Dry Eye Management

What is Dry Eye?

Sometimes people do not produce enough tears or the appropriate quality of tears to keep their eyes healthy and comfortable. This condition is known as dry eye.

Normally the eye constantly bathes itself with tears. By producing tears at a slow and steady rate, the eye stays moist and comfortable. The eye uses two different methods to produce tears. It can make tears at a slow, steady rate to maintain normal eye lubrication. It can also produce large quantities of tears in response to eye irritation or emotion. When a foreign body or dryness irritates the eye, or when a person cries, excessive tearing occurs.

Video: Dry Eyes

This video explains Dry Eye Syndrome, its probable causes, and a number of treatment options.

Symptoms of Dry Eye
  • Stinging or burning eyes
  • Scratchiness
  • Stringy mucous in or around the eyes
  • Excessive eye irritation from cold or wind
  • Excessive tearing
  • Discomfort wearing contact lenses
  • Discomfort or “tired” feeling after reading, computer use, or driving—especially late in the day.(

Excess tearing from dry eye may sound illogical, but it can be understood as the eye’s response to discomfort. If the tears responsible for maintaining lubrication do not keep the eye wet enough, the eye becomes irritated. Eye irritation prompts the gland that makes tears (called the lacrimal gland) to release a large volume of tears, overwhelming the tear drainage system. These excess tears then overflow from your eye.

What Causes Dry Eye?

Tear production normally decreases as we age. Although dry eye can occur in both men and women at any age, women are most often affected. This is especially true after menopause.

People with systemic diseases like lupus, rheumatoid arthritis or thyroid disease often have dry eyes, as do patients with Sjogren’s. A wide variety of common medications can cause dry eye by reducing tear secretion. Be sure to tell Dr. Callahan the names of the medications you are taking.

What is Tear Film?

When you blink, a film of tears spreads over the eye, making the surface of the eye smooth and clear. Without this tear film, good vision is not possible.

The tear film consists of three layers:

  • An oily layer
  • A watery layer
  • A layer of mucus

Each layer has its own purpose. The oily layer, produced by the meibomian glands, forms the outermost surface of the tear film. Its main purpose is to smooth the tear surface and reduce evaporation of tears.

The middle watery layer makes up most of what we ordinarily think of as tears. This layer, produced by the lacrimal glands in the eyelids, cleanses the eye and washes away foreign particles or irritants.

The inner layer consists of mucus produced by the conjunctiva. Mucus allows the watery layer to spread evenly over the surface of the eye and helps the eye remain moist. Without mucus, tears would not stick to the eye.

How is Dry Eye Diagnosed?

Dr. Callahan is usually able to diagnose dry eye by listening to the patient’s history and examining the eyes. This examination includes evaluation of the quality and quantity of tear film, as well as diagnosis of any associated diseases such as infection of the meibomian glands. Special stains are also used to further evaluate ocular surface inflammation and damage.

How is Dry Eye Treated?

Treatment of Associated Conditions:
This may include careful attention to the health of the eyelids, especially around the lashes and meibomian gland openings. In addition, any systemic diseases that may contribute to dry eyes must be addressed.

Adding Tears:
Eye drops (called artificial tears) are similar to your own tears. They lubricate the eyes and help maintain moisture. Many people use artificial tears incorrectly. Tears do not repair the small scratches and irritation on the front of the eye that cause the burning and stinging associated with dry eye. If you wait until your eyes feel dry to put a teardrop in, it will give you temporary relief. The best way to use tears is in a preventive/maintenance manner. If you put the tears in on a regular basis, you will not develop irritation on the surface of your eyes that causes them to feel dry.

We generally recommend that patients with dry eyes use tears at least twice a day for them to be effective. Adding a teardrop prior to sitting down to read, work on the compute, or watch TV. is also helpful.

There are many brands on the market that vary in thickness, amount, and duration of lubrication. You may want to try several to find one that you like. Do not use any drops that claim to “get the red out” or relieve redness. Preservative-free eye drops are available for people who are sensitive to the preservatives in artificial tears. If you use artificial tears more than four times per day, preservative-free tears are best to use.

Increasing Tear Production:
Restatis Ophthalmic Emulsion is a prescription eye drop that helps increase the eye’s natural ability to make tears by decreasing some of the factors associated with ocular inflammation. One drop, twice a day, with continued use might help you make more of your own tears. Because Restasis changes the physiology of the front of the eye in order to be effective, it generally takes three to four months of continued use (along with artificial tears) to notice an improvement in symptoms.

Omega 3 Fatty Acids:
Use of systemic omega-3 fatty acid supplements for dry eye treatment has been reported74to be potentially beneficial, but there have been few studies analyzing their efficacy. The dose associated with treatment of dry eye is 1,000 mg by mouth once a day. This is available as fish Oil or flaxseed oil.

Decreasing Tear Drainage

Punctal Plugs:
Tears leave the eye either by surface evaporation or through the canalicular system depicted below. Various types of plugs can be easily inserted into the punctal to prolong the time that your natural tears, as well as any artificial tears, are present to lubricate the eye.

There are different types of punctal plugs. Temporary plugs can last anywhere from seven days to six months. Some punctal plugs are designed to be permanent. These can be removed if necessary. Insertion of punctal plugs is a non-surgical procedure that is done in the office and generally takes a few minutes. Patients usually notice a decrease in dry eye symptoms within a couple of days.

Patients with dry eyes often use a combination of some or all of the above treatments.