Dry Eye

The Secret of Great Health Care

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Dry Eye

Free Chapter on Dry Eye

The eye needs moisture and lubrication for it to function properly. Without it vision will be compromised and comfort will be minimized. The eye provides its own moisture by producing tears, which are made up of water, oil, mucus and antibodies.

Paradoxically, some patients with dry eyes will have large volumes of tears in the eye. This is the body's response to the dry eye attempting to lubricate the eye. When the body excretes all of these tears in the dry eye, it is not regular tears, mainly just water. It does not have all of the other components of tears and will not provide relief to the symptom of dry eye.

Dry eye can lead to discomfort, pain, stinging or itching. It can also be associated with redness, blurred vision, mucus in the eyes, sensitivity to light or a feeling of something being in the eye.

What causes dry eye

Causes of dry eyes are:

Drying out of the tear film – often due to dry air
The environment – dry air, excessive sun, wind or high altitude
Air conditioning or high heat
Poor tear quality – Tears are made up of oil, water and mucus - if the balance is not optimal than dry eye could be present
Not producing enough tears – more common in older adults
Aging
Eyelid problems such as inflammation of the eyelids or an abnormal position of the eye lids (eyelids turned out or in)
Decreased blinking – which is often seen in those with Parkinson's disease
Imbalance in the tear-flow system
Medications – antihistamines, some antidepressants, Accutane (acne drug), some narcotic pain relievers, diuretics, sleeping pills and some birth control pills
Diseases – Sjogren's syndrome, rheumatoid arthritis

Who needs to see a doctor

Many causes of dry eyes are treatable by environmental manipulation, over-the-counter eye drops and sometimes adjustment in the medications you take. If simple measures to manage dry eye are not working than following up with a health care provider is the next step. If you suspected you have a disease process that causes dry eye, you should see a doctor.

Long-term dry eyes that are not treated can lead to inflammation of the eye and possibly infection or even scarring of the cornea.

Treatment

It is difficult to cure dry eyes, but they can be treated. The first step is to look at the potential causes and see if they can be modified. Some lifestyle modifications can really help with dry eye and should be implemented in those with dry eye (see table 8).

Table 8: Lifestyle modifications for dry eye

Wear goggles when swimming

Cover the eyes with glasses on windy days

Use a humidifier in the home in the winter

Do not rub the eyes

Do not let air blow in your eyes

Blink regularly

Do not smoke

Avoid second hand smoke

If you have inflammation of your eyelids, washing them with diluted baby shampoo can significantly improve eyelid inflammation. Sometimes a doctor will prescribe an antibiotic eye drop. A surgeon can treat misshapen eyelids if they are severe.

Artificial teardrops – both OTC and prescription - are the most common treatment for dry eyes. Not everyone responds to a single eye drop. It often requires some experimentation to determine which is the best option. The ideal eye drop does not contain preservatives. If they do not contain preservatives, they can be used as often as needed. If there is a particular activity that irritates your dry eyes – make sure you use the artificial tears before that activity.

Do not use an eye drop with a redness remover – it can make the red eye worse.

Ointments tend to last for longer periods of time, but they are associated with blurred vision. Using ointments is good before bed.

For those individuals who do not respond to environmental manipulation and eye drops a trip to the doctor may be indicated. The doctor may try one of the following treatment options.

Restasis – a prescription eye drop for dry eyes that helps the body increase tear production and decreases inflammation. One drawback is that many people's eyes burn when they are used.
A procedure to temporary close the tear duct that drains tears from the eye can be tried. If it is helpful the tear duct can be closed permanently.
Specialized contact lenses help hydrate the eye and can be used in severe cases.
Rarely topical steroids are used.
Surgery can be done to close the duct that drains tears into the nose. This will allow more tears to remain in the eye.

To purchase products discussed in this chapter visit The Drug Store.

Over-the-counter products for dry eye

Product	Ingredient	Instructions
Refresh Tears	Carboxymethylcellulose sodium 0.5%	Instill 1 to 2 drops in the eyes as needed
TheraTears	Sodium Carboxymethylcellulose 0.25%	Instill 1 to 2 drops in the eyes as needed
Systane	Polyethylene Glycol 400 0.4% and Propylene Glycol 0.3%	Instill 1 to 2 drops in the eyes as needed
Visine	Glycerin 0.2%, hypromellose 0.2% and Polyethylene glycol 400 1%	Instill 1 to 2 drops in the eyes as needed, 6 years old and older
GenTeal moderate	Hypromellose 0.3%	Instill 1 to 2 drops in the eyes as needed
GenTeal moderate-sever	Carboxymethylcellulose sodium 0.25%, hypromellose 0.3%	Instill 1 to 2 drops in the eyes as needed
GenTeal PM	Mineral oil 15% and white petrolatum 85%	Place ¼ on an inch in the lower lid, one or more time a day
Refresh Lacri-Lube	Mineral oil 42.5% and white petrolatum 56.8%	Place ¼ on an inch in the lower lid
Advanced Eye relieve	Glycerin 0.3% and propylene glycol 1.0%	Instill 1 to 2 drops in the eyes as needed
Sooth XP	Light mineral oil 1.0% and Minteral oil 4.5%	Instill 1 to 2 drops in the eyes as needed