Dry Eyes

By Dr. Charles McCormick III

Most people experience dry eyes from time to time, usually due to adverse environmental circumstances such as dust, pollution or wind. But there’s a big difference between occasionally dry eyes and a chronically dry ocular surface.

This is known as ocular surface disease, or OSD, and it has emerged as a developing specialty area of eye care. Some promising new treatments are being developed to help deal with it, improving upon the various eye drops that have long been used to address chronically dry eyes.

Chronically dry eyes usually present with eyes that are red, irritated and scratchy, and may produce variations in vision quality.

OSD is more common in older people, which adds a little more complexity to medical affairs. Sometimes medications seniors take for other ailments can negatively impact tear secretions. There’s also a certain degree of tissue vitality, which tends to degrade as we age, that has a lot to do with how the eye retains its moist, preserved.

One common cause of dry eyes is Meibomian gland dysfunction, or MGD, in which the glands that secrete moisture to the eyes become blocked. It’s highly associated with blepharitis, a kind of dandruff-like desiccation of the eyelid, which influences the amount of oils secreted to the eye. Impaired oil secretion can lead to reduced tear film integrity.

MGD is frequently treated with hot compresses to the eyes, accompanied by antiseptic eyelid swabbing to lower the level of germs and dust mites responsible for blepharitis. Tiny demodex dust mites, which inhabit the follicle at the base of the eyelashes, can get down into the glandular pores and cannibalize the oils secreted, robbing the patient of functional secretions that support the normal physiology of the ocular surface.

Tea tree olive derivatives are known to remedy demodex blepharitis. Ivermectin is an oral medication that fights parasites such as demodex dust mites.

Patients who develop MGD often have had some sort of other eye dysfunction going on for many decades, as much as 40 years, along with chronically dry eyes. OSD is not to be confused with a three-day bout of pink eye.

The treatment approach for chronically dry eyes utilizes a variety of supportive methods, from eye drops and compresses to oils that optimize the tear glands, and taking steps to protect the ocular surface from harmful conditions, such as wearing protective goggles against the wind and sun.

Other treatment options include punctal plugs, which prevent the drainage of sustaining tears from the eye, spectacle shields or wraparound glasses frames and autologous plasma eye drops, which are usually prepared by an apothecary pharmacy.

For acute cases there is the option of tarsorrhaphy, a surgical fusion of the upper and lower eyelid margins, shortening the palpebral fissure and reducing the exposure of the ocular surface.

The use of certain medicines, such as chronic antihistamines and antidepressants, are known to contribute to dry eyes. People who suffer from rheumatoid arthritis, fibromyalgia, multiple drug sensitivities, stem cell deficiency and depression are more prone to OSD. It’s also a hazard for people who work outdoors with high exposure to wind and sun.

Awareness and treatment opportunities for patients with OSD has been on the rise along with recent medical education trends. New procedures are coming out that show promise, including using warm, clarified butter or ghee in an eye bath.

Hot compresses, eye drops and light massage to the eyelid margins remain good starting points, but talk to your eye doctor if you are troubled by chronically dry eyes.

By Dr. Carissa M. Barina, Ophthalmologist

Do you suffer from teary, watery eyes? You may actually have dry eye, a common condition that can lead to serious problems if not treated.

What causes it? Well, the eye surface is normally bathed in tears that are produced continuously. Tear film insufficiency is a common cause of dry eye in which the eye does not make enough tears to nourish and maintain moisture of the eye surface. So the eye dries out.

This triggers nerve endings on the eye surface to send messages to the brain that more tears are needed. Then the Lacrimal gland, or tear gland, quickly floods the eye with watery tears. The eye overflows with these poor-quality tears, providing temporary relief, but the moisture is not completely restored to the eye surface.

Sound confusing? Think of a dry, dusty desert. When a downpour does finally come, the dry earth cannot absorb the moisture and the land floods.

Although tearing is not the only symptom of dry eye, the more pronounced the dryness, the more severe the symptoms. Other symptoms of dry eye include stinging, burning, scratchiness, blurred vision and eye infections.

So how do you know if you have dry eye? Dry eye is diagnosed during an eye exam. Typically, tests including a Shirmer test, and a Tear Osmolarity test, which measures the amount of tears your eyes produce and how concentrated the tears are. Additional testing may be necessary, including blood work to screen for underlying medical conditions that might cause dry eye — such hyperthyroidism or Sjogrens Syndrome.

Depending on the severity of the dryness, treatment options include replacement tears or artificial tears; Restasis™, a prescription eye drop that stimulates your own tear production; or punctual plugs that keep what little tears your eye does produce on the eye surface longer.

Although dry eye is treatable, it currently is not curable. So interval follow-up appointments with your eye doctor are necessary to monitor your response to therapy and tailor your treatment regimen to your specific needs.

If you are experiencing any symptoms of dry eye described above, please contact us to schedule an appointment.