Dry eye is an under diagnosed and challenging disease afflicting many patients. If you are suffering from redness, irritation, burning, contact lens intolerance or even blurry vision, you maybe needlessly suffering from chronic dry eye. Allow our experienced staff of doctors and anterior segment specialists at Chu Eye Institute to examine your eyes and see if the latest treatments in dry eyes will help you live your life better.

Dry eye occurs when the eye does not produce tears properly, or when the tears are not of the correct consistency and evaporate too quickly. In addition, inflammation of the surface of the eye may occur along with dry eye. If left untreated, dry eye can cause vision reduction along with chronic irritation. Dry eye can make it more difficult to perform some activities, wear contact lenses, or be at a computer for extended periods of time.

With each blink of the eyelids, tears are spread across the front surface of the eye, known as the cornea. Tears provide lubrication, reduce the risk of eye infection, remove debris, and keep the surface of the eyes smooth and clear. After each blink, excess tears in the eyes flow into small drainage ducts called the punctum, in the inner corners of the eyelids, which drain in the back of the nose.

Dry eyes can result from an improper balance of tear production and drainage.

The most common form of dry eyes is due to an inadequate amount of the water layer of tears. This condition, called keratoconjunctivitis sicca (KCS), is also referred to as dry eye syndrome. Dry eyes can also be caused by blockage of the meibomian glands which secrete oils that prevent the aqueous layer from evaporating.

Symptoms:

Dry eye symptoms may include any of the following:

• Stinging
• Burning
• Gritty feeling
• excess tearing after, very dry eye periods;
• a stringy discharge from the eye;
• pain and redness of the eye;
• episodes of blurred vision;
• dry contact lenses;
• reduced tolerance of reading, working on the computer
• eye fatigue.

Causes of Dry Eye:

What are the causes of dry eye?

• Dry eye can be a side effect of some medications, including antihistamines, nasal decongestants, blood pressure medicines, birth control pills, anti-depressants and medications for ADHD.
• Dermatological conditions can result in dry eye.
• Diseases of the glands in the eyelids, such as meibomian gland dysfunction, can cause dry eye.
• Dry eye can occur in women who are pregnant.
• Women who are on hormone replacement therapy may experience dry eye symptoms.
• Dry eye can also develop after the refractive surgery known as LASIK. These symptoms generally last three to six months, but may last longer in some cases.
• Allergies can be associated with dry eye.
• Infrequent blinking, associated with staring at computer or video screens, may also lead to dry eye symptoms.
• Both excessive and insufficient dosages of vitamins can contribute to dry eye.
• Loss of sensation in the cornea from long-term contact lens wear can lead to dry eye.
• Dry eye can be associated with immune system disorders such as Sjögren’s syndrome, lupus, and rheumatoid arthritis. Sjögren’s leads to inflammation and dryness of the mouth, eyes, and other mucous membranes. It can also affect other organs, including the kidneys, lungs and blood vessels.
• Dry eye can be a symptom of chronic inflammation of the conjunctiva, the membrane lining the eyelid and covering the front part of the eye, or the lacrimal gland. Chronic conjunctivitis can be caused by certain eye diseases, infection, exposure to irritants, and tobacco smoke, or drafts from air conditioning or heating.
• If the surface area of the eye is increased, as in thyroid eye disease when the eye protrudes outward the eyelids are opened too widely, dry eye can result.
• Dry eye may occur from exposure keratitis, in which the eyelids do not close completely during sleep.

How do you treat dry eyes?

For most people with mild dry eyes symptoms, treatment involves over-the-counter eye drops and other simple remedies, such as wearing sunglasses when outside or drinking more water. Keeping the eyelid area clean and opening pores of tear glands in the eyelid are important for every dry eye patient. This can be done by cleansing the eyelash region (lid scrub) and applying heat and moisture (hot compress). If your dry eyes symptoms are persistent and more serious, there are a number of medical and surgical treatment options that can be of benefit.

TREATING THE UNDERLYING CAUSE OF DRY EYES

Your doctor will work to determine what’s causing your dry eyes. In some cases these situations can be reversed. For instance, if a medication is causing your dry eyes, your doctor may recommend a different medication that doesn’t cause that side effect. If your symptoms are worse with computer work, then taking breaks during the work day may be helpful. If you have an eyelid condition, such as a condition that makes it difficult to close your eye completely when you blink, your doctor may refer you to an eye surgeon who specializes in plastic surgery of the eyelids. If your signs and symptoms suggest an autoimmune condition, such as rheumatoid arthritis or Sjogren’s syndrome.

ENVIRONMENTAL MODIFICATION

If you experience dry eyes, pay attention to the situations that are most likely to cause your symptoms. Then find ways to avoid those situations in order to prevent your dry eyes symptoms. For instance:

• Avoid air blowing in your eyes. Don’t direct hair dryers, car heaters, air conditioners or fans toward your eyes.
• Wear glasses on windy days and goggles while swimming. The wraparound style of glasses may help reduce the effects of the wind. Goggles protect your eyes from chemicals in pool water that can dry your eyes.
• Add moisture to the air. In winter, a humidifier can add moisture to dry indoor air.
• Consider eyeglass shields to protect your eyes. Safety shields can be added to the tops and sides of eyeglasses to block wind and dry air from getting to your eyes. Ask about shields where you buy your eyeglasses.
• Take eye breaks during long tasks. If you’re reading or doing another task that requires visual concentration, take periodic eye breaks. Close your eyes for a few minutes. Or blink repeatedly for a few seconds to help spread your tears evenly over your eye.
• Position your computer screen below eye level. If your computer screen is above eye level, you’ll open your eyes wider to view the screen.
• Stop smoking and avoid smoke. Ask your doctor for help devising a quit-smoking strategy that’s most likely to work for you.

LUBRICANTS

• Artificial tears: Our doctors can review which brands may be more effective for you. Generally, preservative-free eye drops are the best for sensitive eyes and for while wearing contact lenses. Depending on symptoms, drops may need to be used more frequently. Some people need to put drops in every hour, and some need eye drops only once a day.
• Gels and ointments: These are thicker lubricants that come in a tube, mainly to be applied right before going to sleep. They moisturize the eyes overnight and may be helpful for some, especially waking up with eye discomfort.
• Prescription lubricants: There are some prescription lubricants that may be more effective than over-the-counter lubricants.
• Serum Tears and Platelet-enriched Plasma. For severe cases of DES unresponsive to artificial tears or medications, a patient’s own blood can be drawn to be used as a natural eye drop. A centrifuge, under sterile technique, is used to separate the red and white blood cells from the fluid in the blood. The fluid, or serum, is extracted and mixed with saline to create a 20% Serum tear solution that contains proteins, oils, growth factors, anti-inflammatory agents, and other components that can significantly improve the health of the ocular surface. 

EYELID HEALTH

For people with eyelid inflammation and debris on the lid margin surrounding the hair follicles (blepharitis) and other conditions that block the flow of oil to the eye, regular eyelid washing may help. Your doctor may recommend that you do this daily, even when you do not have dry eyes symptoms. Stopping this daily routine may cause your dry eyes to return.

• Warm compresses- Wet a clean cloth with hot water. Hold the cloth over your eyes for five minutes. Re-wet the cloth with hot water when it cools. Gently rub the washcloth over your eyelids to loosen any debris. While this can be helpful and soothing, it is difficult to maintain an adequate amount of heat for a sufficient amount of time. Eye heating gels and pads are also commercially available.
• Mild Soap Cleanser to Eyelid. Baby shampoo or other lid cleansers such as Ocusoft lid scubs (premoistened lid cloths) may be recommended by your doctor. Put the soap on your clean fingertips and gently massage your closed eyes near the base of your eyelashes. Rinse the soap completely away.

OMEGA-3 FATTY ACID SUPPLEMENTS

Some preliminary research has suggested that omega-3 fatty acids could help relieve dry eyes symptoms. These fatty acids, found in fish and vegetable oils, are thought to reduce inflammation in the body, including in the eyes and eyelids. Omega-3 fatty acids are available in foods such as (salmon, tuna, flaxseed, walnuts) and in supplements.

 MEDICATIONS

• Antibiotics can decrease the amount of bacteria on the surface of the eye, can open up the pores of tear glands, and can help reduce eye inflammation. These are available in drop, ointment, and pill forms.
• Anti-inflammatory Agents. These can be used to control eye irritation and inflammation from chronic DES. Steroid and non-steroidal drops can be used to treat acute symptoms of redness and burning. Topical cyclosporine (Restasis) can be used on a long-term basis, including in patients with autoimmune conditions or after LASIK, to promote increased tear production by glands on the surface of the eye.

IN OFFICE TREATMENT OF DES

Punctal Plugs

Tears drain through a canal in the inner corner of each eyelid into the sinuses and nose. Tiny collagen or silicone plugs or surgical cautery can be used to block the tear drain, allowing the tears to remain in contact with the eyes longer. Plug insertion is an easy, in office procedure, and most times immediate.

Prokera

Dual action treatments are needed to reduce inflammation and promote healing. Prokera is the only FDA-cleared therapeutic device that reduces inflammation and promotes healing. Prokera offers therapeutic benefits for patients with ocular surface diseases such as keratitis and severe dry eye. Prokera looks like a large soft contact lens and is applied in office and dissolves within days or weeks depending on the severity of the inflammation.

If you have additional questions about dry eye syndrome, please do not hesitate to contact our office.