Dry Eye Syndrome

Dry eye syndrome is a chronic lack of sufficient lubrication and moisture in the eye.

Its consequences range from subtle but constant irritation to ocular inflammation of the anterior (front) tissues of the eye. Dry eyes also are described by the medical term, keratitis sicca, which generally means decreased quality or quantity of tears. Keratoconjunctivitis sicca refers to eye dryness affecting the cornea and conjunctiva.

Dry Eye Syndrome Symptoms

Persistent dryness, scratching and burning in your eyes are signs of dry eye syndrome. These symptoms alone may prompt Dr. Chu to diagnose dry eye syndrome.  But sometimes Dr. Chu may want to measure the amount of tears in your eyes. A thin strip of filter paper placed under the lower eyelid, called a Schirmer test, is one way to measure tear production.

Another symptom of dry eyes is a "foreign body sensation," the feeling that something is in the eye. And it may seem odd, but sometimes watery eyes can result from dry eye syndrome, because the excessive dryness works to overstimulate production of the watery component of your eye's tears.

What Causes Dry Eyes?

Tears bathe the eye, washing out dust and debris and keeping the eye moist. They also contain enzymes that neutralize the microorganisms that colonize the eye. Tears are essential for good eye health.

In dry eye syndrome, the eye doesn't produce enough tears, or the tears have a chemical composition that causes them to evaporate too quickly.

Dry eye syndrome has several causes. It occurs as a part of the natural aging process, especially during menopause; as a side effect of many medications, such as antihistamines, antidepressants, certain blood pressure medicines, Parkinson's medications and birth control pills; or because you live in a dry, dusty or windy climate.

If your home or office has air conditioning or a dry heating system, that too can dry out your eyes. Another cause is insufficient blinking, such as when you're staring at a computer screen all day.

Dry eyes are also a symptom of systemic diseases such as lupus, rheumatoid arthritis, ocular rosacea or Sjogren's syndrome (a triad of dry eyes, dry mouth and rheumatoid arthritis or lupus).

Long-term contact lens wear is another cause; in fact, dry eyes are the most common complaint among contact lens wearers.

Recent research indicates that contact lens wear and dry eyes can be a vicious cycle. Dry eye syndrome makes contact lenses feel uncomfortable, and the rubbing of the lenses against the conjunctiva seems to be a cause of dry eyes.

Incomplete closure of the eyelids, eyelid disease and a deficiency of the tear-producing glands are other causes.

Tears are composed of three layers:

• the outer, oily layer;
• the middle, watery, lacrimal layer;
• and the inner, mucous or mucin layer.

Each layer is produced by different glands near the eye. The lacrimal gland located above the outer corner of the eye produces the lacrimal layer, for example. So a problem with any of those sources can result in dry eyes.

Dry eye syndrome is more common in women, possibly due to hormone fluctuations.   Smoking, too, can increase your risk of dry eye syndrome.

With increased popularity of cosmetic eyelid surgery (blepharoplasty) for improved appearance, dry eye complaints now occasionally are associated with incomplete closure of eyelids following such a procedure.

Treatment for Dry Eyes

Dry eye syndrome is an ongoing condition that may not be completely curable (depending on the cause), but the accompanying dryness, scratchiness and burning can be managed.  Dr. Chu may prescribe artificial tears, which are OTC lubricating eye drops that may alleviate the dry, scratching feeling.

Sometimes people use the eye drops that "get the red out" to treat their dry eyes. This won't work unless the eye drops also contain artificial tears, and the original "get-the-red-out" formulation doesn't. These drops can reduce or eliminate the redness temporarily, but they don't treat the cause of the redness, whether it's dryness, environmental irritation or some other problem.  Not only that, but the vasoconstrictors in those formulas that reduce redness by contracting the eye's blood vessels are addictive, in the sense that over time, more and more is needed to achieve the same effect. With frequent use, the effect diminishes after a while — the blood vessels simply won't constrict as much as they did when you first used the drops.

Restasis eye drops (a prescription medication containing cyclosporine) go one step further: by helping your body produce more tears. Restasis treatment is the first of its kind.

If you wear contact lenses, be aware that many eye drops, especially artificial tears, cannot be used while your contacts are in your eyes.  You'll need to remove them before using drops and wait 15 minutes or even longer (check the label) before reinserting the lenses.

If your eye dryness is mild, then contact lens rewetting drops may be sufficient to make your eyes feel better, but the effect is usually only temporary. Check the label, but better yet, check with Dr. Chu before buying any over-the-counter eye drops.  It will probably save you a lot of money, because Dr. Chu knows which formulas are effective and long-lasting and which ones are not, as well as which eye drops will work with your contact lenses.

If the problem is environmental, wear sunglasses when outdoors, to reduce exposure to sun, wind and dust. You may want to try the kind that has a foam or other seal at the sides and/or a close-fitting, wrap-style frame to keep wind and dust from getting behind the lenses and in your eyes.  Again, Dr. Chu can give you recommendations on these types of moisture glasses or goggles.

Indoors, an air cleaner can filter out dust and other particles from the air, while a humidifier adds moisture to air that's too dry because of air conditioning or heating.  Drinking plenty of fluids may also help.  Avoiding alcohol and caffeine will also minimize body fluid loss which contributes to dry eye symptoms.

Dr. Chu sometimes recommends special nutritional supplements for dry eyes. Studies have found that supplements containing certain essential fatty acids (linoleic and gamma-linolenic) can decrease dry eye symptoms.  These oils are often found in flaxseeds and  cold-water fish, such as sardines, cod, herring and salmon, which contain omega-3 fatty acids.

Occasionally, medications are the cause of dry eyes, and discontinuing a drug may resolves the problem.  But in this case, the benefits of the drug must be weighed against the side effect of dry eyes. Sometimes switching to a different type of medication alleviates the dry eye symptoms while keeping the needed treatment. In any case, never switch or discontinue your medications without consulting with your doctor first!

Treating any underlying eyelid disease, such as blepharitis, helps as well. This may call for antibiotic or steroid eye drops plus frequent eyelid scrubs with an antibacterial shampoo.

If contact lens discomfort is the cause of your dry eyes, Dr. Chu may want to switch you to a different lens material or have you wear your lenses for fewer hours each day. In some cases, it is recommended that contact lens wear be discontinued altogether until the dry eye problem is cleared up.

Dry eyes and LASIK may not be a good combination.  If you are considering LASIK, be aware that dry eyes may disqualify you for the surgery, at least until the problem is resolved.  Dry eyes increase your risk for poor healing after LASIK, so most surgeons will want to treat the dry eyes first, to ensure a good LASIK outcome.  This goes for other types of vision correction surgery, as well.

If you would like further information, please call our office at:

301-770-2020

The Best Possible Eye Care

Dr. Robert Chu performs the full scope of advanced technology diagnostic testing and treatment, as well as taking the time necessary to provide each patient with information needed to understand their condition and to achieve the best possible outcomes. If you or a family member or friend have not had a recent eye examination, please take a moment to Request an Appointment.