Facts About Dry Eyes
Dry eye syndrome (DES) is a very common condition that affects millions of people here in the US and abroad. DES is a chronic problem that numerous people have to deal with for many years. Symptoms include eye redness, itchiness, foreign body sensation, tearing, intermittent blurred vision as well as frank eye pain. Most commonly, these symptoms are worse towards the end of the day and with certain activities such as prolonged reading and TV watching. Often contact lens use can aggravate the condition. The good news is that there are effective treatments that can help to manage most of these bothersome and sometime debilitating symptoms.
Treatment consists of lubricating the eyes with artificial tears and currently, there are many different products available. Refresh tears, Systane, Blink, Optive and Genteal are very good products that lubricate the eyes. If these are ineffective to ameliorate symptoms then one can use thicker artificial tears such as Refresh celluvisc and Soothe. For patients who are very bothered by their symptoms and artificial tears are not significantly helping then I usually recommend Restasis and/or punctual occlusion. Restasis is different than artifical tears because it can increase tear production as well as decrease the amount of inflammation and redness that are common with dry eyes. Restasis can improve patients’ symptoms in a matter of weeks but occasionally, it may take months before patients notice a difference. Therefore, at least a 3 month trial of Restasis is tried before giving up on it.
Punctal occlusion is another effective treatment for dry eyes but I generally reserve this for patients who either have failed the above treatment options and/or patients who have low tear production. Tear production can be measured by placing strips of paper for 5 minutes and then measuring how much tears are absorbed. Punctal occlusion works by decreasing the amount of tears drained by the tear drainage system. Each eye has two channels that drain tears and generally only one channel is occluded. If dry eyes are very severe then both channels can be occluded. Punctal occlusion is a simple but effective treatment option that can be performed in the office.
DES can also be associated with local eyelid disease such as blepharitis which is diagnosed during an eye examination. Blepharitis is a medical term to describe eyelid inflammation and it can produce dry eyes by increasing the evaporation of tears. In order to effectively treat DES, concommitent blepharitis needs to be addressed. I recommend mixing baby shampoo with warm water and then placing that mixture onto a washcloth which then is used to scrub the eyelids. Alternatively, one can perform lid hygiene with lid scrub cleaner pads that are sold at pharmacies. Unfortunately, blepharitis is also a chronic condition, so lid hygiene has to be performed on a long-term basis especially during times of DES/blepharitis exacerbations. Mild topical steroids are occasionally prescribed to treat blepharitis as well.
Lastly, DES can also be associated with a disorder called Sjogren’s syndrome (SS). People with this condition suffer from dry eyes, dry mouth and a rheumatologic disorder such as rheumatoid arthritis. Therefore, I always ask my patients with DES whether or not they experience dry mouth because diagnosing SS is important. If it is suspected then blood tests are ordered to screen for it. If blood tests are positive then SS is treated in conjunction with a rheumatologist who may prescribe oral medication.