Dry Eye Syndrome

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Dry eye is a condition that affects a large number of us. Initially, dry eye may be a relatively minor problem, but it can cause serious difficulty for some of us. Dry eye may begin at any age, and tends to get worse as we get older (• See Photo).

Dry eyes are more common in women and are more common after age 40. Dry eye is a chronic condition. It can be treated but not cured. Similar to high blood pressure or diabetes, dry eyes need lifelong treatment.

Symptoms caused by dry eye can include burning, irritation, and itching, as well as tearing or watering eyes. You might not expect tearing to be a problem in patients with dry eye. This paradoxical symptom is related to an abnormal tear film or a tear layer insufficiency. The surface of the eye is dry and sends a signal to the brain to secrete more tears and moisturize the cornea. However, the tears that are secreted by the lacrimal (tear) gland may be of poor quality and not moisten the eye surface in the way that they should.

Other dry eye symptoms may include eye pain or blurred vision. One clue that blurred vision is due to dry eye is that it clears temporarily after blinking. Dry eye symptoms can be especially troublesome while reading, watching TV, and working on the computer. Symptoms tend to be worse on windy days and during the winter months due to dry indoor heat.

In general, artificial tears remain a mainstay of treatment for dry eye symptoms. There are many brands of artificial tears available and they vary in their composition, active ingredients, preservatives, etc. Patients with severe dry eyes are usually prescribed preservative-free artificial tears to reduce side effects such as toxicity that can develop when the tears are used more frequently than four times a day. Sometimes thicker eye gels are prescribed for severe dry eye, in order to provide longer lasting lubrication. Dry eye ointments may be appropriate for people who need additional lubrication at night.

When artificial tears do not reduce the symptoms of dry eyes, other medication such as topical cyclosporin (Restasis) or topical steroids may be prescribed.

Restasis is used twice daily, and takes 6-12 weeks to have maximal effect. Studies have shown that long term use of Restasis can improve the amount or quantity of tears you make, as well as the quality of the tears. Restasis is a long term therapy for dry eyes.

Sometimes dry eyes can be associated with blepharitis or meibomitis (eyelid iritation). Your doctor may prescribe therapies for these problems in conjunction with dry eye treatment.

For severe dry eyes, a procedure can be done to block the system of canals (lacrimal system) that normally drain the tears away from the surface of the eye. This is the equivalent of putting a plug in the drain of the sink. Plastic punctal plugs are placed in any of the four punctae (openings that lead into the lacrimal system) to hold natural or artificial tears on the surface of the eye longer. If permanent closure of the lacrimal punctae is needed, then a surgical procedure to cauterize the punctae may be performed.

Dry eye may develop on its own, or it may result from other problems. Such problems include abnormalities of the eyelids or poor eyelid closure, general health problems or medications used to treat these problems, or environmental factors such as air conditioning, humidity and smoke.

The management of dry eye can vary significantly from patient to patient and we have more treatment choices than ever before. Consult your eye doctor to determine what treatment program will be the most appropriate for you.