When most people experience dry eyes or have dry eye problems they mainly think about the common symptoms that cause discomfort such as dryness, grittiness or burning and do not even realize that in order to have normal vision, it is critical to have a sufficient quantity of healthy tears on the surface of the eye at all times.
Dry Eye is a condition in which there is a deficiency of the tear film that is due to either an insufficient production of natural tears or an excessive evaporation of tears. Systemic conditions such as Sjorgren’s Syndrome or autoimmune connective tissue diseases such as Rheumatoid Arthritis and Lupus Erythematosus, inflammation of the Lacrimal Gland, long term contact lens wear, past eye infections, medications such as antihistamines or allergy medicine, blood pressure medicine, certain allergies and even vitamin deficiencies may decrease the quantity of tears that you produce. Your tears may evaporate too quickly if you suffer from low-grade eyelid inflammation, called blepharitis, which is often caused by Meibomian Gland Dysfunction (MGD), a problem within the tiny tubular glands in your eyelids. Hormonal changes make perimenopausal woman particularly susceptible to dry eyes. Whether you suffer from insufficient production of tears or excessive evaporation of tears, or both, you may experience a decrease in the quantity and quality of your tear film resulting in the surface of the eye being affected.
Diagnosis of dry eye problems requires a careful eye exam. We will thoroughly review your medical history, eye history and eye conditions including any medications that you are taking. Please be sure to tell us about all of the medications you take or have taken recently, including not only the ones prescribed, but those that you may have purchased on your own at the pharmacy. We will use a microscopic technique to observe the height of the tear film as well a clinical test called a Schirmer Test along with specially formulated dyes such as Fluorescein, Lissamine and Rose Bengal to help investigate the functioning of the various layers of the tear film as well as the underlying surface of the eye. This is not uncomfortable and will not interfere with your vision.
Based on our findings we will be able to make a proper diagnosis as to the particular cause of your dry eye syndrome and prescribe the necessary tear substitutes, prescription medications such as Restasis® or Xiidra® eye drops and/or other options to help restore your tear film back to normal and make you more comfortable. If you have mild or even moderate dry eyes, the first course of treatment may be to use specific types of artificial tears that have different characteristics in terms of salt content and viscosity. There may some environmental factors that you need to alter to make you more comfortable such as how and where you are exposed to heat ducts or fans blowing as well as attempting to keep the areas that you spend a great deal of time in at a proper humidity level. Sometimes, if the oily layer of the tear film is deficient, we may suggest that you increase your consumption of oily fish or even take flax seed oil as a dietary supplement or other diet supplements. Most likely you will be asked to drink plenty of water. In instances where these approaches do not help relieve your dry eye symptoms, we may suggest the insertion of tiny punctual plugs that will slow down or even stop the drainage of tears from the eye. These plugs are easily and comfortably placed in the Lacrimal Puncta in your eyelids. Initially you may have a temporary dissolving plug put 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 to affect a long-term solution. For patients with moderate to severe dry eyes we may prescribe Restasis® or Xiidra® eye drops with or without some of the other treatments to help alleviate your dry eye symptoms. If we find an underlying low-grade inflammatory or infectious process it may be necessary to also prescribe an oral antibiotic such as a tetracycline and/or an anti-inflammatory eye drop such as a corticosteroid eye drop. As you can see, the diagnosis and treatment of dry eyes is complex and requires patience and persistence on the part of the doctor and the patient. With careful diagnosis and a systematic therapeutic approach, we can usually help dry eye sufferers.