Dry Eye
Syndrome
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Check out the very informative new "Dry Eye Educational Video" at the Systane™ website.
Background
Dry Eye
Syndrome (DES) is a break down of the tear film and is one of the most common conditions affecting the
eyes. Approximately 33 million Americans in all age groups experience some
symptoms of dry eyes. Most people don't realize how extremely important tears are in
providing comfortable eyes, clear vision, and protection from infections.
| DES
is
a result of: 1. not enough tears being produced because of tear gland (lacrimal gland) dysfunction (see diagram below), and/or 2. poor composition of any, or all of the 3 layers (see diagram at right) that make up tears. Both conditions result in the tear film breaking down. This break down causes dry areas on the front part of the eye (cornea) and results in dry eye symptoms. |
|
Symptoms
Symptoms of DES
can vary greatly and range from mild to severe. Symptoms
include: general irritation, burning, foreign-body sensation (feels like there's something
in your eyes), itching, excess tearing, eye pain or soreness,
fluctuating vision, mucous discharge, redness, contact lens discomfort
etc. These symptoms are often amplified or made worse by smoking, wind,
heat, low humidity, or prolonged use of the eyes (e.g. computer use or reading).
Causes
There are many conditions and factors which can contribute to causing DES.
Like most eye conditions, dry eye syndrome is often related to other health
conditions in the rest of the body. These systemic health problems
include digestive imbalances, and autoimmune conditions such as rheumatoid
arthritis, Sjogren's syndrome and lupus erythematosus.
Dry eyes are very common problem for
women and seem to be a result of fluctuations in hormone levels.
Pregnant women, women who use birth control pills, and post-menopausal women on
hormone replacement therapy often suffer from dry eyes.
Contact lens wear is probably the most common cause of DES.
A contact lens is an unnatural piece of soft plastic that is placed on the
cornea, that can potentially disrupt the natural tear film on the front surface of the
eye. If your eyes
do not react well with the contact lens material or they do not produce enough tears, you may not acquire
comfortable and clear vision and your wearing time may be reduced significantly.
Additionally, long term contact lens wear may cause a reduction in corneal
sensitivity. The sensitivity of the cornea determines how many tears your
eyes produce. Less sensitivity means less tears.
The next most common cause is the natural aging process. As you age, your
tear production decreases. By the age of 65, tear production is
reduced to about 60% from age 18. Obviously, this is quite a significant
reduction that results in increased discomfort.
Several medications can lead to dry eyes: birth control pills,
antihistamines, decongestants, codeine, morphine, heart medications, and even
eye drops like Visine.
Treatment
Options
Artificial
Tears - The first line
of treatment should be to supplement the eyes with Artificial Tears.
Generally, artificial tears are used one to 4 times a day, or on an "as needed"
basis. The newest artificial tear on the market is called "Refresh Endura"
by Allergan®. The company says, "Refresh Endura is the first
lubricant eye drop for dry eye that treats all three layers of the tear film.
Clinical studies show that patients who used Refresh Endura on an average of 2
to 3 times each day saw significant improvement in symptoms." When
instilled, the Refresh Endura formula delivers oil to the tear lipid layer (to
minimize evaporation), water to the tear aqueous layer (to keep the eyes wet)
and gel to the tear mucin layer (to keep the cornea lubricated).
"Refresh Tears" by Allergan®, "Tears Naturale" by Alcon®, and "Bion Tears"
by Alcon® are three other excellent
artificial tear lubricants available at any drug store over the counter.
For those patients who wear contact lenses and experience dry eye symptoms, "Refresh Contacts"
by Allergan® and "Clerz" by Alcon® are two effective artificial tear
drops that can provide increased comfort.
Punctal Plugs - In more serious cases of DES where discomfort is unbearable and/or contact lens wearing time is reduced to the point of being impractical, Punctal Plugs are recommended. A punctal plug is a small collagen or silicone cylinder that is inserted into the punctum (tear drainage hole - see diagram below) to reduce the drainage of tears from the front surface of the eyes. With each blink, your eyelids coral the tears from the lateral surface of your eye towards your punctum, which is the start of your eye's drainage system. If you reduce the amount of tears that are draining, then more tears remain on the surface of your eyes and do their job to coat, comfort, and protect.
Procedure - First
of all, DES
is considered a medical condition, and
thus, some medical insurance companies will fully cover the procedure.
There are two types of Punctal Plugs: temporary and permanent. The
difference between the two is the type of material the plugs are made of. The temporary plugs
are used diagnostically (on a trial basis) and made of collagen that dissolves
over a given time period (weeks to months). The permanent plugs are made
of a silicon-based material that do not dissolve and are
meant for long-term use. Though they are called 'permanent' plugs, we can
very easily remove them if necessary. If Drs. Berke or Ryan decided with you to insert
punctal plugs, they would first insert a pair of diagnostic temporary plugs to
determine if they help your condition. If we find after the trial period
that they do significantly increase your comfort, then we would proceed to
insert the permanent plugs.
The newest temporary Punctal Plugs on the market are plugs that last 4-6 months
and then dissolve. We will soon have these in our office and will
be able to perform this very helpful procedure.
PREVENTION
Diet plays probably the most significant role in dry eye prevention. Some
types of foods increase the risk for dry eyes, while others can decrease the
risk.
Increasing the Risk of DES:
1. Consuming large amounts of sugar and/or artificial sweeteners
has been linked to dry eye syndrome. Avoid certain things like sodas, as
well as some processed foods that have hidden sugar in them like cereals,
ketchup and salad dressings.
2. Toxic fats found in commercial red meats, dairy products, fried
foods, and hydrogenated oils (such as margarine and shortening) can disrupt
proper metabolism of essential fatty acids in the body and can indirectly lead
to dry eye symptoms.
Reducing the Risk of DES:
1. Flaxseed oil/n-3 fatty acids - Cynacon/Ocusoft is a company that
has recently introduced Hydrate Essential, a new dry eye medication that
contains flaxseed oil, which is an n-3 fatty acid. The company reports, "Many
reports have linked flaxseed oil to increased comfort when used to manage dry
eye. Researchers suggest that in general, most individuals could benefit
from a diet that includes more n-3 fatty acids. Such therapy may also
benefit a person's skin, mucosa, cardiovascular system and central nervous
system." Along with flaxseed oil, Hydrate Essential is combined
with evening primrose oil (which has a high amount of a rare essential fatty
acid, gamma-linolenic acid), and bilberry extract, which fights inflammation.
We are currently looking into obtaining samples from Cynacon/Ocusoft for our
office. Depending on your location, you may be able to find these in drug
stores right now. However, we do know that flaxseed oil is available in
capsule form at Trader Joe's.
2. Vitamin A - this very important vitamin is needed for the health of
all epithelial (surface) tissues; it is found naturally in the tear film of
healthy eyes and is key to the production of the mucous layer of the tears.
Using drops with vitamin A can help protect the eyes from free radicals, toxins,
allergens, and inflammation. Try a daily dose of 10,000 I.U. of vitamin A
and 25,000 I.U. of beta-carotene. Note: if you have a thyroid condition,
please consult your physician before starting a regimen of vitamin A.
3. Vitamin B6 - this vitamin helps in the proper absorption of magnesium, which
in turn, aids the body in producing prostaglandin E-7, which is necessary for
tear production.
4. Vitamin C - is found in higher concentrations in the tear film than that
found in the blood.
5. Potassium - is usually very low in dry eye patients. This is usually
found in conjunction with low consumption of folic acid, vitamins C and B6, and
high consumption of sugar. Increase your potassium intake to at least
500mg/day by consuming more fruits and vegetables (one banana contains 400mg).
Links
If you want more information on Dry Eye Syndrome, check out
the following links:
http://www.healthlinkusa.com/Dry_Eyes.htm
http://www.eaglevis.com/patients.htm
http://www.altdryeyes.com/dryeyes.htm
If you have any further questions, by all means, feel free to contact us.
