The Nitty Gritty of Dry Eyes

Dry Eyes is a chronic and progressive condition that affects millions of people. In the United States, dry eyes rarely leads to blindness, but in parts of the world near the equator and where medical care is non-existent, it can result in eye diseases that cause blindness. Common symptoms to watch for are dryness, burning, grittiness or sandiness, foreign body sensation, excessive tearing chronic red eyes or eyelid margins, soreness around the eyes, contact lens intolerance or discomfort, and even blurry or fluctuating vision. Even recurrent styes can be a symptom.

Risk factors are aging in men and women, females, especially females undergoing hormonal changes due to age or pregnancy, low intact of omega-3-fatty acids, systemic diseases such as hyperthyroidism, Lupus, Rheumatoid Arthritis and Diabetes Mellitus. Sjogren’s Syndrome is often associated with dry eyes. Environmental factors play a big role as well, especially here in the dry, dusty, windy and sunny Central Valley. Prolonged work in front of a VDT can also be a risk factor. Even excessive cell phone use by children has been shown to increase dry eye incidence. Don’t forget sitting in front of an A/C vent in your office or car can be a risk factor as well.

So exactly what causes dry eyes? The human eye is bathed in a soothing, protective tear film, which shields the outer surface of the eye from dessication, infection, and injury. The tear film is composed of three distinct layers: an thin inner layer of mucin, which binds the tears to the cornea, the front of the eye; the thicker aqueous or watery layer, which carries nutrients and oxygen to the cornea; and the outer oil layer, which literally floats on and covers the aqueous layer, and keeping it from evaporating.

Dry Eye symptoms start to occur when not enough aqueous is being produced (aqueous-deficient dry eyes), and/or the oil layer is deficient, allowing excessive evaporation of the aqueous tears (evaporative dry eyes). Dry eyes results from a combination of the two processes, which is believed to occur in a continuum, not just one or the other. In my experience, evaporative dry eyes dominates.

Treatment is designed to mitigate one or both of the two types mentioned above, each requiring different protocols. Treatment can involve application of artifical tears, gels or ointments, prescription eyedrops such as Restasis, Xiidra, or steroids, vigorous lid hygiene scubs and hot compresses, oral prescription medications, punctal plugs, which reduce the drainage of tears from the eyes. Even room humidifiers and moisturizing goggles can be helpful.

The testing and evaluation for dry eyes is constantly evolving, with new ways to test for and manage dry eyes. Even newer contact lens materials and designs have been developed for people who previously did not tolerate lenses due to dry eyes. If you are experiencing symptoms associated with dry eyes, talk to your Brookside optometrist about your concerns.