The name “dry eye” can be a little confusing since one of the most common symptoms is excessive watering! It makes more sense, though, when you learn that the eye makes two different types of tears.
The first type, called lubricating tears, is produced slowly and steadily throughout the day. Lubricating tears contain a precise balance of mucous, water, oil, nutrient proteins, and antibodies that nourish and protect the front surface of the eye.
The second type of tear, called a reflex tear, does not have much lubricating value. Reflex tears serve as a kind of emergency response to flood the eye when it is suddenly irritated or injured. Reflex tears might occur when you get something in your eye, when you’re cutting onions, when you’re around smoke, or when you accidentally scratch your eye. The reflex tears gush out in such large quantities that the tear drainage system can’t handle them all and they spill out onto your cheek. Still another cause of reflex tearing is irritation of the eye from lack of lubricating tears. If your eye is not producing enough lubricating tears, you have dry eye.
Symptoms of dry eye:
- Watery eyes
- The feeling that there’s sand in your eyes
- Eyes that itch and burn
- Vision that becomes blurred after periods of reading, watching TV, or using a computer
- Red, irritated eyes that produce a mucus discharge
Causes of dry eye:
- Age: As we get older, glands in the eyelid produce less oil. Oil keeps tears from evaporating off the eye. Decreased oil production allows tears to evaporate too quickly, leaving the eye too dry.
- Diseases including diabetes, Sjogren’s and Parkinson’s
- Hormonal changes, especially after menopause
- Prescription medications: These include some high blood pressure medications, antihistamines, diuretics, antidepressants, anti-anxiety pills, sleeping pills and pain medications. Over-the-counter medications including some cold and allergy products, motion sickness remedies, and sleep aids can also cause dry eye.
- Hot dry or windy conditions: High altitude, air-conditioning and smoke can also cause dry eye.
- Reading, using a computer or watching TV
- Contact lenses
- Eye surgery: Some types of eye surgery, including LASIK can aggravate dry eye.
- Inflammation: Recent research suggests that dry eye may be caused by inflammation due to an imbalance of “good” fats and “bad” fats.
Diagnosing dry eye:
Your eye doctor can check for dry eye by examining your eyes with magnifying instruments, measuring your rate of tear production and checking the amount of time it takes for tears to evaporate between blinks. The doctor can also check for pinpoint scratches on the front surface of the eye caused by dryness using special, colored eye drops call fluorescein or Rose Bengal.
Treatments for dry eye:
The most common treatment is use of artificial teardrops that help make up for the lack of natural lubricating tears. Artificial tear products come in liquid form, longer lasting gelform and long-lasting ointment form, which is most often recommended for nighttime use. Many different brands of artificial tears are available over-the-counter. Some contain preservatives and some do not. Unpreserved tears may be recommended for people whose eyes are sensitive to preservatives. Artificial tears can generally be used as often as needed, from a few times per day to every few minutes. You should follow the regimen your doctor recommends.
When infection, inflammation of the eyelids or clogged oil glands contribute to dry eye, special lid cleaning techniques or antibiotics may be recommended. It may also help to avoid hot, dry or windy environments or to humidify the air in your home or office.
Restasis is an exciting new treatment for Dry Eye Disease. Restasis drops help the eyes produce more tears by reducing inflammation, which is often a cause of dry eye. Unlike artificial tears, Restasis is the first drug proven to effectively treat a cause of Dry Eye Disease rather than only temporarily alleviate symptoms.
Punctal occlusion is a medical treatment for dry eye that may enable your eyes to make better and longer use of the few lubricating tears they do produce.
RESTASIS (cyclosporine ophthalmic emulsion) 0.05%
Restasis is an exciting new treatment for Dry Eye Disease, a painful and irritating condition. Restasis drops help the eyes produce more tears by reducing inflammation, which is often a cause of dry eye. Unlike artificial tears, Restasis is the first drug proven to effectively treat a cause of Dry Eye Disease rather than only temporarily alleviate symptoms.
Restasis is for those:
- whose tear production is suppressed due to inflammation caused by dry eye disease
- whose doctor has determined that Restasis is the appropriate treatment for their condition
If your doctor prescribes Restasis, you’ll probably use one drop in each eye every 12 hours. There is presently no cure for Dry Eye Disease; however, you will receive benefits from Restasis for as long as you continue its use. Restasis can be used with artificial tear products, but your need for these will most likely decrease as your eyes improve.
The most common side effect of Restasis is a temporary burning sensation. Patients with an active eye infection or those who have allergies to any of the ingredients should not use Restasis. Keep in mind that Restasis is a treatment, not a cure. There is presently no cure for Dry Eye Disease.
If you and your doctor decide that Restasis is an option for you, you will be given additional information about the treatment that will allow you to make an informed decision about whether to proceed.
Xiidra is a prescription medicated eye drop used to treat the symptoms of dry eyes. It works by decreasing inflammation on the surface of the eye, which results in improved tear chemistry and ocular comfort. The drops are used twice a day.
The drops are generally well tolerated with no serious side effects, though some patients report the, after placing the drops in the eyes, they temporarily notice a bad taste at the back of the tongue. This can be minimized by brushing the teeth after placing the drops in the eyes.
One way to alleviate dry eye is to help the eyes to make better and longer use of the small amount of lubricating tears they do produce. This is accomplished by closing off the small funnel-like drain hole found in the inner corner of the upper and lower eyelids. These drain holes, called punctums can be closed with tiny plugs called punctal plugs. The plugs can be placed in the two tear ducts, top and bottom, in both eyes or in only the lower ducts. The punctum can also be permanently closed with a heat or laser procedure.
Punctal plugs can be temporary or permanent. Temporary plugs dissolve a few days after insertion. If your dry eye symptoms disappear when the temporary plugs are inserted, your doctor may consider permanent punctal occlusion.
Punctal occlusion is for those:
- who have been diagnosed with dry eye
- whose doctor has determined that punctal occlusion is the appropriate treatment for their condition
What to expect on procedure day
Your treatment will be performed in an examination room. It does not require a surgery center. Once you have been checked in and settled comfortably, drops will be used to numb your eye; no injections or needles are used.
Your doctor will pull your eyelid up and ask you to look toward the outside of your head, away from your nose. Using a forceps-like applicator, the plug will be placed into the corner of your eye, then released. An applicator or another tool will then be used to gently push the plug into your natural punctal opening and you’ll be asked to blink. Once the plugs get wet, they will expand to completely fill the opening. The entire procedure takes only a few minutes. Many patients report immediate relief from dry eye symptoms and resume normal activities immediately.
Punctal Occlusion Risks
Serious complications with punctal occlusion are extremely rare, but like any medical procedure, it does have some risks. If you experience side effects, your doctor can remove the plugs. Going to a specialist experienced in punctal occlusion can significantly minimize risks.
If you and your doctor decide that punctal occlusion is an option for you, you will be given additional information about the procedure that will allow you to make an informed decision about whether to proceed.
Intense Pulsed Light (IPL)
Intense Pulsed Light(IPL) is a technology that has traditionally been used for improving the skin tone in areas with pigmented spots or unsightly blood vessels on the surface of the skin. More recently, it has been demonstrated to be an effective treatment for dry eyes. The treatment is performed in the clinic, and needs only a few minutes. With shields placed over the eyes, the IPL handpick applies light energy to the skin along the upper cheeks. In research studies, this treatment has been demonstrated to result in decreased inflammatory signaling on the surface of the eyes and improved dry eye symptoms.
Most patients need three IPL treatments, spaced out several weeks apart. Re-treatments may be needed if symptoms return. The treatment is very safe, but patients must be carefully selected by their physician to increase the chances of success and to minimize potential see effects such as undesired skin tone changes or cold sore break-outs.
Schedule a Consultation
If you are suffering from dry eye and would like to learn more about treatment options, call 800-244-9907 to make an appointment at Central Valley Eye Medical Group.