Dry Eye

The layer of tear film on the eye is constantly thining & evaporating. Normally this process, known as tear film break up, isn’t a problem. New tears are continuosly being produced to maintain the tear film. When a person blinks, it is just the body’s automatic reflex to spread the new tear film across the eyes.
Problems arise when the quantity or quality of the tear film changes, If an insufficent amount of tear are produced, there are dry spots which develop on the surface of the eye. These dry spots start making the eye uncomfortable.

Dry eye can make it more difficult to perform some activities such as using a computer or reading for an extended period of time & it can decrease tolerance for dry environments such as sitting in an air conditioned room or an airplane for a long time. It can also make the person more uncomfortable in dry hot climates.

In addition inflammation of the surface of the eye may occur along with dry eye, if left untreated this condition can lead to pain, ulcer or scars on the cornea & some loss of vision. However permanent loss of vision from dry eye is uncommon. Dry eye can also compromise results of cataract & refractive surgery.

Although the condition is not curable the symptoms of the dry eye can improve with treatment.
The primary treatment is installation of artificial tears at variable intervals depending upon the severity of dry eye. Artificial tears are available in the form of eye drops, gels & ointments for night use.

Lubricants: The lubrication eye drops provide relief from the symptoms & are an important replacement of naturally produced tears. Artificial tears are now available in preservative free formulations which are less toxic to the ocular surface & can be used more frequently & safely.

Immunomodulators: Cyclosporine, an anti inflammatory medication has been shown to have clinical benefits in the treatment of dry eye. It decreases the corneal damage & improves the quality of tears thereby reducing symptoms of dry eye. Similarly Chloroquine phosphate has also shown similar benefits. Both these medications are available as eye drops which need to be instilled twice a day along with the lubricants for 3 to 6 months to who beneficial effects. in some cases of severe dry eye, short term use of corticosteroid eye drops that decrease inflammation is required.

Punctal Plug: These plugs are inserted into the punctum (drainage holes at the inner corner of the eyelids) and they help by allowing the natural tears to remain longer in contact with the eye rather than draining out quickly through the punctum. This keeps the limited volume of tears on the eye for a longer time, thereby decreasing symptoms of dry eye. These plugs are not felt. They are made of silicone or callagen, They are available in temporary (reversible) or permanent forms.

Supplements: Some studies also show a beneficial effect of dietary supplements such as Omega 3 fatty acids & Vitamin D in decreasing symptoms of dryness.
Treating eyelid conditions like inflammation or infection of eyelid margin also benefit the individual.

Dry eye symptoms may include any of the following

• Stinging or burning of the eye;
• A sandy or gritty feeling as if something is in the eye;
• Episodes of excess tears following very dry eye periods;
• A stringy discharge from the eye;
• Pain and redness of the eye;
• Episodes of blurred vision;
• Heavy eyelids;
• Inability to cry when emotionally stressed;
• Uncomfortable contact lenses;
• Decreased tolerance of reading, working on the computer, or any activity that requires sustained visual attention
• Eye fatigue.

Dry eye can be a temporary or chronic condition:

• It can be a side effect of certain medications. Including antihistamines, nasal decongestants, tranquillizers, certain blood pressure medicines, Parkinson’s medicines, birth control pills and antidepressants.
• Skin disease on or around the eyelids
• Diseases of the glands in the eyelids, such as meibomian gland dysfunction
• Dry eye can occur in women who are pregnancy.
• Women who are on hormone replacement therapy
• Dry eye can also develop after the refractive surgery known as LASIK. These symptoms generally last three to six months but may last longer in some cases.
• Allergies can be associated with dry eye.
• Infrequent blinking, associated with staring at computer or video screens
• Both excessive and insufficient dosages of vitamins
• Long-term contact lens wear
• Dry eye can be associated with immune system disorders such as Sjogren’s syndrome, lupus, and rheumatoid arthritis.
• Chronic inflammation of the conjunctiva, the membrane lining the eyelid and covering the front part of the eye, or the lacrimal gland. Chronic conjunctivitis can be caused by certain eye diseases, infection, exposure to irritants such as chemical fumes and tobacco smoke, or drafts from air conditioning or heating.
• If the surface area of the eye is increased, as in thyroid disease when the eye protrudes forward or after cosmetic surgery if the eyelids are opened too widely
• Dry eye may occur from exposure keratitis, in which the eyelids do not close completely during sleep.