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Dry eye is a condition where your eye is not producing enough lubricating tears. This can be a little confusing since one of the most common symptoms of dry eye syndrome is excessive watering of the eyes! How is this possible? The eye makes two different types of tears.
The first type, known as lubricating tears, contains a precise balance of water mucus, oil, nutrient proteins and antibodies to nourish and protect the front surface of the eye. Lubricating tears are produced slowly and steadily throughout the day.
The second type of tear, called reflex tears, do not have much lubricating value. Reflex tears are exactly what the name suggests, they are an automatic reflex to flush the eye when it is suddenly irritated or injured. These tears gush out in such large quantities that the tear drainage system can't handle them all and they spill out onto your cheek. Reflex tears might occur when you get something in your eye, when you're cutting onions, when you're around smoke, or when you accidentally scratch your eye. With dry eye syndrome the primary cause of reflex tearing is irritation of the eye from lack of lubricating tears.
In addition to continuous reflex tearing, many patients describe their symptoms as if they had a spec of sand in their eye. Itching and burning can occur. Vision can become blurry and the eyes can become red and produce a mucous discharge.
Dry eye syndrome often occurs as a part of the natural aging process. As we age, glands in the eyelid produce less oil which allows tears to evaporate too quickly. Oil keeps tears from evaporating off the eye, preventing the eye from becoming too dry.
Other causes of dry eye can include:
- Diseases such as Diabetes, Sjogren's and Parkinson's.
- Post-menopausal or other hormonal changes
- Prescription medications include some high blood pressure medications, antihistamines, diuretics, antidepressants, anti-anxiety pills, sleeping pills and pain medications.
- Over-the-counter medications including some cold and allergy products, motion sickness remedies, and sleep aids.
- Hot dry or windy conditions
- High altitude, air-conditioning and smoke
- Reading, using a computer, or watching TV
- Contact lenses
- Various types of eye surgery including LASIK
- Recent research suggests that dry eye may be caused by inflammation due to an imbalance of "good" fats and "bad" fats.
Measuring your rate of tear production and checking how long it takes for tears to evaporate in between blinks are two ways your eye doctor can check for dry eye. By using magnifying instruments, the doctor can also check for pinpoint scratches on the front surface of the eye caused by dryness using special, colored eyedrops called fluorescein or Rose Bengal.
Treatment for Dry Eye Syndrome
Artificial teardrops that help make up for the lack of natural lubricating tears is the most common way to treat dry eye. There are many different over-the-counter brands of artificial tears that come in liquid, or longer-lasting gel form (most often recommended for nighttime use). Some contain preservatives, some do not. Preservatives may cause irritation to those patients with sensitive eyes. In most cases, artificial tears can be used as often as needed although you should follow the regimen your doctor prescribed to you.
Special lid cleansing techniques or antibiotics may be recommended when infection, inflammation of the eyelids or clogged oil glands contribute to dry eye. Patients may also be advised to avoid hot, dry or windy environments or to humidify the air in their home or office.
A new and exciting treatment for dry eye disease is Restasis. Restasis is a product that reduces inflammation by helping the eye produce more tears. Restasis is the first drug proven to not only temporarily alleviate the symptoms of dry eye, but to effectively treat the cause.
Punctal occlusion is a medical treatment for dry eye that may enable your eyes to more efficiently use the limited lubricating tears they produce. During this treatment, your doctor will insert a small plug (called a "punctal plug") in one or more puncta to slow the drainage of tears from your eyes. By slowing the rate of your tear drainage, more tears stay on your eyes and relieve your dry eye symptoms. This is a simple, in-office treatment that is performed in seconds and the doctors at Slade & Baker Vision Center can do this during your exam at our office.