1. What is Dry Eye Syndrome or Dry Eyes?
Dry eye syndrome (dry eyes, dysfunctional tear syndrome, or keratoconjunctivitis) is an ocular disease in which the tear film that covers over the surface of the eye is deficient. There are two basic types of dry eye syndrome. The most common type is called evaporative dry eye. The second type is called aqueous deficient dry eye.
2. What are the Symptoms of Dry Eye Syndrome?
- Foreign body sensation
- Intermittent blurred vision
Sometimes people have very little symptoms even though they have significant dry eyes. One aspect of dry eye syndrome is that the salt level in the tear film is elevated compared to the normal body level due to the decreased amount of tears present. This happens slowly over months and years of time. The increased salt levels burns and deadens the nerve endings on the surface of the eye. People may not begin to have symptoms until they have reached an advanced stage of dry eye syndrome.
3. What Causes Dry Eye Syndrome?
The risk factors for developing dry eye syndrome are:
- Contact lens wear
- Long periods of starring at computers, TVs, smart phones, video games, reading
- Hormonal changes in women
- Type of job
- Eyelid disease
4. How does the Environment Affect Dry Eye Syndrome?
The environment that we live and work in can have a major impact in developing dry eyes. People who work outdoors with exposure to the sun, wind, and irritants in the air have an increased incidence of dry ryes. Air conditioning vents, heating vents, and ceiling fans can blow air on the eyes and cause evaporation of the tears from the eye. People who live in Arizona or other dry climates have more problems with dry eyes than someone living in more moist climates such as Florida.
5. Can Contact Lenses Cause Dry Eye Syndrome?
Wearing contact lenses causes a mild irritation to the eye which over years of time can lead to damage to the cells on the eye. Contact lenses also desensitize the eye which leads to poor blinking. Poor blinking diminishes how the tears are spread over the surface of the eye, increases the amount of time the eye is exposed to the air, and decreases the release of the oil or lipid produced by the meibomian glands.
6. Can LASIK Cause Dry Eye Syndrome?
LASIK can lead to dry eye problems. The nerves in the cornea are cut which causes an alteration in the sensation or desensitizes the eye. This disrupts the normal autoregulation between the cells on the cornea. It also leads to decreased blinking. In most cases this is transient as the nerve regenerate.
7. Can Medications Cause Dry Eye Syndrome?
Certain medications are known to have the side effect of decreasing tear production such as:
- Antihistamine and decongestants
- Some blood pressure medications
8. Does Working on Computers Cause Dry Eye Syndrome?
Starring at a computer for long periods of time can lead to dry eye syndrome. This is also true for starring for long periods of time while watching TV, reading, sewing, crossword puzzles, driving, playing video games, and continually texting. During these times you significantly decrease your blinking which decreases how the tears are circulated on the surface of the eye and decrease the amount of oil or lipid released from the meibomian glands.
9. Can I Wear Contacts if I have Dry Eye Syndrome?
You can wear contacts with dry eyes but you have to realize that doing so may make your dry eyes worse over a long period of time. You also need to be aggressive about treating your dry eyes so that you can wear them comfortably.
10. Do Older People Get Dry Eye Syndrome More Often?
As we age, the amount of tear production decreases just like other things in our bodies. The majority of people with dry eyes are older. We are now seeing many more young people with dry eyes due them starring at their smart phones, computers, and playing video games.
11. Why do Women have More Dry Eye Syndrome?
The largest group of people with dry eyes is post menopausal women. There are female and male hormone receptors in the tissues in the eye. In post menopausal women, the decrease in testosterone and the increase in estrogen with replacement therapy is thought to decrease tear production. There are a few studies that show improvement in dry eyes with testosterone cream applied to the eyelids.
12. Are There Any Diseases Associated with Dry Eye Syndrome?
Dry eye syndrome is associated with the following diseases:
- Autoimmune diseases such as Lupus and Scleroderma
- Rheumatoid arthritis
- Parkinson’s disease with decreased blinking
- Sjogrens syndrome
- Steven-Johnson syndrome
- Graves’s disease
13. Artificial Tears Don’t Help my Dry Eyes
Many people complain that the artificial tears don’t work or that they burn when they put them in their eyes. Many people believe that applying one drop a day in their eyes should treat their dry eyes. In many cases, it may require artificial tears several times a day to relieve their symptoms. If your eye is inflamed and irritated, the artificial tears (especially those with preservatives) may at first burn or your eye will not be immediately cured by using one drop. You may need more artificial tears in the beginning so that the eye can improve and then you r eye will feel better.
14. How can the Eye Water When I have Dry Eye Syndrome?
The most common type of dry eye is evaporative dry eye where the tears evaporate off the eye. The lacrimal gland (produces the liquid layer of the tear film and also produces tears when you cry) is still able to produce normally. If your eye becomes inflamed and irritated, the lacrimal gland will produce extra tears in response the irritation. This is just like when you scratch your eye, get something in your eye, or have allergies; your eyes will water in response. Watery eyes are a very common complaint of people with dry eyes.
15. How does Restasis Treat Dry Eye Syndrome?
Restasis is made by Allergan and is a Cyclosporin A drug. It is an anti-inflammatory and works by decreasing the inflammation in the eye secondary to dry eyes. As the inflammation decreases, the function of the cells on the eye improves. It is the first drug approved for the treatment of dry eyes. It works for many people but does not treat all types of dry eye syndrome.
16. Are There Special Glasses or Goggles for Dry Eye Syndrome?
There are goggles that keep moisture on the eye and keep the environment out. Special eyeglass frames are designed to fit closely to your face and has a foam-like material that seals the eye from the environment. They are designed so that your eyeglass prescription can be placed in the frame. There is a frame that has a sponge-like material that you can wet with water which then releases its moisture.
17. Can Dry Eye Syndrome be Cured?
Similar to other diseases such as high blood pressure, dry eye syndrome is a chronic disease. There are many treatments available and your symptoms can be controlled in most cases.
18. Can Dry Eye Syndrome Damage your Eyes?
Dry eye syndrome can lead to damage to the tissues of your eyes. In more severe cases the cornea the cornel can become scarred leading to loss of vision. It can keep you from being able to work, read, watch TV, or drive a car. It is very important that you follow you eye doctors instructions to reduce your risk of any damage to your eyes.
19. How are Dry Eyes Diagnosed?
First the eye doctor will take a history about your symptoms. There are several tests now available to not only diagnose that you have dry eyes but the type and severity of your dry eyes. This is extremely important because the type of treatment depends on the type and severity of the dry eyes disease.
- Slit lamp exam (microscope used to examine the eye) of the surface of the ocular tissues.
- Different stains will show the evidence of damaged cells on the eye called fluorescein, rose Bengal, and lissamine green.
- Shirmer’s test
- Keratograph 5
- MMp29 for inflammation
- Tear osmolarity
- Tear break up time
- Expression and examination of the meibomian glands
20. How is Dry Eye Syndrome Treated?
The treatment depends on the type and severity of the dry eye syndrome. Treatment includes:
- Artificial tears with the brand based on the type of dry eye
- Hot compresses
- Punctal plugs
- Meibomian gland probing
- Special glasses or googles
- Tranquil Eyes
What are Tears?
There are three basic layers which make up the tear film. They are;
The inner mucous layer which provides a hydrophobic interface and helps distribute the tear film. It is produced by the goblet cells in the conjunctiva.
The middle liquid layer which contains proteins, ions, and water is what people think comprises their whole tear. It is produced by the lacrimal gland.
The outer lipid or oily layer is produced by the meibomian glands in the eyelids. The lipid layer covers over the liquid layer to keep it from evaporating form the eye.