Dry Eye Syndrome can have a significant impact on daily activities and quality of life. In this article, we’ll take an in-depth look at this afflictive eye condition and provide a plan for relief for those suffering from dry eye syndrome.
What is dry eye syndrome?
Dry eye syndrome (DES) is a condition that occurs when the eyes do not produce enough tears, the tears are not of the correct consistency, or when they evaporate too quickly.
Dry Eye Syndrome is a common problem, in fact, it’s the most common eye disease in the U.S., affecting between 25 and 30 million Americans. In southern states, like here in Tampa, Florida, where the air conditioning is running most the year, it is common to see patients with DES aggravated by tear film evaporation due to the cold dry air blowing from AC vents.
Dry eye syndrome is more common in women than men, especially women older than fifty. The prevalence also increases in people with certain underlying medical conditions like Sjogren’s Syndrome, rheumatoid arthritis and other autoimmune disorders.
Dry Eye Syndrome symptoms
Symptoms of DES can vary from person to person and range from mild to severe. DES can cause significant discomfort and can lead to vision problems if left untreated. You should see your doctor if you experience these symptoms of dry eyes for several days in a row or if your symptoms seem to get worse over time:
The main symptom of dry eye syndrome is a feeling of dryness in your eyes. Other common symptoms include:
- Itchy or irritated eyes
- Burning
- Grittiness
- A sensation that something is in your eye
- Sensitivity to light
- Redness (in the eye or around the eyelids)
- Watering
Causes of dry eye syndrome
Dry eye syndrome is caused by a number of factors. The overlying reason for DES is a deficiency in the tear film, which can be caused by genetics, aging, allergies and environmental factors like wind or dust. Tears are necessary to lubricate and protect the eyes, without them, the eyes can become irritated, red, and inflamed. The most common cause of dry eye disease is age-related tear production.
There are many other causes of dry eye syndrome. Some of the most common are:
- Certain medical conditions, such as earlier-mentioned rheumatoid arthritis or Sjogren’s syndrome, diabetes.
- Medications (such as antihistamines for allergies, antidepressants, blood pressure drugs, hormone replacements, ulcer drugs, decongestants, birth control pills)
- Environmental factors (pollution, wind, dust, air conditioning and heating systems)
- Injury to the eye or eyelids
- Problems with blinking
- Contact lens use (especially extended wear lenses)
- Eye surgery
Types of Dry Eye Syndrome
- Keratoconjunctivitis sicca (KCS): This is also known as “dry eye” or “keratoconjunctivitis sicca” (KCS). It is a chronic condition characterized by insufficient tear production and excessive evaporation of tears from the surface of the eyes due to impairment in their tear-producing glands.
- Sjögren’s syndrome: It is an autoimmune disease that causes inflammation throughout your body including your eyes.
- Contact lens intolerance: Contact lens intolerance occurs when you have difficulty wearing contact lenses because they make your eyes feel irritated or painful.
- Atopic keratoconjunctivitis: Atopic keratoconjunctivitis (AKC) is a type of chronic dry eye that occurs as a result of sensitivity to allergens such as dust mites, pet dander.
More about tears
As we mentioned earlier, tears are necessary to keep the surface of the eye moistened and protected, so when there are not enough tears in the eye, or they are not the proper viscosity, the eye can become inflamed and irritated. This can lead to blurred vision and even blindness if left untreated.
How are tears produced?
Tears are produced by three different glands in your eyelids: the meibomian glands, the lacrimal gland, and the accessory lacrimal gland. The first two of these glands produce oil that mixes with water and mucus to create tears. The third type of gland produces only watery tears.
Quick Tip from Dr. Berger
Tearing is a common symptom of dry eye that many patients don’t understand. I like to compare the eye to a sink. The sink faucet has two settings. One setting is called the basal tear rate. That’s the steady drip-drip of the sink keeping it moist. If the sink dries out because the basal tear rate is reduced or there’s dirt or coffee grounds in the sink, the faucet flips on full blast to wet the sink or wash away the sink debris. That reflex tear results in tears running down the face.
There are three ways to keep the sink moist. Dump water in the sink (artificial tears), help the faucet increase its basal tear rate ( Restasis, Ceequa, Xiidra & Tyrvaya) or block the drain (punctal plug or punctal cauterization).
The Tear Film
The tear film is made up of three mixed layers: a lipid layer, a mucin layer, and an aqueous layer. The lipid layer produced by the meibomian glands helps prevent evaporation of the tear film into the air. the mucin layer produced by conjunctival goblets cells provides a protective barrier to prevent bacteria and viruses from binding, and provides added lubrication. The aqueous layer produced by the lacrimal and the accessory lacrimal glands prevents excessive evaporation by keeping the surface of the eye wet and helps distribute oxygen to the cornea (the clear, outermost layer of the eye).
Dry Eye Diagnosis
Dr. Berger will diagnose dry eye syndrome by asking questions about your symptoms and medical history, conducting a physical exam, and performing additional tests. He will also ask you to describe any other symptoms you’re experiencing, such as blurred vision, sensitivity to light, or other eye problems.
The physical exam will involve looking into your eyes with a special eye microscope, called a slit lamp, to see if there are any abnormalities in the surface of your cornea, iris, or eyelids. Dr. Berger will also check for the presence of inflammation. If he suspects that you have dry eye syndrome, he will order additional tests to confirm his suspicions. These tests can include:
- Schirmer’s test – a quick and simple office test that determines whether the eye produces enough tears to keep it moist.
- Tear Lab – another office test that takes a sample of the pooling tears in the lower eyelid and measures for tear film osmolarity.
- Slit lamp exam – as mentioned earlier, the slit lamp microscope is the most common and helpful tool to the eye doctor. Many observations of the eyelids, cornea and tear film can be made using this indispensable tool.
- Corneal staining – this is a common practice that utilizes fluorescein and a cobalt blue filter to look for dry patches on the corneal surface, and tear break-up time.
Treatments for dry eye syndrome
The standard treatment for dry eye syndrome is artificial tears (lubricants) eye drops and gels, which can be applied often throughout the day. If this does not work, Dr. Berger may prescribe immunomodulators medications like Restasis, Ceequa or Xiidra.
- Tyrvaya – Dr. Berger has found the new Tyrvaya nasal spray to be very effective. Tyrvaya is a prescription drug sprayed into the nostril and is used to treat the signs and symptoms of dry eye disease.
- Tear Care – is a device recommended for patients who have dry eyes as a result of Meibomian Gland Dysfunction (MGD). MGD is blockage or some form of dysfunction of the tear layer’s oil-producing meibomian glands. The device provides a mild heat treatment to the area of the eyelids where the meibomian glands are located.
- Autologous serum eye drops – are customized drops made from a patient’s own blood. This treatment is usually reserved only for cases of severe dry eyes.
- Oral Ivermectin – used for severe, dry-eye-causing blepharitis (inflammation of the eyelids). Ivermectin is a medication that fights parasites such as demodex dust mites seen in blepharitis.
Dry Eye Syndrome prevention
- Stop smoking and avoid smoke.
- Position your computer screen below eye level and remember to blink regularly while using.
- Use artificial tears regularly.
- Avoid air blowing in your eyes.
- Add moisture to the air.
- Wear wraparound sunglasses.
- Avoid becoming dehydrated.
- Take eye breaks while using your computer or reading for long periods of time.
Side note:
For years, many eye doctors recommended diluted baby shampoo eyelid scrubs to treat and prevent blepharitis – which can cause dry eye syndrome. Though this can be temporarily effective, Dr. Berger cautions against it because there are no antiseptic properties in the treatment. Eyelids can become dried out, exacerbating the problems. Also, warm washcloth compresses technically makes sense, however, it is not possible for the wet washcloth to stay warm enough to be effective.
Dry eye syndrome is a common problem that can cause a lot of discomfort. This article looked at the causes of dry eye syndrome and some of the best ways to treat it. If you are suffering from dry eye syndrome, be sure to like and follow our page for more information and treatment options.
Dr. Berger and Bay Area Eye Institute
Craig Berger, MD opened the Bay Area Eye Institute in Tampa, Florida in 2007, specializing in the treatment of dry eye disease, corneal conditions, cataract and cornea transplant surgery.
Along with Dr. Berger, Doctors Gamell and Kerris, treat and manage a large spectrum of eye conditions and diseases at Bay Area Eye Institute. They accept most health insurances and will accommodate quick new-patient appointments.
The practice focuses on patient satisfaction. Their philosophy is to put the patient first, provide physical and emotional comfort, and strive for the highest care possible. Your time and comfort are paramount. They feel that patient education is an important aspect of treatment and will take the time to explain ocular conditions and treatment plans.
At Bay Area Eye Institute, they offer the most modern and complete care for dry eye disease. Their office employs state-of-the-art technology and careful testing is conducted to tailor the treatment of your dry eyes. They also utilize the most modern surgical techniques and technology for cataract, cornea transplantation, and glaucoma and eyelid surgery along with the latest astigmatic and presbyopia correcting intraocular lenses.
Bay Area Eye Institute is conveniently located in north Tampa and is easy to get to from all Tampa Bay area counties. They are open 8:00 a.m. to 5:00 p.m. on Monday-Thursday and 1:00 to 5:00 on Friday. Call them today and ask about setting up a dry eye evaluation with Dr. Berger.
