Dry Eyes

Symptoms of dry eyes are likely the most common complaint confronting the Ophthalmologist. Diagnosing dry eyes can be challenging since the symptomatology overlaps with several other very common eye conditions. Typical the patient complains of blurry or fluctuating vision, burning, itching, foreign-body sensation, eye fatigue and ironically watering eyes (epiphora).

The tear film is fairly complex in nature consisting of three major components. The inner mucous layer produced by conjunctival goblet cells, the middle aqueous layer produced by the conjunctival glands of Wolfring and Krause , and the outer oil layer produced by the eyelid meibomian glands. Each component is essential for normal ocular function and each layer can be affected separately or together in various combinations leading to slightly different symptoms and ocular surface difficulties. Tears not only maintain the moisture of the eye surface, but also provide a barrier to infection and several nutrients.

Dry eyes affect females more than males and the incidence increases with age especially in post-menopausal females. Secondary dry eyes can be induced by chronic use of eye medications (drops), conductivities (especially viral), chemical injuries, and autoimmune diseases such as Sjogrens and Steven Johnson syndromes.

Dry eyes are primarily treated by trying to replace synthetically or induce the ocular adnexae to produce intrinsically the deficient component(s). Various advanced tear substitutes (artificial tears) can replace any one of the deficient layers. Two breakthrough drops in this regard are Soothe and Freshkote. Cyclosporin drops (Restasis) have been shown to actually stimulate aqueous production. Other therapies such as hot compresses, eyelid massage, fish or flaxeed oil (rich in omega 3 and 5 fatty acids), and oral antibiotics including tetracycline, doxycycline and minocin which are used for there ability to thin oil secretions are directed at stimulating sluggish Meibomian glands to produce oil.

After taking a good history and evaluating the tear film abnormality with a slitlamp exam, schirmer test, tear breakup time and lid margin evaluation an appropriate therapeutic plan can be instituted. Despite our best diagnostic efforts, sometimes a simple trial and error approach is needed to find the appropriate regimen to reduce or eliminate the patients if the workup does not reveal the underlying cause.