Dry eye continues to be the most common condition we see at For Your Eyes Only Optometric Center and causes a wide variety of symptoms that compromise both vision and comfort. The most common complaints with dry eye are fluctuating or blurry vision often changing with the blink, redness, gritty or sandy sensation, pain or even watering eyes. While there are a plethora of eye drops on the market to treat dry eye, some are much better than others for specific types of dry eye. In order to know which therapy is best for you, an evaluation of the tear layer must be done.
While the tear film would seem to be very simple, it is a lot more complicated than most people realize. While the main function of the tear layer is arguably immunologic, I will focus on it’s role as a lubricant. Your body can produce two distinctly different types of tears, the first being ‘Basal Tears’ which coat the eye under normal circumstances and protect against dry eye. These Basal Tears up of 3 distinct layers. The mucus layer is responsible for adhering the tear to the front surface of the eye, the aqueous layer that provides the bulk of the tear layer and lubricates the eye, and the lipid layer which prevents evaporation. A deficiency in any of these three layers can cause Dry Eye Syndrome, and will require different treatment depending on what is causing the dry eye.
Reflex tearing such as what you get from cutting an onion or being upset are different in composition from the basal tears that generally coat your eye. Reflex tearing can also be the response to irritation of the corneal surface such a particle of sand, or damage to cornea from dry eye. These reflex tears, however, do not contain the same mucus and oil that basal tears do and do not effectively lubricate the eye. These short lasting tears are merely meant to wash an irritant from the eye not moisturize long term. This is the reason that watery eyes (from reflex tearing) often stems from irritation created by Dry Eye Syndrome.
Dry Eye Therapy: Most dry eye therapy targets either the aqueous or lipid (oil) layer of the tear film.
-Artificial Tears. Traditional artificial tears while better than medicated eye drops such as Naphcon, Visine or Clear Eyes only increase the bulk of the aqueous layer but do little help if the dry eye is evaporate in nature. At For Your Eyes Only, we often recommend specific drops that contain an oil component that can increase the time the drops stay on the corneal surface. Medicated eye drops such as those listed above contain ingredients that constrict blood vessels making the eyes appear white and moist, but don’t lubricate the eyes effectively and have a rebound effect that gives them an addictive quality.
-Hot Compress. The goal of a hot compress is to allow your body to naturally create more oil from the Meibomian glands located inside both the upper and lower lids. There are many ways to preform a hot compress all with the same goal to heat these glands and apply pressure to coax the oil from the glands and melt the waxy deposits on the lid margins. Anything that can hold heat will work well as a compress: a wash cloth with hot water, dry rice microwaved inside a (clean) sock or commercial products can all be used. The temperature should be very warm to hot without burning the skin, and the compress should be applied along with gentle pressure for 5 min 2-4 times/day depending on the severity of the dry eye.
-Lid Scrubs. Cleaning the eye lid margins where the meibomian glands release their oil is very important to maintaining a healthy lipid tear layer. Proper lid hygiene can be preformed with a moist Q-tip with baby shampoo gently scrubbing the knife edge of the lid (right along the lash line). Ocusoft, a commercial product can also be used to clean the lid margins. This is generally preformed 1-2 times/day.
-Omega 3 Fatty Acids/Fish Oil Supplements. 2000Mg/ day of essential fatty acids from fish oil can also help decrease lid inflammation and improve the quality of the tear film. If fish oil supplements can not be tolerated (they can leave an aftertaste for some people), flax seed oil can also be used.
-Boric Acid EyeWash Solution. This over-the-counter remedy used once per day will clean away debris and allergens in the tear film leaving the eye feeling fresh and comfortable. This remedy is especially useful with those suffering from ocular allergies.
In most cases we will begin with these homeopathic remedies, but if dry eye persists, further measures can be perused.
-Restasis Prescription eye drops. These medicated eye drops have been proven to increase the aqueous layer of the tear film in those who have a “volume-related” dry eye. While this twice per day eye drop is very helpful, it does take about 3 months of continuous use to see the effects, so concurrent treatment will often be initiated.
-Punctal Plugs. These small silicone plugs can be inserted either temporarily or permanently into the puncta, or drainage opening of the eye lids. Blocking the drainage duct allows more tears to remain trapped within the eyes keeping them better lubricated.
-Prescription antibiotics. Doxycycline can be given orally to decrease inflammation caused by staph bacterial inside the eye lids. This can be helpful in persistent dry eye.
At For Your Eyes Only Optometric Center, we can do a detailed evaluation of your tear layer and establish a customized treatment plan to alleviate any of your dry eye symptoms.