What are dry eyes?
Dry Eye (also called dry eye syndrome) is a very common medical condition that goes undiagnosed in many individuals. Dry eyes occur when people either don't have the correct composition of tears or they don't have enough tears on the surface of their eyes to lubricate the eyes and keep them comfortable.
Dry Eye ( also known as keratoconjunctivitis sicca) can be the result of a functional problem in the tear-producing glands (lacrimal gland) of the eyes. In Chronic Dry Eye the eye has a decreased ability to produce tears due to inflammation on the surface of the cornea. Inflammation on the cornea sends a signal back to your bodies' lacrimal gland, via a neuronal feedback loop, to produce fewer tears.
How common is dry eyes? Up to 25% of all visits to Eye Doctors are due to dry eye, making it one of the most common complaints seen by Eye Doctors. It is estimated that there are currently over 9 million Americans suffering from moderate to severe dry eyes. This means that dry eye syndrome is one of the leading reasons for patients to seek eye care.
Dry Eye symptoms are not just annoying to patients, they also create a decreased quality of life, reduced work capacity. Furthermore, dry eye syndrome is associated with a decreased ability to perform activities that require visual attention, such as reading and driving a car.
Who is at risk for dry eyes?
Age: Dry eye's prevalence increases with age, so that it is extremely common in older people of both sexes.
Gender: The condition affects two-to-three times more women than men. About six million women and three million men in the U.S. have moderate or severe symptoms of the diseases. An additional 25 to 30 million people in this country have mild cases of dry eye.
Medical conditions: Those individuals with medical conditions such as hormonal changes associated with aging and menopause are commonly affected by dry eyes. Dry eye affects more women than men because hormonal changes, such as those that occur in pregnancy, menstruation, and menopause, can decrease tear production.
Other medical conditions such as arthritis, lupus and Sjögren's syndrome also have been shown to contribute to dry eyes. Sjögren's syndrome is a chronic, multi-organ, autoimmune disorder in which the patient has, in addition to dry eyes, both arthritis and dry mouth. Certain types of thyroid disease can interfere with blinking.
Computer Users: Studies have shown that computer users blink significantly less than non computer users. Each time a person blinks, the eyelid coats the eye with tears. The blink rate for a normal human is once every eleven seconds. In computer users that rate can decrease to as low as once or twice in a three minute time span.
Medications
Medications such as antihistamines, some antidepressants, birth control pills, nasal decongestants, and the prescription acne drug Accutane are known to cause dry eyes. . Research has shown that in older women hormone replacement therapy makes dry eye worse. Always make sure to indicate all medications when filling in the health questionnaire portion of the eye exam.
LASIK surgery patients
Lasik surgery, while a safe and beneficial surgery, does have as its most common side effect dry ness. In both Lasik and other types of refractive surgeries of the cornea, dryness can either occur or be made worse by these surgeries. In Lasik the corneal nerves are cut during the creation of the corneal flap. The corneal nerves stimulate tear secretion. Thus, when the corneal nerves are cut, fewer tears are made due to the decreased stimulation to these nerves.
Contact lenses and dry eyes
When a contact lens is fit improperly or is of the wrong material, the rubbing of the contact lens against the conjunctiva is a cause of dry eyes. A vicious cycle ensues when a contact lens patient has dry eye syndrome. Dry eyes will make the contact lenses feel uncomfortable as the moisture leaves the contacts via osmosis to the dry cornea. This causes the contacts to rub against the conjunctiva. The rubbing of the contacts can cause dry eyes because the conjunctiva is responsible for secreting the mucous layer of the tear film.
To combat dry eyes Graf Optical uses the most popular dry eye contact lens on the market, the Johnson and Johnson Acuvue Oasys. The Acuvue Oasys is specifically designed for dry eye sufferers. It uses silicone acrylate and Hydraclear technology to resist drying and thus irritating the conjunctiva.
The anatomy of a tear
The bodies tear film is broken down into three main layers. The outer, oily layer of the tear film is produced by the meibomian glands in the eyelids. Without the valuable top oily layer of the tear film, our tears would evaporate quickly. The thick, middle, watery layer is made by the lacrimal gland above the upper eyelid and washes away irritants. The inner, mucus layer is secreted by the goblet cells in the conjunctiva of the eyelids and helps the tear film stick to the cornea.
Symptoms
The most common dry eye symptoms, which may worsen as the day goes on, include
Grittiness
Itching
Burning
Stinging
Pain
Stringy mucus discharge
Watery Eyes
The oddest dry eye symptom too many is watery eyes. The excessive dryness works to over stimulate production of the watery component of your eye's tears. Just as your eye waters excessively when poked in the eye, so your eye waters frequently when the corneal nerves are irritated by dry eyes. In the most severe dry eye cases there may be a risk for corneal infections, scarring or ulceration. These conditions can cause permanent vision loss, so it is important to seek professional help if you have severe symptoms of dry eye.
Environmental Factors and Dry Eyes
It is important to remember that while environmental factors can further aggravate Chronic Dry Eye, they are not the cause. Anything that may cause dryness, such as an overly warm room, hair driers, smoke, or wind, should be avoided by any person with dry eye. To reduce the environmental factors in dry eyes, consider a humidifier in heated rooms.
If environmental factors contribute to dry eyes, there is a positive benefit to wearing sunglasses. Wearing sunglasses reduces the corneas exposure to sun, wind.
Testing for Dry Eye at Graf Optical
Eye doctors use a combination of routine clinical exams and other specific tests for dry eye. Graf Optical eye doctors may use any of the following clinical tests to check for dry eyes.
Tear Break Up Test (TBUT): The Tear Break Up Test (TBUT) measures the time it takes for tears to evaporate (break up) on the eye. A Break Up rate of ten seconds or less is considered diagnostic of dry eyes.
Schirmer test: This test uses a tiny strip of paper placed on the edge of the lower eyelids. This test measures how much moisture is in the eye, and is thus a test of the quantity of tears on the eye's surface. This test can be used to gauge the severity of the problem. Less than 10 mm of wetting over a five minute period is considered diagnostic of dry eyes.
Dye Staining Tests: Rose Bengal and Lissamine Green which are placed on the eye to stain the surface. A surface that picks up stain more has been affected by dryness to a greater severity.
Treating Dry Eyes
It is important to note that dry eye syndrome is a persistent continual condition that may not always be cured. Treating dry eyes means managing and controlling the symptoms.
Artificial Tears and Lubricants
The first step in controlling dry eye syndrome involves a Graf Optical eye doctor prescribing artificial tears for temporary relief. The artificial tears such as Refresh Liquigel are meant to relieve the symptoms of dry eyes. These solutions give some temporary relief, but do little to arrest or reverse any damaging conditions. Many artificial tear brands are available without a prescription. If the preservatives in some eye drops irritate the eye, our eye doctors will switch you to preservative-free artificial tears to reduce irritation. Some people with dry eye complain of scratchy eyes when they wake up. Morning dry eyes can be treated by using an artificial tear ointment at bedtime, such as Refresh Celluvisc.
Restasis (cyclosporine ophthalmic emulsion) 0.05%
In the event that artificial tears do not relieve the symptoms, your Graf Optical eye doctor will next consider prescribing Restasis (http://www.restasis.com). Restasis (cyclosporine ophthalmic emulsion) 0.05% is the number one doctor prescribed dry eye medication. Topical steroids (in eye drops) are safe for short-term use, to combat inflammation, but can cause side-effects when used for a long time. For longer term use Restasis is recommended. Restasis actively suppresses inflammatory mechanisms, rather than just passively lubricate the surface of the eye. Restasis is usually given twice a day, 12 hours apart.
Punctal Plug Occlusion
For people who have not found dry eye relief with drugs, punctal plugs may help Tears drain out of each eye, and into the nose, through a small opening known as the punctum. Each eyelid (upper and lower) has a punctum. In a common in office procedure known as punctal occlusion Graf Optical eye doctors insert tiny silicone plugs into the punctum. These plugs serve the purpose of keeping more tears on the eye's surface by slowing the rate of drainage from the eye. Artificial tear use may be greatly diminished after punctal plug insertion.
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