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Dry Eye

What Is Dry Eye?

Some people do not produce enough tears or the appropriate quality of tears to keep the eye healthy and comfortable. This is known as "dry eye". Tears are produced by two different methods. One method produces tears at a slow, steady rate and is responsible for normal eye lubrication. The other method produces large quantities of tears in response to eye irritation or emotions. Tears that lubricate are constantly produced by a healthy eye. Excessive tearing occurs when the eye is irritated by a foreign body, dryness or when a person cries.

Conjunctival Chalasis (Conjunctivochalasis)

Conjunctivochalasis is a common eye surface condition characterized by the presence of excess folds of the conjunctiva located between the globe of the eye and the eye-lid margin.

Symptoms range from dry eye, epiphora, and irritation, to localized pain, foreign body sensation, subconjunctival hemorrhage, and ulceration; and are often made worse by vigorous blinking. Diagnosis can be made under a slit lamp upon the observation of redundant conjunctival folds.

Symptoms of Dry Eye:

Excess tearing from "dry eye" sounds illogical, but if the tears responsible for maintenance lubrication do not keep the eye wet enough, the eye becomes irritated. When the eye is irritated, the lacrimal gland produces a large volume of tears that overwhelm the tear drainage system. These excess tears then overflow from your eye.

• stinging or burning eyes
• scratchiness
• stringy mucus in or around the eyes
• excessive eye irritation from smoke or wind
• excess tearing
• difficulty wearing contact lenses

Normal Tear Film:

A film of tears, spread over the eye by a blink, gives the eye a glassy smooth optical surface. Without a healthy tear film, good vision is not possible. The tear film consists of three layers:

• an oily layer

• a watery layer

• a layer of mucus.

The oily layer, produced by the eyelid's meibomian glands, forms the outermost surface of the tear film. Its main purpose is to smooth the tear surface and reduce evaporation of tears. The middle watery layer makes up most of what we ordinarily think of as tears. This layer, produced by the lacrimal gland, cleanses the eye and washes away foreign particles or irritants. The inner layer consists of mucus produced by the conjunctiva, the paper-thin mucous membrane that covers the surface of the eyeball. Mucus allows the watery layer to spread evenly over the surface of the eye and helps the eye remain moist. Without mucus, tears would not stick to the eye.

Causes of Dry Eye:

Tear production normally decreases as we age. Although dry eye can occur in both men and women at any age, women are most often affected. This is especially true after menopause. Dry eye also can be associated with other problems. For example, people with dry eyes, dry mouth and arthritis are said to have Sjogren's syndrome. A wide variety of common medications, prescriptions and over-the-counter can cause dry eye by reducing tear secretion. Be sure to tell your ophthalmologist the names of all the medications you are taking, especially if you are using:

• diuretics;
• beta-blockers
• antihistamines
• sleeping pills
• medications for "nerves"
• pain relievers

Since these medications are often necessary, the dry eye condition may have to be tolerated or treated with "artificial tears." People with dry eye are often more prone to the toxic side effects of eye medications, including artificial tears. For example, the preservatives in certain eye drops and artificial tear preparations can irritate the eye. Special preservative-free artificial tears may be required.

How Is Dry Eye Diagnosed?

We are typically able to diagnose dry eye simply by examining your eyes. Sometimes tests that measure tear production may be necessary. One test, called the Schirmer tear test, involves placing filter-paper strips under the lower eyelids to measure the rate of tear production under various conditions. Another uses a diagnostic drop (fluorescein or rose bengal) to look for certain patterns of dryness on the surface of the eye.

How Is Dry Eye Treated?

• Adding Tears

Eye drops called artificial tears are similar to your own tears. They lubricate the eyes and help maintain moisture. Artificial tears are available without a prescription. There are many brands on the market, so you may want to try several to find the one you like best. Preservative-free eye drops are available if you are sensitive to the preservatives in artificial tears. If you need to use artificial tears more than every two hours, preservative-free brands may be better for you. You can use the tears as often as necessary; once or twice a day or as often as several times an hour.

Tear drainage duct without silicone plug

Tear drainage duct with silicone plug in place.

• Conserving Tears - Punctal Plugs

Conserving your eyes' own tears is another approach to keeping the eyes moist. Tears drain out of the eye through a small channel into the nose (which is why your nose runs when you cry). We may close these channels either temporarily or permanently. The closure conserves your own tears and makes artificial tears last longer.

A tear plug is in place in the lower eyelid drainage duct. Natural tears are retained rather than drained away, allowing more natural lubrication for the eye.

• Other Treatments for Dry Eyes:

Tears evaporate like any other liquid. You can take steps to prevent evaporation. In winter, when indoor heat is on, a humidifier or a pan of water on the radiator adds moisture to dry air. Wrap-around glasses may reduce the drying effect of the wind, but are illegal to wear while driving in some states.

Anything that may cause dryness, such as an overly warm room, hair dryers or wind, should be avoided by a person with dry eye. Smoking is especially bothersome. Some people with dry eye complain of "scratchy eyes" when they wake up. This symptom can be treated by using an artificial tear ointment or thick eye drops at bedtime. Use the smallest amount of ointment necessary for comfort, since the ointment can cause your vision to blur.

Dry eye due to a lack of vitamin A in the diet is rare in the United States but patients' symptoms are frequently relieved by Dietary supplements of Flax seed oil and formulas such as EVOA Dry Eye pills. Visit the EVOA website at and see more information in our education section.