DRY EYES

Aqueous tear-deficient dry eye is a disorder in which the lacrimal glands fail to produce enough of the watery component of tears to maintain a healthy eye surface.

Evaporative dry eye may result from inflammation of the meibomian glands, also located in the eyelids. These glands make the lipid or oily part of tears that slows evaporation and keeps the tears stable.

Dry eye can be associated with:

• Inflammation of the surface of the eye, the lacrimal gland, or the conjunctiva
• Any disease process that alters the components of the tears
• An increase in the surface of the eye, as in thyroid disease when the eye protrudes forward
• Cosmetic surgery, if the eyelids are opened too widely

Dry eye symptoms may include any of the following:

• stinging or burning of the eye
• a sandy or gritty feeling as if something is in the eye
• episodes of excess tears following very dry eye periods
• a stringy discharge from the eye
• pain and redness of the eye
• episodes of blurred vision
• heavy eyelids
• inability to cry when emotionally stressed
• uncomfortable contact lenses
• decreased tolerance of reading, working on the computer, or any activity that requires sustained visual attention
• eye fatigue

If symptoms of dry eye persist, consult an eye care professional to get an accurate diagnosis of the condition and begin treatment to avoid permanent damage.

DIAGNOSIS

Tests and procedures that may be used to determine the cause of your dry eyes include:

• A comprehensive eye exam. An eye exam that includes a complete history of your overall health and your eye health can help your doctor diagnose the cause of your dry eyes.
• Measuring the volume of your tears. Your doctor may measure your tear production using the Schirmer test. In this test, blotting strips of paper are placed under your lower eyelids. After five minutes your doctor measures the amount of strip soaked by your tears.
• Determining the quality of your tears. Other tests use special dyes in eyedrops to determine the surface condition of your eyes. Your doctor looks for staining patterns on the corneas and measures how long it takes before your tears evaporate.

RECOMMENDED MEDICATIONS

Prescription medications used to treat dry eyes include:

• Drugs to reduce eyelid inflammation. Inflammation along the edge of your eyelids can keep oil glands from secreting oil into your tears. Your doctor may recommend antibiotics to reduce inflammation. Antibiotics for dry eyes are usually taken by mouth, though some are used as eyedrops or ointments.
• Eyedrops to control cornea inflammation. Inflammation on the surface of your eyes (cornea) may be controlled with prescription eyedrops that contain the immune-suppressing medication cyclosporine (Restasis) or corticosteroids. Corticosteroids are not ideal for long-term use due to possible side effects.
• Eye inserts that work like artificial tears. If you have moderate to severe dry eye symptoms and artificial tears don’t help, another option may be a tiny eye insert that looks like a clear grain of rice. Once a day, you place the hydroxypropyl cellulose (Lacrisert) insert between your lower eyelid and your eyeball. The insert dissolves slowly, releasing a substance that’s used in eyedrops to lubricate your eye.
• Tear-stimulating drugs. Drugs called cholinergics (pilocarpine, cevimeline) help increase tear production. These drugs are available as pills, gel or eyedrops. Possible side effects include sweating.
• Eyedrops made from your own blood. These are called autologous blood serum drops. They may be an option if you have severe dry eye symptoms that don’t respond to any other treatment. To make these eyedrops, a sample of your blood is processed to remove the red blood cells and then mixed with a salt.