DRY EYE DISEASE is a very common problem that increases with age. The associated inflammation can cause serious damage to the eye as well as the common frustrating symptoms of redness, blurred vision, burning, light sensitivity, contact lens intolerance, mucous strands, and even excess tearing. Left untreated, the cornea can become scared and decrease vision. There is a decrease in vision and associated quality of life.
The tear film is a three layer film of a mucin base, liquid aqueous layer, and a lipid or oil outer layer.
For some, they simply don't produce enough aqueous. Inflammation, dehydration, some medications like antihistamines, hormone changes, autoimmune diseases like Sjogren's or RA, LASIK, poor contacts or improper use, and other factors influence aqueous production. Wind and fans cause faster evaporation also.
Others have poor lipid coverage. This leads to fast evaporation of the aqueous. It often allows the aqueous to drip out of the eye onto the cheek. The lipids are secreted from meibomian glands that are located behind the eye lashes. Blepharitis, a common inflammation effecting these glands can greatly effect tear coverage. Not blinking enough decreases lipid production and secretion. Prolonged meibomian gland blockage or lack of blinking can lead to permanent destruction of these glands.
Mucins are complex proteins of 10 or more varieties that help bind the aqueous layer to the cornea. Without them, tears do not adhere to the cornea and the eye dries out. We are still trying to understand what effects mucin production but it is thought that vitamin A deficiency and even preservatives from overused eye drops may decrease mucin production.
Treatment We favor a layered approach to treatment based on the root problem if the cause can be determined.
The tear film is a three layer film of a mucin base, liquid aqueous layer, and a lipid or oil outer layer.
For some, they simply don't produce enough aqueous. Inflammation, dehydration, some medications like antihistamines, hormone changes, autoimmune diseases like Sjogren's or RA, LASIK, poor contacts or improper use, and other factors influence aqueous production. Wind and fans cause faster evaporation also.
Others have poor lipid coverage. This leads to fast evaporation of the aqueous. It often allows the aqueous to drip out of the eye onto the cheek. The lipids are secreted from meibomian glands that are located behind the eye lashes. Blepharitis, a common inflammation effecting these glands can greatly effect tear coverage. Not blinking enough decreases lipid production and secretion. Prolonged meibomian gland blockage or lack of blinking can lead to permanent destruction of these glands.
Mucins are complex proteins of 10 or more varieties that help bind the aqueous layer to the cornea. Without them, tears do not adhere to the cornea and the eye dries out. We are still trying to understand what effects mucin production but it is thought that vitamin A deficiency and even preservatives from overused eye drops may decrease mucin production.
Treatment We favor a layered approach to treatment based on the root problem if the cause can be determined.
- First, avoid air blowing in the eyes, get good hydration, a proper diet, and be aware of medications that effect dry eye. Take breaks when on devices and blink often. Avoid smoking and second hand smoke.
- Second, if these things do not help, consider adding an artificial tear like Systane or Refresh. Use preservative free types if you use them often. Change to a more anti-inflammatory diet. Use a humidifier if the humidity is low in your room.
- Third, if you are making no progress, there may be treatments available from your eye doctor. Prescription dry eye drops to reduce inflammation like Restasis, Xiidra, and Cequa may be helpful. Punctal Plugs can be placed to reduce aqueous drainage. Amniotic Membranes can be inserted for certain corneal conditions. Blepharitis Treatment can be done with at home Blephadex, and in office Blephex and iLux.
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