Friday, January 1, 2010

Dry Eyes: Causes and How to Treat

Dry eyes can be a very challenging and uncomfortable problem for those patients that suffer with this condition. Dry eyes can sometimes be a mild problem that only causes inconsistent discomfort. On the other extreme it can be severly debiltating causing blurred vision, constant discomfort, and even eye pain. Dry eyes can even make the patient more susceptible to eye infections.

The causes of dry eye can be physical as well as environmental. Some patients just do not make enough tears. Tears are primarily created in a gland that sits just above the outside part of the eye and behind the bone that sits above the eye. This gland is called the "lacrimal gland". With age this gland produces fewer tears. There are other sources of tearing, called accessory lacrimal sources, but the majority of tearing comes from the lacrimal gland. It is confusing for patients to be told by their eye doctors that their eyes are dry when the primary complaint that is often offered to their eye doctor is that their eyes often tear or "water" at the end of the day or in the morning or during certain tasks. Here's what's happening: There are two types of tearing that patients encounter. The first is the normal slow and constant tearing from the lacrimal gland that keeps the tissues of the eye lubricated. If this mechanism is working there is normally not an issue with dry eyes. If there is not sufficient lacrimation from the lacrimal gland this causes the tissues of the eye to dry out. This results in dry and irritated eye tissues which causes the eyes to produce a reflexive amount of tearing in response to the irritation which yields a great deal of tears in response to the irritation. A similar abundance of tears occurs when we respond to something that makes us cry because we are saddened or are extremely happy. This excessive tearing is what causes the watery eyes that often bother patients when working on a computer at the end of the day.

The key to keeping the eyes comfortable and normally hydrated is to make sure that the slow constant tearing from the lacrimal gland is maximized. This can present as a real challenge due to many factors. Certain medications cause the eyes to be drier than normal. Certain activities increase eye dryness....especially using a computer...because our blink rate is significantly reduced. Climate can play a role as well. Working indoors in an air conditioned environment can contribute to eye dryness as the air conditioning system pulls water from the air. Not drinking enough water can also contribute to eye dryness.

In addition to the amount of tears that our eyes produce it is important that the quality of the tears is proper. It is important for the eye doctor to not only work to increase the amount of tears that are produced, but to make sure that the quality of the tears is such that there are no inflammatory components in the tear film.

Luckily there are a number of things that can be done to improve tear quantity and tear quality. Sometimes all that is needed is a simple eye drop. If using eye drops on a consistent basis it is important for the drops to be of the "non-preserved" variety. The preservative that is often included in over the counter eyedrops can often cause irritation if used on a long term basis.

Other techniques involve the use of "puntal plugs". These are tiny plugs that are easily inserted into the inside areas of the eye lids. These plugs "dam up" the eye and capture your tears before they can drain away. We have all had the experience of crying and then having to "blow our noses" in response to the tearing. The excess tearing causes some of the tears to spill over onto our face. In addition, some of the tears drain away into an area in the back of our nose through passages that connect this area with the openings in our eyelids that I have mentioned above. It is these openings in the inside area of our eyelids that are "plugged" to "dam up" the eyes. The plugs can be inserted in a simple painless procedure that takes about ten minutes per eye. It is important that the tear quality be good before plugs are inserted. If the plugs are inserted and the tear quality is not good, this can lead to further inflammation and irritation. There is also a medication that can be used to increase tear production. The product is called "Restasis". It consists of topically applied cyclosporin and it is dosed twice a day. This product can be used in conjunction with contact lens wear.

Please contact your eye doctor if you have any issues with dry eyes. Several treatment options exist and your eye doctor can determine the best treatment options for you. Solving dry eye problems can lead to greater eye comfort, healthier eyes, and to more successful contact lens wear.

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