Dry Eyes (Tear Film Instability)

WHAT IS DRY EYE?    Dry eye or dysfunctional tear syndrome, is a very common eye problem.  “Dry eye” is the result of not being able to produce adequate quality tears (hyperosmolarity) to keep the eye comfortable. Without a good quality tear film,   (spread over the eye by a blink), good vision is not possible.  The symptoms of dry eye include  stinging or burning eyes, scratchiness, stringy mucus around the eyes,  increased irritation from smoke/reading / driving / using the computer, or difficulty wearing   contact lenses. It is not uncommon  for patients with dry eye to TEAR EXCESSIVELY, especially when they walk outside.  The quality of the tears is as important as the quantity of tears.

Causes  Tear production normally decreases   as we age. Although dry eye can occur in men and women, it is more common in   women, particularly after menopause. Dry eye can also be associated with   rheumatoid arthritis & dry mouth, as well as a variety of over-the-counter and   prescription medications.   Diuretics   (water pills), antihistamines, sleeping pills, medications to calm “nerves”,   and some pain relievers may make dry eyes worse.  Hyperosmolarity is thought to be a key factor in patients with dry eye.

 

Diagnosis and treatment  Ophthalmologists use a slit lamp microscope to examine the tear film, which is usually irregular in patients with dry eye.  When the diagnosis is in   question, measurement of the tear production with a filter paper strip may be   performed.

Over-the-counter eye drops and ointments (available without a prescription), called artificial tears or lubricating ointment can be used to moisten the eyes. Examples include liposic, refresh ultra, systane, lacrilube, teargel etc.. and are available at your local pharmacy.

Preservative-free drops in small packets are   also available. You can use the preservative free  tears as often as necessary, from four times  per day to several times per hour. 

In   some patients that tear excessively, ocular lubricants may help stabilize the   tear film, and actually decrease the amount of tearing.  Solid inserts (Lacriserts) placed in the lower lid space, gradually   release lubricants may also be beneficial to some people.

If there is ocular inflammation topical cyclosporine drops (Restasis) sometimes help. 

Flax seed oil, salmon, mackerel, or other omega 3 foods may help some patients.  If you have a very dry eye and a very dry   mouth, you may want to consider oral medications such as Salagen.

Warm compresses over the closed eyelids may help patients who have plugged oil glands (meibomian glands).  

Another   approach is to conserve the tears you do produce. Tears drain out of the eye through a small opening in the eyelid called the punctum. The punctum can be closed off the punctum if required. 

Wearing glasses as an air current barrier may help.  Many devices can be found at the website www.dryeypain.com

Moisture chambers are available.  A small tegaderm patch, or small piece of saran wrap taped to forehead (avoiding the nose) can be used at night.  There are commercially available Lagophthalmos Kit goggles 

 

Like  any other liquid, tears evaporate. To decrease evaporation use a humidifier.  Even a pan of water on the radiator may help. Try to decrease ocular irrtation from wind, tobacco, overly warm rooms and hair dryers. 

Eyelid surgery  to partially close the outer eyelids (tarsorraphy) may help.

If you have troubles blinking an upper lid load weight can be taped on or placed permanently under the skin.

Non-OHIP treatments that act like warm compresses include:  1) Intense pulsed light acts like a warm compress in some patients.  2)  According to the manufacturer The LipiFlow® thermal pulsed light system applies a “combination of localized heat and pressure therapy to the blocked meibomian glands in the eyelid, during a 12 minute in-office procedure applied to the inner eyelid.”  One of the eye centres in Toronto offering LipiFlow is Herzig Eye.

**** Dr. Ing has NO financial interests in any of the products mentioned above.*****