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Dry Eye

What is dry eye syndrome?

Dry Eye Chart Dry eye syndrome results from a decrease in the amount or quality of the eyes’ natural tears. The discomfort and blurred vision associated with Dry Eye can impact significantly upon quality of life. More common in women than in men, it may be worse during the winter when the wind blows cold air and when heating systems pump dry air.

Dry spots on the eye develop as the tear film evaporates in between blinks, causing intermittent blurring and irritation that often feels like an itch or burn, or like sand or gravel inside the eyes. During times of emotional stress or irritation, our eyes produce a different tear. This water-like tear flushes out irritants in the eye, but has a very limited lubricating ability. It is a natural reflex for the eye to produce this watery tear when it detects irritation from dryness, and this is the reason why dry eyes are watery

Our tears, produced by glands found in and around our eyelids, are made up of different layered components. The main water-like layer keeps the surface of the eye moist; a second layer of mucus helps the water layer stabilize and adhere to the eye; and the third layer is oily, preventing the water layer from evaporating. This unique tear formula, comforts and protects our eyes with moisture and lubrication throughout the day and night.


What is the cause of dry eyes?

Whilst there are several causes, typically a combination of problems occur to result in dry eye. Systemic medical conditions associated with dry eyes are the collagen-vascular diseases such as Sjogren’s disease, lupus, and rheumatoid arthritis. Many medications including antihistamines, oral contraceptives or hormone replacement therapy, and beta-blockers may contribute as well.

Environmental factors such as heat, wind, smoke, and low humidity also play a role in the development of symptoms. Often, specific activities contribute to dry eyes, for example prolonged computer use, reading, or driving, as we blink less frequently during these tasks. As a result, fewer tears get delivered to all areas of the eye.

Another common factor leading to dry eye is Meibomian Gland Dysfunction (MGD), or Blepharitis. The meibomian glands are the tiny glands in the eyelids that produce the outer, oily layer of the tear film. In may people, as a result of skin type, these glands function poorly resulting in a poor quality tear film. Please see the section on Blepharitis and MGD for more information on this condition.


What is the management of dry eyes?

Given the variety of causes of dry eye syndrome, there is no single treatment or cure.. After addressing and modifying, if possible, known causative factors, then there are many steps that can be taken to reduce the symptoms and therefore the effect that this condition has on your lifestyle.

In most cases, dry eye may be effectively treated with over-the-counter artificial tear supplements. It is recommended to use these on a regular basis, according to your level of symptoms. Tear film supplements are available either preserved or unpreserved, and may be drops, gels, or ointments. Given the natural tear film refreshes every three seconds when we blink, quite frequent use is required to improve symptoms, not just once or twice a day. Dr. Beltz will advise you of the best tear film supplement and the best frequency of use for your eyes.

If Meibomian Gland Dysfunction is identified as the cause, more specific treatment is required to improve the overall quality of your natural tears (see section on Blepharitis and MGD). Oral supplements, particularly those containing Omega-3 fatty acids and flaxseed oil (eg theratears nutrition) may be recommended in order to improve the quality of your natural tears.

Cases resistant to the above treatments may require punctal plugs, tiny devices to prevent the tears from draining away so quickly. They are effective in holding more natural tears against the surface of the eye. Combining plugs with artificial tears will achieve maximum comfort.

In the more severe cases, courses of anti-inflammatory drops, such as corticosteroid preparations or cyclosporine preparations may be required. Extreme circumstances may necessitate serum tears, special lubricating drops that are made from your own blood products.

Dr. Beltz will help you to find the best regimen for your particular eyes, and teach you how to manage this condition.