Dry eye syndrome is one of the most common and frustrating ocular conditions.
Dry eye syndrome is a common ocular condition affecting about 10% of those over age 65. The International Dry Eye Workshop has defined dry eye syndrome as a multifactorial disease of tears and the ocular surface that results in symptoms of discomfort, visual disturbance and tear film instability with potential damage to the ocular surface. This is accompanied by inflammation of the ocular surface. This etiopathogenetic classification distinguishes two types of dry eyes: an aqueous deficiency and an evaporative state. The aqueous deficiency is further divided into Sjögren’s or non-Sjögren’s syndrome.
The current management of dry eye syndrome is usually treated generically, in a “one-size fits all” fashion. Dry eye syndrome is more complex however, and a tailored approach to this multifactorial disease should be fashioned. This condition is so common, and potentially so challenging, that we have established the Dry Eye Clinic at Baltimore Eye Physicians.
PATHOPHYSIOLOGY OF THE TEAR FILM
The precorneal tear film is composed of three layers: mucin, aqueous and lipid. The innermost mucin layer is produced by the goblet cells in the conjunctiva and creates a hydrophilic epithelial surface. The aqueous layer provides the bulk of the tear film. Baseline tear production keeps the eye moist and is primarily produced by the accessory lacrimal glands. The main lacrimal gland is more responsible for reflex tearing. The outermost lipid layer of the precorneal tear film is produced by Meibomian glands. They are specialized sebaceous glands within the lid which provide tear film stability.
The three layers of the tear film are inherently unstable. Blinking acts to distribute tears and prevent tear breakup or drying. Any
abnormality in the precorneal tear film, or in its distribution will cause symptomatic dry eyes.
WHAT ARE THE SYMPTOMS OF DRY EYE?
The usual symptoms include:
WHAT CAUSES DRY EYE?
Tear production normally decreases with age. Women are more often affected, especially after menopause.
Dry eye can be associated with other problems. People with dry eyes, dry mouth and arthritis may have Sjögren’s syndrome. (More information on
As noted there are two main categories of dry eyes: an aqueous deficiency or an evaporative state. The aqueous deficiency is the most common cause, and may be associated with Sjögren’s syndrome. Sjögren’s is an autoimmune condition characterized by rheumatoid arthritis, dry mouth and dry eyes. This form of dry eye tends to be more pronounced and progressive and may cause significant ocular symptoms.
Mucin deficiencies result from changes of the conjunctiva that reduce goblet cell production. This alteration creates a hydrophobic ocular surface that does not maintain moisture. The conditions producing mucin deficiency are ocular pemphigoid, chemical burns, erythema mutiforme and irradiation.
Lipid abnormalities are commonly associated with dysfunction of the Meibomian glands. Some changes are now recognized as a significant contributing factor in dry eye syndrome. Meibomian gland dysfunction produces an unstable tear film with an increased tear break up time leading to symptomatic dry eyes. Frequently there is a combination of factors that contribute to dry eye syndrome.
A wide variety of common medications can cause dry eye by reducing tear secretion.
- Sleeping pills
- Narcotic pain relievers
HOW IS DRY EYE DIAGNOSED?
Sometimes tests that measure tear production are necessary. One test, called the Schirmer tear test, involves placing filter-paper strips to measure the rate of tear production. Another test uses diagnostic drops to look for certain patterns of dryness on the eye surface.
HOW IS DRY EYE TREATED?
The Dry Eye Clinic at Baltimore Eye Physicians was established to manage dry eye patients. Our approach to these patients is to identify the cause(s) and provide a tailored management to each individual patient. Because multiple factors may exist, multiple approaches may need to be utilized; such as:
- Tear Supplementation
- Gels at bedtime for extra lubrication
- Punctal occlusion – Blockage of tear drainage system
- Oral supplements – Fish oils/Omega3 Fatty Acids
- Topical Steroid drops
- Repair lid abnormalities
Conserving your tears
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.
A temporary method of closing the channels may involve the use of punctal plugs. Some plugs are dissolvable, some are not, but all are relatively easy to place.
Dry eyes are much more common during the winter. This is because heating systems significantly lower the humidity in the house. This is aggravated by fire places~ or wood burning stoves which further reduce humidity. Humidifying the air or stopping ceiling fans may be required to control dry eye symptoms. With newer innovations in contact lens technology, often times switching a patient from glasses over to contacts can significantly reduce symptoms. There are other advanced therapies that we offer if patients symptoms are still not alleviated.
Adherence to the principles of advanced technology, vision excellence, and high patient satisfaction characterize Baltimore Eye Physicians as one of the regions premier eye-care centers. We offer comprehensive eye care services at our state-of-the-art-practice and on-site surgical center, along with a skilled, caring staff who are committed to our patients.
Part of the unique concept of Baltimore Eye Physicians is our cutting edge, Medicare approved, ambulatory surgical center conveniently adjacent to our practice. Patients appreciate not only the accessibility and convenience of our surgery center to our medical practice, but also the continuity of care they receive from our highly trained and sympathetic staff, whose purpose is to create a caring environment for each and every patient. Our staff is always available for consultation for all your ocular needs.