What is Dry Eye?
The medical term for dry eye is keratoconjunctivitis sicca or keratitis sicca. Tears are produced by goblet cells lining the conjunctival outer coat as well as the larger lacrimal gland under the eyelid.
Everyone will likely experience the symptoms of dry eyes at some point in our lives. Blinking replenishes our tear film providing the moisture eyes need. The prevalence of electronic devices has resulted in a decrease in blink rate. Red, itchy, sandy, gritty, burning, and tired eyes are some of the more common complaints. Excessive tearing is also a sign of Dry Eye disease, often a result of poor tear film quality. Many dismiss and accept these symptoms as “normal”. This is an incorrect assumption. Though dryness can be transient, it becomes problematic and potentially vision threatening when it persists into Chronic Dry Eye disease.
About Tear Film
The tear film not only keeps the eyes lubricated, it also maintains the optical and anatomical integrity of the ocular surface. It provides a smooth interface between the eyelids and the eye itself. It also helps remove environmental debris that can cause ocular allergies. The tear film partially supplies nutrients to the cornea, as well as help defend the eye from infection. Without a sufficiently healthy tear film, the front surface of the eye is more susceptible to irritation, infection, and allergic reaction. The ocular surface insult dry eyes are subject to eventually lead to inflammation of the cornea which can lead to blurry vision. In severe cases, corneal scarring may lead to permanent vision impairment.
The tear is composed of three layers. From outer to inner the top layer is oily to prevent evaporation of the tears, under the lipid (oily) layer is the aqueous layer, and the inner most layer is called the mucin layer (which supplies nutrients). Dry eye occurs due to insufficiency in your tear production.
Other Diseases that can Cause Dry Eye
Certain medical conditions may also cause Chronic Dry Eyes. Autoimmune disease (e.g. Sjogrens, Rheumatoid Arthritis, Lupus, etc.), Bell’s Palsy, Menopause, Skin disease (e.g. Rosacea, eczema, etc.), and Thyroid disorders are only some of the more common conditions. Medications such as anti-histamines, anti-depressants, birth control pills, tranquilizers, and certain blood pressure medications can also cause dry eyes.
Diagnosing and Treatment of Dry Eye Syndrome
Measurement of your tears
Middlesex Eye Physicians is an Accredited Dry Eye Center utilizing TearLab to measure your tear film. Your tear osmolarity number informs our Middlesex Eye Physician what level of tears your eyes have enabling them to develope a more and effective treatment plan for your dry eye(s).
A sample of your tear will be tested. The microchip will absorb the tear. The tear will be placed in out TearLab unit and your "tear number" will be calculated. Your physician will determine the health status of your tear film along with your treatment plan.
Fortunately, there are many treatment options available for dry eye disease. Though, it is important to customize and tailor these treatment options to each individual. Regardless of the severity or cause, dry eye disease should be addressed and treated accordingly before it threatens vision, and before it affects the quality of your life.
Artificial tears containing active ingredients such as carboxymethylcellulose, hydroxypropyl methylcellulose, glycerin, castor oil, Polyethylene glycol or polyvinyl alcohol are used in mild cases of dry eyes. Not all artificial tear brands work the same or work for all patients. More severe case require additional treatment. If you find yourself using your artificial tears three or more times a day you should use a preservative free tear. Most patients find that artificial tears do help, however the effect is only temporary, lasting only 10-15 minutes. Many of these patients will experience significant relief with punctal occlusion.
The puncta is the small opening found on the edge of the upper and lower eyelids next to the nose. Tears drain out of the eye through the puncta into the nose, this is why your nose runs when you cry. If you aren't producing enough tears then you don't want the tears that you are producing to be drained away. Punctal occlusion is painless and performed in the office, taking only a couple of minutes.