About Dry Eyes

Dry Eyes or Dry Eye Syndrome is an extremely common eye problem thought to affect some 60 million people in the United States. When we think about having dry eyes, we typically think about the symptoms of dryness, redness, burning, grittiness and the discomfort that they create. However, many people do not realize that in order to have clear and consistent vision, it is necessary to have a normal and healthy tear film of sufficient quality and quantity on the eye’s surface at all times. Without a healthy stable tear film, not only will you suffer the symptoms of dry eyes, but you will likely experience visual symptoms as well.

Dry Eye is an eye problem caused by a deficiency of the tear film from not producing enough of one’s own natural tears or an excessive evaporation of tears. As a result of either of these problems or both of these problems there is a compromise of tear film quantity and quality.

Understanding the Tear Film

The tear film is actually made up of three distinct layers. The innermost layer called the mucous layer which directly coats the eye and helps the tear film “stick” to the eye. The mucous layer is produced by Goblet cells in the conjunctiva or  “skin of the eye”. The middle layer, called the aqueous layer, is composed primarily of saline and elevctrolytes, and brings moisture and oxygen to the cornea. The Lacrimal Gland produces the aqueous layer, which is located under the outer portion of your upper eyelid. The outermost layer of the tear film is called the lipid layer, and it is responsible for preventing the tear film from evaporating. The tiny tubular glands in your eyelids  produce the lipid layer.  All three layers are critical to having and maintaining a normal tear film. If any of the three layers of the tear film are deficient you may suffer the symptoms of dry eyes.

Insufficient Tear Production

Insufficient tear production can occur as a result of a number of different conditions. Systemic conditions such as Sjorgren’s Syndrome and autoimmune connective tissue diseases such as Rheumatoid Arthritis and Lupus Erythematosis will often decrease the quantity of tears that you are able to produce due to the chronic inflammation associated with these diseases. Sometimes, patients with Sjorgren’s Syndrome will actually experience a “triad of symptoms” including dry eyes, dry mouth and arthritis all at once. Since the Lacrimal Gland produces normal healthy tears, any condition that causes inflammation of the Lacrimal Gland may also cause patients to have a reduced quantity of the aqueous layer of the tear film resulting in an inability to maintain a normal and stable tear film. Some conditions that can cause Lacrimal Gland inflammation may include contact lens wear, eye infections, allergies and even some vitamin deficiencies.

Excessive Evaporation of Tears

There are many factors that can cause your tears to evaporate too quickly, again producing the symptoms of dry eyes. These include environmental factors such as being exposed to forced hot air heat at home or at work, dry climates in general, air travel, reduced blinking from contact lens wear or from looking at a computer screen or reading for long periods of time, air pollution or even just blowing your hair dry.

Tears may evaporate too quickly even if you suffer from minor low-grade eyelid inflammation. Your eyelids contain the small tubular glands called Meibomian Glands. Even minor inflammation of the eyelids, called blepharitis, or ocular rosacea can cause the Meibomian Glands to stop producing their oily film. This oily film is required as an outer layer of the tear film to prevent evaporation. Without it, you will almost certainly experience quick evaporation of tears and dry eyes. This is especially noteworthy for perimenopausal women, as it is believed that 75% of women in this age group have some presence of facial rosacea. This along with the general hormonal changes occurring during this time, make perimenopausal woman particularly susceptible to dry eyes. In addition, your tear film may evaporate too quickly if the tears are not properly spread and replenished over the surface of the eye because of inadequate eyelid movement This may be due to improper or incomplete closure of your eyes during sleep, certain eye “bulging” conditions that may be related to thyroid problems, or a loss of tone or shape of the eyelids with age or as a result of trauma or inflammation, so that they turn in or turn out.

Diagnosis of Dry Eyes

In addition to being a Comprehensive Ophthalmologist, Dr. Brass is a Fellowship trained Corneal Specialist. By being a Corneal Specialist he brings special expertise and experience to patients in the areas of ocular surface disease and the diagnosis and treatment of dry eyes.

During your routine eye examination or during a dry eye consultation, Dr. Brass can evaluate your tear production by using a specialized microscopic technique to observe the height of the tear film. Dr. Brass may also perform a Schirmer Tear Test that can actually test your Lacrimal Gland and measure the rate at which you produce natural tears, by placing a piece of absorbent paper inside the lower eyelid for a brief period of time. He will use eye drops containing special dyes in order to help observe the functioning of the various layers of the tear film as well as the underlying surface of the eye.

Based on these observations and tests it will be possible for Dr. Brass to diagnose the specific deficiencies in the tear film that are causing your dry eyes. Depending on the diagnosis and the severity of the tear film deficiency he may prescribe specific artificial tears, lubricant eye drops, punctal plugs, Restasis eye drops and/or other measures to help restore your tear film back to normal and make you more comfortable. The specific treatment regimen that Dr. Brass will prescribe will really depend on the most likely cause and the severity of your dry eyes.

Treatment of Dry Eyes

For most patients with mild to moderate dry eyes the first course of treatment Dr. Brass may prescribe might be to use unpreserved or transiently preserved artificial tears or lubricant eye drops. Depending on the nature of your tear film deficiency, Dr. Brass may prescribe a specific type of artificial tear that has different characteristics in terms of salt content, viscosity or lubricity. It is important that you use only the eye drops that Dr. Brass prescribes and use them exactly as he directs. He may also ask you to modify certain environmental factors that may be contributing to the dry eyes if he believes that they are contributing to your dry eye symptoms.

If the oily layer of your tear film is deficient Dr. Brass may suggest that you increase your consumption of oily fish or even take flax seed oil as a dietary supplement. He will again make specific recommendations about dietary supplements if they are necessary. The amount of water you drink may also contribute to dry eyes and so you must drink plenty of water throughout the day.

If these treatment options do not adequately restore your tear film so that you are more comfortable, Dr. Brass may elect to insert tiny plugs in the lacrimal puncta, or drainage ducts located in the nasal area of your eyelid margin. These plugs, called punctal plugs, help to slow down or even stop the drainage of tears from the eye. Dr. Brass easily and comfortably places these plugs in the lacrimal puncta in the eyelids. Initially he may put a temporary dissolving plug in place to see if your dry eye symptoms are actually responsive to this treatment. If the results are good, it may be necessary to place a more permanent type of plug in the lacrimal puncta to affect a long-term solution.

Sometimes there are instances where you may not respond to the above sequence of treatment options because of some underlying low-grade inflammatory or infectious process. These include cases of rosacea and blepharitis. In these cases it may be necessary for Dr. Brass to also prescribe an oral antibiotic such as a tetracycline or an anti-inflammatory eye drop such as a corticosteroid eye drop.

If Dr. Brass finds that you suffer from moderate to severe dry eyes or have already been using artificial tears, lubricant eye drops and already have punctual plugs without relief, he may prescribe Restasis eye drops. Restasis is an advanced type of cyclosporine eye drop that acts by blocking a specific type of inflammatory cell from entering the Lacrimal Gland, which produces normal tears. By reducing or blocking inflammation in the Lacrimal Gland, it functions much more effectively so that you can actually make more of your own natural tears.

The diagnosis and successful treatment of dry eyes is complex. Dr. Brass is committed to providing you with a careful and thorough dry eye evaluation in order to find the best possible solution. With an accurate diagnosis and a systematic approach to treatment, Dr. Brass finds that dry eye sufferers can usually achieve a positive result. If you, a family member or a friend suffers from dry eyes, please schedule an appointment at Brass Eye by calling 518.782.7827 or e-mailing your request.