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Community Eye Care of Indiana
DRY EYE: WHY IS IT A DISEASE AND NOT JUST A NUISANCE?

Do you have dry eyes? Up to 12 million Americans suffer from a disease
called dry eye syndrome. People with dry eyes frequently experience
burning and stinging of their eyes, their eyes often feel sticky, and their eyes
are often red. Some people with dry eyes also have periods when their eyes
get so watery that tears spill over their eyelids and run down their cheeks.
For more information about dry eye, go to
any of the following websites:

www.nei.nih.gov
www.preventblindness.org
www.eyemdlink.com
Schepens Eye Research Institute

 TREATMENT OPTIONS FOR DRY EYES

Dry eye syndrome occurs when your eye doesn’t make enough tears to
keep your eye moist and comfortable. Dry eye syndrome is more than just
a nuisance. Your tears are important in keeping your eyes healthy. If you
have dry eyes, many different treatments are available to maintain moist
and healthy eyes, including:

Environmental changes: Mild dry eyes can often be improved by making
simple changes in your surroundings. One common cause of dry eye is air
blowing in your face, which can evaporate your tears faster than your eye
can make them. Don’t sit directly in front of a heating or air-conditioning
vent at home or at work, and in the car, make sure these vents are not
aimed directly into your face. Avoid using hair dryers, or at least shield your
eyes when using one. If you smoke, you should seriously consider quitting,
because smoking also aggravates dry eyes.

Dietary changes: You are what you eat, and studies have shown that
eating foods rich in omega-3 fatty acids can decrease dry symptoms. Fish
such as tuna, salmon, and halibut, and various seed- and nut-derived oils
such as flaxseed, walnut, soybean, and canola, are all good dietary
sources of omega-3 fatty acids. Fish oil capsules are also commercially
available at drug stores and health food stores.

Tear replacement therapy: If the environmental changes alone don’t
restore your eyes’ moisture level, many over-the-counter eye drops—called
artificial tears—are available. These drops are highly effective in soothing
dry eyes for most people, but they must be used regularly—often 4 times a
day—in order to maintain constant moisture throughout the day. Artificial
tears are available in multi-dose bottles and in single-dose vials. The
bottles are easier to handle and contain preservatives so that the tears won’
t spoil before you use the whole bottle. Some people develop allergies to
or irritation from the preservatives if they use the drops more than 4 times a
day. The single-dose vials do not contain preservatives, and are
recommended for anyone who needs to use the drops more than 4 times a
day. These products can be purchased without a prescription in any
supermarket or drug store.
   WOMEN AND DRY EYE

Dry eye syndrome is among the most common eye conditions in the
United States. What is dry eye syndrome? In healthy eyes, a thin layer of
tears coats the outside surface of the eye and keeps it moist. Dry eye
syndrome occurs when the eye doesn’t make enough tears, or doesn’t
make effective tears, or the tears that it does make evaporate too quickly
and leave the eye dry and vulnerable.

People with dry eyes often experience dryness, stickiness, and stinging or
burning of their eyes. The eyes are often red and irritated. Sometimes the
eyes water excessively in an effort to soothe the irritation, but these reflex
tears are usually not adequate to fix the problem, and all they do is spill
over the eyelid and run down the cheek.

The cause of dry eye syndrome is unknown, but the disease affects
approximately 77 million Americans. The disease becomes more common
as we age, and is particularly common in women over the age of 35.

Dry eye syndrome affects women two to three times more often than men.
This is thought to be related to hormones. Male hormones (such as
testosterone) seem to be good for the tear glands, and female hormones
(particularly estrogen) seem to be bad for the tear glands. In a recent study,
women who were on hormone replacement therapy after menopause had
up to a 70% higher risk for developing dry eyes than women not using
hormone replacement therapy.

One particular form of dry eye syndrome occurs in patients with Sjögren’s
syndrome. Patients with Sjögren’s syndrome suffer from dry eyes and dry
mouth, because their bodies mistakenly produce small molecules that
attack their moisture-producing glands, in addition to causing other
problems, such as rheumatoid arthritis or lupus. Ninety percent of people
with Sjögren’s syndrome are women.

Dry eye syndrome is more than a nuisance. Left untreated, severe cases
of dry eye syndrome can lead to problems such as inflammation, infection,
and scarring of the eye surface, resulting in permanent loss of sight.

Treatment options: If you have dry eye syndrome, there are numerous
treatments available to help protect your eyes and your sight. For many dry
eye sufferers, small changes in their daily habits can make the problem
better, such as smoking cessation or making sure heating and air-
conditioning ducts are aimed away from your face and eyes at home and at
work. Diets high in omega-3 fatty acids—including fish, nuts, or
supplements—can also improve dry eye symptoms. For others, tear
replacement drops can help re-establish moisture to the eye or small plugs
can be placed in the tear ducts to prevent tears from draining away too
quickly. In addition, a new prescription medication called cyclosporin is
now available. Marketed under the brand name Restasis®, cyclosporin
helps your tear glands produce more of your own natural tears.  
YOUR EYES SHOULD NOT ITCH AND BURN AS YOU AGE

Aging is unavoidable, and as you age, your body undergoes many
important changes. Your eyes are no exception. One of the most common
problems associated with aging eyes is dry eye syndrome. If your eyes
frequently burn or feel itchy or scratchy, you may have dry eye syndrome.

As its name suggests, dry eye syndrome is caused by inadequate
moisture to the eye. The front surface of the eye must be kept moist at all
times in order to work properly. This is why your body produces tears—to
keep the eye moist and healthy so that your vision will be crisp and clear.
Tears have three main ingredients: a mucin layer that coats the outer
surface of the eye, an aqueous or watery layer that provides moisture to the
eye surface, and a lipid or oil layer on the outside to slow down
evaporation so that your tears will last longer on your eye. Each of these
three key ingredients is made by a different set of tear glands in your
eyelid. If any of the three ingredients is missing, or if your tears evaporate
too quickly, you will develop dry eye syndrome.

The symptoms of dry eye syndrome include burning, itching or scratching,
and a sensation of grittiness like sand in your eyes. Your vision may be
blurred. Often these symptoms worsen throughout the day, becoming
worse in the late afternoon or evening. Although this sounds backwards,
some dry eyes water excessively. This is because a dry eye is often
irritated, and eye irritation often triggers tearing to help soothe the eye. If
your eye becomes dry and irritated because your tears are defective, then
making lots more defective tears is no solution: instead you just end up
with irritated, wet eyes.

There are many causes of dry eyes, but the most common cause is simply
getting older. As you age, your body produces less oil.  This results in dry,
irritated skin, and also dry eyes. The eyes get dry because the oil layer of
your tears is deficient, and the water in your tears evaporates too fast.
Women are particularly vulnerable to dry eyes as they age, because the
hormonal changes that accompany aging often reduce tear production.

Dry eye syndrome can be treated in a variety of ways. Environmental and
lifestyle changes may be all that is needed. Perhaps you sit too close to a
heating or air conditioning duct that is drying out your eyes, or perhaps
cigarette smoke is irritating your eyes. Tear replacement therapy can
effectively moisten your eyes. Placing small plugs in your tear ducts can
reduce tear drainage, making your tears last longer. And new prescription
medications can help stimulate your tear glands to produce more of your
natural tears.

Itching and burning is not a normal sign of aging. If your eyes itch and burn,
tell your doctor. Your doctor will help you identify possible reasons for your
dry eyes, and will design a treatment plan to relieve your symptoms.
WHAT CAN I DO FOR MY DRY EYES?

Dry eye syndrome is a common condition that affects as many as 10
million people in the United States. Symptoms of dry eye syndrome
include burning and an itchy or scratchy sensation, like having sand or grit
in your eyes. Many people with dry eye syndrome have intermittent blurry
vision that temporarily improves with rapid blinking. There are many
causes of dry eye syndrome, but in general, the condition occurs because
your tears are either abnormal or they are evaporating from your eye’s
surface too quickly.

Dry eye syndrome is often a nuisance, and in some cases, can lead to
scaring of the eye’s surface with loss of vision. There are several
treatments available. These range from simple lifestyle modifications to
prescription medications, depending on the severity of the condition.

can make tears evaporate too quickly. Most heating systems dry out your
can make tears evaporate too quickly. Most heating systems dry out your
home’s air even if you don’t sit too close to the vent; a humidifier can help
put moisture back into the air. Cigarette smoke can irritate and dry out the
eye surface as well, and quitting smoking often improves symptoms of dry
eye syndrome.
eye syndrome.


If your eyes don’t produce enough tears or don’t produce healthy tears,
there are tear replacements available. These artificial tears are sold over
the counter in most drugstores and grocery stores. If your symptoms are
mild to moderate, putting artificial tears into your eyes two to four times
daily often helps relieve your symptoms. Artificial tears are available in
multi-dose bottles and single-dose vials. The multi-dose bottles are less
expensive but contain preservatives that some people cannot tolerate
more than four times daily. The single-dose vials contain no preservatives,
and can be used more than four times daily, but they are generally more
expensive.

If you require artificial tears more than four times daily, you may benefit
from punctual plugs. The punctum is the opening in the lower eyelid through
which your tears drain away. Plugging the punctum makes your tears—or
artificial tears—stay on your eye surface longer, which improves your dry
eye symptoms. Punctal plugs are quickly, easily, and painlessly inserted
during an office visit, and provide significant relief for many dry eye
sufferers. If for any reason you are unsatisfied with them, they can be
removed as easily as they are inserted.

Moderate to severe dry eye may require medical therapy. Prescription
eye drops are available that stimulate your tear glands to produce more of
your own natural tears. All medications have side effects, and prescription
medications can be costly, so this solution may not be for everyone.

If you have dry eye symptoms, talk to your eye doctor. Based on your
lifestyle and the severity of your symptoms, your doctor will work with you to
design a treatment plan to make your eyes comfortable.

Dry Eye: Why is Dry Eye a Disease and Not Just a Nuisance?

Dry Eye: Treatment Options for Dry Eye

Dry Eye: Women and Dry Eye

Dry Eye: Your Eyes Should Not Itch and Burn as You Age

Dry Eye: What Can I Do for My Dry Eyes?
Your eyes normally make small amounts of tears all
day long. Tears play several important roles in
keeping your eyes healthy and your vision clear.
Tears lubricate the eye’s surface, wash away debris,
provide a smooth surface to help keep your vision
clear, and also contain natural antibiotics that keep
your eyes safe from germs that might cause
infections.

Tears coat the eye in a smooth film made up of three
separate layers. The layer of tears closest to the front
surface of the eye is called the mucin layer. Its job is
to smooth out the uneven spots on the eye surface.
Next, a layer of aqueous tears covers the mucin layer.
The aqueous layer is watery, and makes up the
majority of the tear film. Its job is to lubricate the eye
and keep it moist. The final layer of the tear film is an
oily layer called the lipid layer. This is the outermost
layer, and its job is to cover the aqueous layer and
prevent it from evaporating.        
Each layer of the tear film is made by a different part
of the eye. The mucin layer is made by the eye
surface itself. The aqueous layer is made by a tear
gland tucked under the upper eyelid. And the lipid
layer is made by small glands in the eyelids. For the
tear film to do its job, all three layers have to be in
their proper places in the correct amounts, like a
recipe. If any layer is missing or abnormal—which
can happen for a number of reasons—the tear film
becomes disorganized and no longer soothes the
eye like it should.

When that happens, the symptoms of dry eye syndrome occur. The front
surface of the eye gets dried out (causing stickiness) and gets inflamed
(causing stinging and burning). Once it gets inflamed, the eye ignores the
proper tear film recipe and starts making large quantities of the aqueous
layer in an effort to soothe itself. These bad tears don’t soothe the eye at
all—they just run down your face, washing away the mucin and lipid layers
as well. This makes the eye even more irritated, so it makes even more
bad tears, and the cycle continues.

For some people, the stinging and burning and redness and watering may
seem like little more than a nuisance, but in fact, if left untreated, dry eye
syndrome can lead to serious eye problems, including blindness. Dry eyes
are inflamed eyes. Inflammation of the front surface of the eye increases
the risk of some infections, and can also lead to scarring. Once scarring
occurs, permanent loss of sight can occur.
Prescription medications: A new prescription medication called
cyclosporine is now available. Marketed under the brand name Restasis®,
cyclosporin helps your tear glands produce more of your own natural tears.
Your natural tears help protect the surface of your eyes, improve the
comfort of your eyes, and improve the quality of your vision.