Dry Eyes

Dry eyes can be a very uncomfortable condition which may be temporary or long term. Dry eyes can cause pain, visual blurring, burning, foreign body sensation, irritation, light sensitivity and redness The discomfort is related to the breakdown of the ocular surface and varies from mild to severe.

The cause of dry eyes may be due to environmental factors (low humidity, wind/fans, air conditioning, contact lenses,) related to medical conditions (Sjogrens’ syndrome, drugs, pemphigoid, vitamin A deficiency) or from anatomic dysfunction (incomplete blink, eyelid scarring, paralysis abnormal tear film.)

The drugs which aggravate dry eyes include the following: Weight loss products (Dexatirm, Accutrim) Cough preparations (Benylin cough Syrup, Triaminic DM Liquid, Novahistine DMX Syrup) cold Preparations (Dimetapp Elixir, Alka-Seltzer Plus Cold, Contac Cold formulas, Antihpyertensives (Minipress, Catapres) Diuretics (Lasix, Bumex, Diuril) Antipsychotics (Mellaril, Thorazine) Antiparkinson Agents (Cognetin, Artane), Sedatives (Dalmane, Valium, Halcion), Caffeine and Nicotine.

Dry eyes are frequently a chronic disorder that can be controlled but rarely “cured.” Dry eyes can be associated with dry mouth and arthritis, known as Sjogrens syndrome. There are five levels of treatment for dry eyes; environmental factors, lubricants, punctal occlusion, medications, and surgery.

Environmental Factors for Dry Eyes
There are many issues associated with your local environment that can make dry eyes worse. For example; smoking, air conditioning, dust, air pollutants, allergens, ceiling fans or car vents can create dry eye issues even among people without an underlying dry eye problem. Many times these situations can be improved with simple avoidance, home or room humidifiers, and barriers like contact lenses, sunglasses, or wind protective goggles; such as those used by the military in Iraq, or for motorcycle riding: See WileyX.com

Lubricants for Dry Eyes
Artificial tears are the mainstay for treating dry eyes. There are many different brands of artificial tears that may be purchased over the counter. Artificial tears frequently have the name “Tears,” such as, Tears Plus, Tears Naturale, Hypotears…etc. In addition, thicker artificial tear ointments or salves are available (Lacrilube, Refresh PM, Duolube).

The natural tear film has three layers; an oily top layer, a watery middle layer, and a mucous deep layer. It may help to try artificial tears from each category designed to replace individual tear layers to discover which one works best for you.

  • Oily layer tears: Bion tears, Soothe, Refresh Endura
  • Watery layer tears: Hypotears, Refresh, Genteal
  • Mucous layer tears: Celluvisc, Systane, Ultratears

The goal in treating dry eyes is to keep your eyes comfortable all of the time. The biggest mistake is failure to use the drops enough.

You may require using drops frequently (up to every hour during the day) to keep your eyes comfortable. If hourly drops become a burden or are unsuccessful, you should use ointment. The ointment last much longer but blurs your vision. Therefore, you can either use ointment at bedtime, or you can use ointment during the day by alternating eyes. In this manner, you will have one eye for vision and the other eye protected with ointment. A simple way to gauge how much ointment you are using is to place a ribbon of ointment on a Q-tip before rolling it in between the lower eyelid and eyeball. In this manner, you will know exactly how much you put in and be able adjust this amount depending upon your response. For example, if you place too much ointment in your eye, you may wake up with blurry vision. In that case use a little less the next night.

If you require frequent use of artificial tears and ointment (more than four times per day) we recommend that you use preservative free preparations (Celluvisc, Refresh PM, Hypotears ointment…etc.) This will prevent the development of allergic reactions to the preservatives.

Punctal Occlusion for Dry Eyes
When lubricants are not enough, you can increase the available tears in your eyes with punctal occlusion. When you place a stopper in a sink it keeps water in the sink, and punctal occlusion works the same way. Plugs allow you to keep your natural tears and any artificial tears in your eye longer.

There are two tear ducts that drain tears away from your eye located along the nasal upper and lower eyelids. There are various methods to occlude the tear ducts, both temporary and permanent. It is best to begin with temporary or reversible methods to determine your needs; i.e. occlusion of the lowers, uppers or all four puncta. When necessary, the tear ducts can be permanently occluded with minor surgery, usually done in the office. While surgery can reverse permanent punctal occlusion, it is better to be sure you do not develop spillover tearing with temporary occlusion before you commit to permanent occlusion.

Medications for Dry Eyes
Restasis® is an anti-inflammatory medication (cyclosporine) that can help produce a better quality of tears in patients with chronic dry eyes. Restasis® can reduce the inflammation of the ocular surface that may interfere with producing a normal tear layer. It is typically used twice daily and may take up to two months for the full effect to become apparent.

Topical steroids may be necessary for more significant inflammations causing dry eye symptoms. However, steroids are best used for short-term control of ocular surface inflammation and should be closely monitored by an ophthalmologist to avoid complications like glaucoma, cataract, or infections.

Mucolytic drops can be custom formulated to decrease the thickness of tears when excess mucous production is an issue.

Serum tears can be custom formulated from components within your own blood which have been found to be helpful to stabilize the surface of the eye in cases of severe dry eye. Serum tears are custom blended by a pharmacy using your own blood serum mixed with artificial tears.

Omega-3 fatty acid dietary supplements have been reported as helpful in treating dry eyes, but their use has not been fully studied.

Antibiotics may be helpful to treat local eyelid infections that can make dry eye symptoms worse.

Surgery for Dry Eyes
When necessary, surgery can be performed to improve eyelid function and reduce the exposure of the eyeball. Surgery can improve the quality of the ocular surface by improving each blink, maximizing eyelid efficiency moving the tears across the eyeball, accelerating tear drainage, and allowing the available tears to work on a smaller area. The type of surgery may include raising the lower eyelid, lowering the upper eyelid or making the eyelid fissure smaller by narrowing the inside and outside corners. In selected cases, the lining of the ocular surface may be improved by grafting stem cells from the opposite eye for unilateral dry eye problems, and grafting amniotic membrane, or from the mouth for more extensive and bilateral dry eye issues.