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Dry Eye Syndrome (Tear Film Dysfunction)
The eye depends on the flow of tears to provide constant moisture and lubrication to maintain vision and comfort. Tears are a combination of water, for moisture; oils, for lubrication; mucus, for even spreading; and antibodies and special proteins, for resistance to infection. These components are secreted by special glands located around the eye. When there is an imbalance in this tear system, a person may experience dry eyes.
Dry Eye
Physiology of the Lacrimal Gland System:
There are 2 sets of glands that produce tears to lubricate the eye:

1- Accessory Lacrimal Glands: are a set of small glands located in the upper eyelid and are responsible for continuously moisturizing the surface of the eye. A decrease of production of tears in these glands is the most common cause of Dryness in the eye.

2- Large Lacrimal Gland: This gland is mainly responsible for emergency flushing of the eye, for example, when we have a foreign body in the eye or when we cry. This gland is NOT responsible for continuous hydration of the surface of the eye

The tears usually moisturize the surface of the eye and then drain to the nose through the Nasal lacrimal duct and are swallowed afterward. That's why usually when we cry we sniffle and that's why many times we can taste the drops when we use them in the eye.

When tears do not adequately lubricate the eye, a person may experience:

-Pain in and around the eye
-Light sensitivity
-A gritty sensation
-A feeling of a foreign body or sand in the eye
-Blurring of vision
-Fluctuation of vision
-Eye fatigue following reading or use of computer.
-Runny eyes in windy conditions

Note that these symptoms may not always be there and may fluctuate with environmental changes. Symptoms are usually worse when exposed to dry and dusty air conditions similar to being on an airplane or when the weather is dry and cold and the indoors are heated. Even when you are driving and the heater or air condition is on, the dry air hitting your eyes can cause worsening of the dryness in the eye and cause your vision to become blurry, teary and/or irritated

Sometimes, a person with a dry eye will have excess tears running down the cheeks, which may seem confusing. This happens when the eye isn't getting enough lubrication. The eye sends a distress signal through the nervous system for more lubrication. In response, the eye is flooded with tears from the back-up gland (called Lacrimal Gland) to try to compensate for the underlying dryness. However, these tears are mostly water and do not have the lubricating qualities or the rich composition of normal tears. They will wash debris away, but they will not coat the eye surface properly. In addition, because these emergency tears tend to arrive too late, the eye needs to regenerate and heal and treatment is necessary.
Dry Eye Testing
Testing for dry eyes can be performed through several methods.

- Schirmer's test is performed by placing a small piece of filter paper inside the lower part of the eyelids. The eyes are closed for a few minutes and taken out to measure the amount of tear production.
- Tear Breakup time: Fluorescein eye drops are used to determine tear film stability. This is how we determine if the quality and not the quantity of tears is abnormal.
- Staining of Cornea using Rose Bengal, Fluorescein or Lissamine Green may reveal the abnormal epithelium of the cornea caused by inadequate lubrication.
- Blood Testing sometimes is required when suspecting Sjogren syndrome or autoimmune conditions like Rheumatoid arthritis or Thyroid dysfunction or Collagen Vascular Diseases

How are dry eyes treated?
Although dry eyes cannot be cured, there are a number of steps that can be taken to treat them. You should discuss treatment options with an ophthalmologist. Treatments for dry eyes may include:

• Drink plenty of water to keep the body moisturized.
• Minimize periods in certain weather conditions like windy and dry weather.
• Protect the eyes from harsh weather conditions like wind and dust.
• Make sure medication is not causing dry eyes.
• Eat healthy food containing eye nutrients especially vitamin A, C, and E and if need be take supplements containing flax seed and Omega-3 fatty acids.
• When watching TV, using the computer or other eye straining activities, take frequent breaks and blink often.
• People who wear contact lenses should take them out and keep eyes well hydrated.
• Get plenty of sleep to keep eyes healthy.

Artificial tear drops and ointments. The use of artificial teardrops is the primary treatment for dry eye. Artificial teardrops are available over the counter. No single drop works for everyone, so you might have to experiment to find the drop that works for you. If you have chronic dry eye, it is important to use the drops even when your eyes feel fine, to keep them lubricated. If your eyes dry out while you sleep, you can use a thicker lubricant, such as an ointment, at night.

Temporary punctal occlusion. Sometimes it is necessary to close the ducts that drain tears out of the eye. This is done via a painless short procedure where a plug that will dissolve quickly is inserted into the tear drain of the lower eyelid. This is a temporary procedure, done to determine whether permanent plugs can provide an adequate supply of tears.

Permanent punctal occlusion.If temporary plugging of the tear drains works well, then silicone plugs (punctal occlusion) may be used. The plugs will hold tears around the eyes as long as they are in place. They can be removed. Rarely, the plugs may come out spontaneously or migrate down the tear drain. Many patients find that the plugs improve comfort.
Dry Eye Treatment
Restasis In 2002, the FDA approved the prescription eye drop Restasis for the treatment of chronic dry eye. It is currently the only prescription eye drop that helps your eyes increase their own tear production with continued use.

Supplements. . Some over the counter supplements like Flax oil and Omega 3 Fatty Acids (found in Fish Oil) when taken by mouth may help stabilize the tear film and reduce the symptoms of dryness. Such supplements are readily available in stores and pharmacies (eg Flax oil, Theratears supplements).

Other medications. Other medications, including topical steroids, may also be beneficial in some cases.

Surgery.If needed, the ducts that drain tears into the nose can be permanently closed to allow more tears to remain around the eye. This is done with local anesthetic on an outpatient basis. There are no limitations in activity after having this surgery.
Contact Information
If you need further information or setup a complimentary free lasik screen please contact Dr. Jaoude at 302-684-2020
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