Dry Eye

Dry Eye is a disease affecting the tears and ocular surface causing discomfort, visual changes and red eyes amongst others. A deficiency in the quality or quantity of the tears produced causes inflammation of the ocular surface resulting in an unstable tear film.Women are more predisposed to dry eye disease than men. Patients find that dry eye disease affects their daily activities and way of life.

Dry eyes should not be confused with allergies as the symptoms are similar. Dry eye is classified as being either aqueous deficient or evaporative.

The tear film consists of 3 layers:
  • Outer lipid layer- secreted by meibomian glands 
  • Middle aqueous layer- secreted by lacrimal glands 
  • Inner mucin layer- secreted by goblet cells of conjunctiva 

Dr Deist screens dry eyes patients with the Tear Lab to provide him with information about the osmolarity of the tears as tear osmolarity increases in dry eye patients. This test is quick, painless and the patients receive the results immediately.Tests such as Rose Bengal staining, Tear break up time (TBUT),Schirmer test, Lisamine green and Fluorescein have been used to diagnose dry eye. The limitation on some of these tests is that blepharitis and allergies produce similar staining patterns.

Patient's with dry eyes often complain of red, itchy and watery eyes proceeding to get worse during the latter part of the day. These symptoms result in the eyes feeling tired and may cause visual disturbances. Contact lens wearers have reduced tolerance to lens wear and may use ocular lubricants or reduce the wearing time to ease the discomfort.Due to the foreign body sensation patients often complain about a gritty feeling.

Dry eye can be age related however hormonal changes and menopause are also contributing factors for woman. Rheumatoid disease and Sjogrens disease results in dry eyes. Medication such as oral contraceptives, anti histamines, anti depressants, beta blockers and diuretics are causes of dry eye. After refractive surgery some patients may experience dry eye symptoms. A deficiency in Vitamin A or Omega 3 will result in dry eyes and these patients are recommended to take supplements or modify their diet. Depending on the surrounding environment people are prone to dry eyes such as air conditioning in offices and dry outdoor environments. People who work extensively on computers often blink insufficiently resulting in the ocular surface becoming drier. Eyelid disorders after eyelid plastic surgery could result in dry eye. Long term contact lens wearers are prone to dry eye disease.

As a preventative measure it is imperative that patients be educated about their condition so that they eliminate certain factors such as the air conditioner and use humidifiers. Most dry eye patients make use of artificial tears that are readily available at your local pharmacies. Anti-inflammatory therapy and protective eye wear such as a bandage contact lens are used to promote healing. Punctual occlusion is used to reduce tear drainage thereby keeping the eyes lubricated. Punctual occlusion maybe temporary, reversible or permanent. Temporary punctual occlusion requires the insertion of collagen plugs into the canaliculi that dissolve in a couple of weeks. Reversible occlusion is longer lasting, the silicone plugs dissolve after a few months. Permanent occlusion is used in patients with severe dry eye. Severe cases of dry eye may require autologous serum eye drops or lid surgery to minimize ocular surface exposure.

For more information please go to www.tearlab.com

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