Dry Eye Treatment

WHAT IS DRY EYE?

When a patient says that they have dry eyes, I hold on to my seat a little bit tighter. 

Most patients that have dry eye syndrome describe it as: irritated and gritty, the feeling of something in the eye such as an eyelash, constant watery eyes, a lot of mucus around the eyes in the morning, burning sensation and other general discomforts. Other times, patients experience the visual side effects of dry eyes such as blurry or inconsistent vision, or decreased contrast.

When I diagnose their symptoms as dry eyes, I often get these follow up questions; 

“What are dry eyes?  How do I get dry eyes?  What causes it? How come my lubrication drops aren’t working?  What is the cure or answer to my problem?”

Before we dive deep into dry eyes, let’s first understand why we need tears and why the absence of tears causes a big problem to the health of our eyes and vision quality.

We see the world through a semi-perfect lens called the cornea that is covered with a very thin layer of liquid called tears. Tears provide the cornea with oxygen, keeps the nerves on the cornea from becoming irritated, and gives us a clear and smoother surface to look through.  So if tears are absent or inadequate, the cornea feels irritated (like something is in the eyes) or the vision fluctuates and decreases the overall quality of vision, and in some cases, can actually damage the cornea from a lack of oxygen.  

“So how come my eyes feel really dry but they are constantly watering?”

Sometimes, as a response to severely dry eyes, the body tries to overcompensate by producing a bunch of tears and dumping them all out at once.  Other times, the tears that are produced are not of the right consistency; they are too runny and cannot adhere to the surface of the eye correctly, and instead run down your cheek and face.  

“So what is causing my eyes to feel dry?”

Generally speaking there are three types of dry eyes. 

The first and most common type is called evaporative dry eyes.  In this situation, your eyes are producing enough tears, but they evaporate too quickly.  Near our eyes, are small oil glands (called meibomian glands) that secrete oils to keep the surface of the eyes lubricated by keeping our tears from evaporating too quickly. 

The second type is called aqueous deficiency dry eyes, which means that the eyes are not producing enough tears.  Lacrimal glands are responsible for the production of tears.  Autoimmune conditions like Sjögren's, chemotherapy, radiation or other health conditions can cause the lacrimal glands to malfunction. 

The third type is a combination of the previous two types.

“What causes my meibomian glands to malfunction?”

One key word: Inflammation.

Generally speaking, inflammation in the body or specifically in the eyes can cause the meibomian glands to secrete much thicker oils than needed, and eventually shut down and stop the production of oils entirely.  While anti-inflammatory drops can mask the effects of inflammation and decrease the pain of dry eyes significantly, our true goal for our patients is to get the meibomian glands to produce better, healthier oils.

Another cause of inflammation in the glands around the eyes is the overactivity of bacteria, also known as Demodex, which typically can be managed by better eyelid hygiene. However, even patients that have excellent eyelid hygiene can still have overgrowth of Demodex, in which case an additional hypochlorous spray could be added to your nightly routine.

Acne medication such as Accutane, retinol-containing skincare products, Botox, certain makeups, eyelash serums, and glaucoma drops can also cause meibomian gland dysfunction.

“What is the cure or answer to my problem?”

Managing other health conditions can indirectly decrease the severity of dry eyes. For example, our patients who suffer from rheumatoid arthritis, a condition that typically affects the patient’s joints, can experience meibomian gland dysfunction.  Improvement in the care of rheumatoid arthritis, in addition to adding hypochlorous spray, can greatly improve the dryness of the eyes.

Changing eating habits has shown to greatly correlate the inflammation in the bodies, and eyes.  Foods such as processed white sugars, are extremely inflammatory to the body.  Reducing the amounts of these kinds of foods in your every day diet can greatly improve your ocular and overall health.  

Excessive use of computers and backlit devices can also cause dry eyes in two ways. First, when we are on computers or using our phones for an extended amount of time, we tend to blink substantially less.  Blinking helps the spread of tears and oils from the glands to the eyes.  Secondly, long hours on the computer or with up-close devices is stressful to the trigeminal nerve, which is the largest nerve in the head.  When the trigeminal nerve is stressed or fatigued, it can translate to headaches, dizziness and dry eyes. A solution for this is to take frequent breaks from the computer every few hours.

The rest of the reasons for dry eyes are numerous and can vary greatly from person to person. Managing dry eyes requires knowing the root cause of the issue.  There is not a one-size-fits-all solution to resolve dry eyes; one solution for one patient may not be as successful to another.  But the good news is that there are many solutions, such as drops and therapies!  

Give us a call, schedule your consultation, and let's get to the root of this thing !!