Dry Eye

Dry eye is a chronic and common condition, afflicting about 10 million Americans. It is estimated that almost 75% of people over age 65 will experience dry eye. It occurs in both men and women, although it is most common in pregnant or post-menopausal women.

The tear film is made up of a mucous layer against the eye, a middle aqueous (water) layer, and an outer lipid (oily) layer. All three components are critical for a normal tear film. If any of the three layers are deficient, the eye may suffer symptoms of dryness. The cause is usually an imbalance between tear production and/or tear volume drainage and evaporation.

People with dry eye usually have complaints of burning, stinging, itching, redness of the eyes, "sticky" eyelids, sandy or gritty sensation, foreign body sensation and/or tearing (excessive watering). Tearing with dry eye seems strange at first. This excessive watering is explained by the fact that an underlying dry eye may become irritated, sending a "signal" for increased tear production to "flush-out" the eye. This response is similar to the presence of a foreign body, such as an eyelash or hair, in the eye. Certain conditions can contribute to dry eye symptoms: normal aging, problems with blinking, use of caffeinated products, exposure to tobacco products, computer use, contact lens overwear and some contact lens solutions, environmental factors (dry climate, low humidity, wind exposure or smoke), certain medications (oral contraceptives, antihistamines, antidepressants, antihypertensive to name a few), some medical conditions (arthritis, Sjogren's syndrome or thyroid dysfunction) and chemical or thermal burns.

Dry eye syndrome can be classified as mild, moderate or severe. The severity and cause(s) of dry eye generally dictates the course of treatment. Your doctor may recommend one or more of the following:

  • A humidifier in the home has been found to be helpful for many patients. Due to "hard" tap water in most areas, however, distilled water is usually required.
  • A diet rich in essential fatty acids has been shown to help. Fatty acids reduce eyelid inflammation, decrease lacrimal gland apoptosis (programmed tear gland cell death), stimulate tear secretion and thin oil secretions from the eyelids. In short, the underlying causes of dry eye are treated, not just the symptoms. Products such as TheraTears Nutrition may require 1 to 3 months of use before improvement is noted. TheraTears Nutrition contains 187 IU of vitamin E, 1000 mg of flaxseed oil and Omega-3 fatty acids (450 mg of EPA and 300 mg of DHA).
  • An artificial tear used with the eyes on a regular basis, 4 times a day or more is best. If the condition is to be treated with artificial tears chronically, it is recommended to use non-preserved artificial tears. Artificial tears without preservatives are packaged in disposable ampules. Artificial tears with preservatives are packaged in bottles.
  • Occlusion of the puncta (tear drainage openings), located in each of the four lids, may be completed. This usually involves simple insertion of a punctual plug into one or more of the tear drainage duct openings. The tiny plugs, usually made of silicone or collagen, can be inserted with little or no discomfort and are rarely felt by the patient afterwards. In the unusual case that the patient then has too many tears, the plug can just as easily be removed.
  • Restasis is a prescription medication that causes increased tear production for the eyes. It treats an underlying cause of dry eye, not just the symptoms.