DRY EYE SYNDROME or OCULAR SURFACE DISEASE
Ocular surface disease is the preferred name because many people with “dry eyes” have symptoms of tearing. Other symptoms include: burning, stinging, redness, irritation, blurred vision, inability to wear contacts comfortably, foreign body sensation, and in severe cases, corneal breakdown with scaring.
This condition is more common with advancing age but can occur in youth and in both sexes. The tear film actually consists of:
- a mucous coat on the eye secreted by cells in the conjunctiva
- lacrimal fluid excreted by the lacrimal gland
- an oil layer excreted by oil glands on the lid margins.
A defect in any or all of the above, results in ocular surface disease, and that is why some therapies may vary.
Causes can be aging, hormonal changes, auto-immune disease, medications, chemical or thermal ocular injuries, poor blinking, and other rare conditions or past infections.
Therapy usually starts with artificial tears used 4-6 times daily or as needed. Some people can develop or have sensitivity to the preservatives used to prevent contamination and that is why preservative free artificial tears are also available (these come in individual vials that can be separated and used once then thrown away). There are many over the counter artificial tears, gels, and ointments that which can be tried. If replacement tears are not effective, closing the outflow of tears in the nasal corner of the lids either by silicone plugs or surgical closure can be very effective. Some people who have an auto-immune component to their dry eyes have improvement in their symptoms after using Restasis, (which works by immuno-suppression) but it must be taken for at least two months before the result is appreciated and is usually continued long term.
A condition known as BLEPHARITIS, which is an inflammation or infection of the oil glands of the lid, can exacerbate symptoms and may need to be treated also. Usually that consists of lid hygiene, sometimes antibiotics, and hot and cold compresses.
If a local area of oil glands are occluded, and HORDEOLUM or CHALAZEON results which is a large swollen area on the eyelid margin that may form a white or yellow “head” on the outside or inside of the lid. These are commonly called styes. This can swell up quite quickly and turn red. In its early development, this condition responds well to hot compresses, or surgical removal may be indicated. In the chronic phase it feels like a round ball in the lid when felt by your fingertip.
Our physicians recommend the following treatment plan for their dry eye patients:
- Artificial Tears (Soothe, Refresh Tears, Optive, Blink) 4-6 x/Day.
- Regular Lid Hygiene -While in the shower, place a small amount of baby shampoo on a wet washrag. Wrap the washrag around your finger and while keeping your eyes closed gently rub the area of your lids where your eyelashes enter the lid for about 10 seconds each eye. This should be part of your daily routine while in the shower.
- Omega 3 Fatty Acid Supplements or Fish Oil Supplements- Please follow the dosage listed on the bottles of these supplements. These have been found to have anti-inflammatory properties (We now know that dry eye syndrome has an inflammatory component to it).
If the treatment plan above does not yield the appropriate results, our physicians may recommend the following:
- Silicone Punctal Plug Insertion- This is a quick in-office procedure performed by our physicians where a very small silicone plug is inserted into the tear duct of each eye to slow the drainage of the tears from the eye, therefore creating more tears on the surface of the eye.
- Restasis – This is a fairly new treatment option for our dry eye patients and has been one that has been shown to improve symptoms dramatically in many patients. Restasis is a prescription eye drop used 2x/day that has anti-inflammatory properties that allows your eye to actually make more tears. Improvement in symptoms is generally not seen until 8-12 weeks after initiation of treatment.
