye should not interfere with your lifestyle. Don’t suffer from chronic dry eye one more day!

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