Dry eye syndrome or simply dry eye is the #1 problem eye doctors face in Edmonton and the most common health condition encountered in the eye care profession. Patients suffering from dry eyes need to be taken and treated seriously as it can have profound affects on their daily lives. Dry eye syndrome may simply be a mild irritation, or it can have serious visual consequences that require the aid of an eye care practitioner. Dry eye syndrome can both be acute or chronic in nature based on the underlying cause.
Dry eye syndrome is either a deficiency in the quantity or quality of a persons tear film layer. Medically the diagnosis goes under 2 names, either keratoconjunctivitis sicca or keratitis sicca, 2 big words that simply mean dry irritated eyes. Your tears are a combination of water for moisture, oils for lubrication and mucous to help spread and adhere the tear film to the outer layer of the eye (the cornea). Tears are produced by glands in your eyelids, which are different from the tears we shed when we cry or when our eyes water, which comes from the lacrimal glands located under the eyebrow area.
Dry Eye Syndrome will often illicit feelings of sharp needle like pain, burning, light sensitivity, gritty sensation, itchy, redness, blurred vision, and watery eyes. Chronic or acute dryness symptoms may also lead to a patients inability to wear contact lenses or undergo refractive laser eye surgery.
A number of eye tests can be performed by your optometrist to confirm your diagnosis of dry eye syndrome. Specific tests include the Shirmer test, and the tear break up test (TBUT). A new computerized test developed by the people at TearLab is now available, which measures the osmolarity of the tear film. The best testing however still involves a detailed examination of the ocular surface, the eyelid area and the tear film layer. An accurate case history can also shed light as to the diagnosis and potentially the underlying cause of your dry eyes.
Dry eye syndrome is caused by a number of factors and includes: medications (anti-histamines, birth control, anti-depressants, hypertensive meds, etc.), environmental factors (computer work, reading, dry office, dry home, etc.), lifestyle (sports, sunlight or wind exposure), contact lens wear (over wear, extended wear, dirty lenses, poor lens fit, or chemical toxicity secondary to contact lens solutions, etc), age, menopause, and smoking. Dry eye syndrome may also be the result of underlying medical problems such as Sjogren’s syndrome or ocular rosacea.
Dry eye syndrome is usually seen as a chronic eye condition by most eye care professionals. With appropriate care and treatment however, it is possible to reduce or completely eliminate a patients symptoms. Always discuss your unique circumstances with your optometrist to determine the best treatment option that fits both your lifestyle, comfort level and budget.
Treatment Options for Dry Eye Syndrome
☐ Warm Compresses – Take a washcloth and wet it with warm water. Close your eyes and gently hold the warm washcloth over your eyes until it cools off. Repeat this cycle 4 times or for approximately 1-2 minutes. Warm compresses should be performed every morning and every evening before bed. Performing warm compresses more regularly has no adverse side effects. Warm compresses help to open up your oil glands and tear glands. Showering or bathing alone will not do this.
☐ Lid Scrubs – Lid scrubs are performed to remove any oil buildup from the eyelid area. Lid scrubs are always performed after warm compresses, as the warm compresses help to soften the oil. Lid scrubs are best performed in the shower, by placing a small amount or baby shampoo on a washcloth or using a commercially available product like Lid Care Towelettes. Gently wash around the lid area, taking special attention around the oil gland area located right along the lid line by your eyelashes. Thoroughly rinse any soap residue away. Lid scrubs should always be performed prior to using any medicated ointments or creams around the eyelid area.
☐ Environment / Personal Factors – If your dry eye symptoms is being caused by any environmental or personal factors that you can control, try to reduce or limit your exposure. This may mean reducing how long you wear your contact lenses for in the day. Looking up and away from your computer screen at work, or the newspaper at home every 15 to 20 minutes. It may also mean discussing alternative medical therapies with your family physician if your dry eye is the result of a new or existing medication.
☐ Water & Air Humidifiers – Drinking water and limiting your intact of dehydrating beverages that include caffeine and alcohol, is a simply way to keep your whole body feeling better. Humidifiers are also a great way to help decrease tear evaporation. Edmonton is a dry city that only gets dryer in the winter. Adding a humidifier to your home furnace and air conditioner can greatly improve your home environment. Using a standalone warm air humidifier in the bedroom can also dramatically reduce dryness in the morning.
☐ Fatty Acid Supplements – Oral polyunsaturated fatty acid supplements are the newest trend in dry eye treatments. A large study out of the University of Waterloo, found that adding fatty acid supplement to ones diet, either through supplementation or better dietary choices can help to reduce ocular inflammation, improve oil secretion and improves dry eye symptoms overall. Supplement options include: Flaxseed Oil, Omega 3 and Fish Oil.
☐ Lubricating Eye Drops – Lubricating eye drops such as Systane Ultra, Blink tears, or Refresh tears are a great way to add additional lubrication to your eyes and provide comfort and relief. Please don’t get trapped into the mind set that all lubricating eye drops are the same, as they are most certainly not. Each brand of eye drops on the market targets a specific area of the tear film. Some lubricating eye drops may be better suited than others, depending upon your unique situation. In order to gain any positive affects from lubricating drops, they must be used regularly. I also highly discourage my patients from using any 'red eye' lubricating eye drops, as they can often worsen dry eye symptoms, and increase healing times. Be certain to discuss any chemical or preservative allergies that you may have with your doctor, as there are now numerous 'preservative free' formulations available on the market. (Image via Alcon Canada website)
☐ Lubricating Eye Ointments – If additional lubrication is required for longer periods of time, than lubricating ointments such as Refresh PM are a great alternative. Ointments however, do produce more matting or buildup around the eyelids and can greatly blur ones vision. So typically they are used only before bed or prior to having a nap. However in some severe cases of dry eye syndrome they may be our go to product. Most lubricating ointments are also 'preservative free' which allows them to be used more frequently and in greater amounts.
☐ Medications - In some dry eye syndrome cases, medications may be used to help treat either the underlying cause of your dry eye, or the symptoms. Occasionally using antibiotics or anti-inflammatory medications can help bring your dry eye under control, and make it easier to manage with over the counter medications or homeopathic treatments. You may also see advertising for a product called 'Restasis', which is a prescription medication used to treat inflammatory dry eye. Watch their commercial.
☐ Temporary Punctal Plugs –These are small collagen plugs that are placed in the lower and potentially upper punctual canals in your eyelids. They are invisible to the naked eye, but prevent tears from draining out of your eyes, thus maximizing the contact time with your eyes and reducing your dry eye symptoms. Depending on the style of plug used, temporary punctual plugs can last for 3 days up to 3 months prior to dissolving away.
☐ Permanent Punctal Plugs – These are similar to temporary punctual plugs, but are usually made out of silicon. They are designed to last longer, and are used if temporary plugs are found to be successful in treating your dry eye syndrome.
Always discuss both the risk and benefits with your optometrist, prior to starting any medical treatment.
To learn whether or not you suffer from dry eye syndrome, and what treatment options might best suit your unique personal situation please schedule an appointment for a routine eye health exam.