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Common Eye Diseases :: Dry Eye Syndrome |
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DRY EYE SYNDROME-Suresh G. Kamath, M.D.
Dry Eye Syndrome is becoming an epidemic among adults and especially the elderly. At least one out of every ten adults suffer some degree of Dry Eyes. The symptoms can vary from occasional mild eye irritation to severe debilitating eye pain and blindness. In most cases dry eye can be “controlled” to give the sufferer greater comfort and improved vision.
Normally our eyes are bathed in a thin and constantly flowing tear film. The tears emerge from tear glands around the eyes and exit the surface of the eyes by evaporation and through two small tear drainage ducts into the nose. This flow of tears washes away debris—including mucous, dust, pollen, germs, and any other offending particulate matter from the environment. This keeps the surface of the eye clean and free from infection and smooth so that light can be focused properly giving clear vision.
Tears are made up of three parts: oil, water and mucous. Different glands around the eyes make these parts in proper amounts and thickness. If these glands do not work properly one or more of these parts may be produced in the wrong amount or thickness. When this balance is upset the tears will not perform their “duties” to the surface of the eye. This deficiency in tear production is one of the causes of dry eyes. These glands may not work correctly because of: aging; menopause and other hormonal changes; scarring from infections or burns; inflammation from “autoimmune” disorders like Sjogren’s, Rheumatoid Arthritis, Lupus, and Scleroderma; or because of eyedrops for Glaucoma or Allergies or medications taken by mouth for High Blood Pressure, Depression, Irregular Heart Rhythms, Parkinson’s, Stomach Ulcers, Muscle Spasm, Decongestants, Antihistamines and Anesthetics.
Instead of a deficiency in tear production, Dry Eye can also be caused by increased tear evaporation. This is usually caused by a problem with the oily part of the tears. Normally the oil component of tears coats the wet surface of the eye and keeps the watery part from evaporating too quickly. Some Dry Eye patients suffer from irritated oil glands due to a condition called Blepharitis. Blepharitis can occur on its own or in association with a skin disease like Rosacea.
Increased tear evaporation can also be caused by other problems with the surface of the eye. Diseases that interfere with normal eyelid closure or blinking like Parkinson’s, Bell’s Palsy, and Strokes keep the eyelids open wider and longer than usual resulting in greater tear evaporation.
Problems with sensation of the surface of the eye reduce the body’s stimulation of tear production. (A breeze or dust in the air would normally stimulate tearing). Contact Lens wear or laser corrective eye surgery (PRK and LASIK) can cause decreased sensation of the surface of the eye and therefore less stimulation for tear production.
In any of these cases the surface of the eye will suffer due to the abnormality in the tears. Patients may suffer from a sandy or gravelly sensation in the eyes, burning or dry eyes, light sensitivity, blurry vision, eye pain, infections and scarring of the eyes. Many patients with dry eyes will actually experience excess tearing due to the imbalance in the three components of the tears resulting in the tears dripping out of the eye instead of “sticking” to the surface of the eye. These people may have “wet cheeks” but have dry eyes!
Many patients with dry eyes will have fluctuating symptoms. These symptoms can be worse after using the eyes for extended periods of time (like reading) or towards the end of the day. Often symptoms are also worse in certain warm and dry environments like the dry heat in a car or house in winter, large office buildings or malls with “climate control” or in dry parts of the country.
Any patient with these symptoms should see an Ophthalmologist for evaluation and treatment. The symptoms described so far can occur with dry eye or with certain other eye surface diseases or a combination of both. An Ophthalmologist can determine whether dry eye and/or other surface diseases are at play using the examining microscope (slit lamp). The physician will look for a poor tear film or “debris” on the surface of the eye and certain patterns of “staining” of the eye surface with special dyes. The Schirmer Test may be used to help in diagnosis. Sterile filter paper is placed over the edge of the eyelid to see how much “wetness” is produced over a few minutes. The Ophthalmologist will also look for Blepharitis, Allergy, infections, and review the medical history for autoimmune diseases (like Rheumatoid Arthritis), dry mouth, and medications that can cause dry eye.
Occasionally additional consultation with a Rheumatologist, Dermatologist, Infectious Disease Specialist and/or Ear Nose Throat Specialist may be suggested if certain skin, infectious or immune system diseases (like Sjogren’s which includes dry eye, dry mouth and an autoimmune disease like Rheumatoid Arthritis) are suspected.
Once this evaluation is complete, the treatment plan is based on the severity of the problem and the symptoms. Mild dry eye may be treated with Artificial Tear Drops a few times a day or whenever symptoms occur. Warm compresses may be helpful, especially with Blepharitis (oil gland irritation).
Moderate dry eye may require the addition of lubricant gels or ointments. A humidifier and turning down the thermostat can be of great benefit. Preservative free Artificial Tear Drops can reduce the risk of preservative irritation when these drops are used frequently.
Some patients still have trouble in spite of these measures. In these cases we place plugs in those ducts that take the tears away from the eyes and drain them into the nose. Imagine the surface of the eye like a sink that one wants to fill to soak dishes. If one turns on the faucet the water will enter the sink but most of it will leave the sink through the drain. If a stopper is placed in the drain the water level will rise. Remember that tears are produced by the tear glands, flow over the eyes and out through the two tear drainage ducts (one in the upper eyelid and one in the lower eyelid) into the nose. A “plug” in one of these drainage ducts of each eye will help tears to stay on the eyes longer. In the worst cases, when very little or no tears are produced both the tear drainage ducts of each eye can be plugged. This will also keep the Artificial Tear drops, gels and ointments from draining away quickly.
In some patients who cannot close the eye(s) properly because of Bell’s Palsy, Stroke, or injury, dry eye can be reduced by partially closing the eyelids surgically.
An exciting new development in Dry Eye therapy involves the use of a medication called Cyclosporine A [brand name: RESTASIS]. RESTASIS is a drug that has been used for inflammatory conditions like Rheumatoid Arthritis and to prevent rejection of organ transplants like kidneys. It works by slowing down the immune system to prevent it from damaging joints (inflammation) in Arthritis and organ tissue in transplants. Recent research has shown that there is a similar kind of immune system component (inflammation) in Dry Eye Syndrome. RESTASIS has recently become a valuable eye drop in severe cases of Dry Eye. It is used two to four times a day in addition to the previously described Artificial Tear drops, gels, ointments and/or plugs. Many patients will experience significant improvement in symptoms and may require less frequent use of tear drops. Unfortunately, RESTASIS Eye drops are extremely expensive, sometimes not covered by prescription plans, and need to be used regularly. The cost and need for long term use may keep many patients from the potential sight saving benefits of this medication.
There are many other treatments for Dry Eye caused by other problems. The Ophthalmologist must make a comprehensive review of the patient’s medical history and health problems, medications, occupation, environment, hobbies, and lifestyle and tailor therapy that will be best for that individual. Because of the many options available, most Dry Eye sufferers need not lose their sight, and most can live relatively comfortably!
Suresh G. Kamath, M.D.
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See also... |
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 Overview
Cataract - Article 1
Cataract - Article 2
Glaucoma
Dry Eye
Blepharitis
Macular Degeneration
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Suresh G. Kamath, M.D. is a Board Certified Physician and Surgeon. Dr. Kamath specializes in the medical and surgical care of the eye (Ophthalmology), eyelids and skin (Eye or Oculoplastic Surgery).
Our mission at Capital Eye Care is to provide excellent care in an environment that combines education, clinical leadership and service to the community.
We offer office based surgery for most eyelid and skin procedures for adults.
We accept all new and established patients for routine, emergency and elective/cosmetic visits.
We accept patients age seven and above.
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