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DESCRIPTION
Dry eyes occur when the tear ducts do not produce enough fluid (tears) to keep the eyes moist, resulting in burning and irritation. This problem is more common in women than in men, and women's susceptibility increases after menopause.
Contact lens wearers are particularly prone to develop dry eye problems. Dry eyes generally stem from a lack of vitamin A. This problem often comes with age, but it can also be caused by certain drugs, including antidepressant imipramine (Tofranil), beta-blockers (used for treatment of high blood pressure and heart problems), and marijuana, birth control pills, and antihistamines (used for allergies).
DRY EYE SYNDROME OVERVIEW
To help keep your eyes comfortable and your vision optimal, a normal, thin film of tears coats your eyes. Three main layers make up this tear film:
- The innermost layer is the thinnest. It is a layer of mucin (or mucus). This very thin layer of mucus is produced by the cells in the conjunctiva (the clear skin that lines the eye). The mucus helps the overlying watery layer to spread evenly over the eye.
- The middle (or aqueous) layer is the largest and the thickest. This layer is essentially a very dilute saltwater solution. The lacrimal glands under the upper lids and the accessory tear glands produce this watery layer. This layer's function is to keep the eye moist and comfortable, as well as to help flush out any dust, debris, or foreign objects that may get into the eye. Defects of the aqueous layer are the most common cause of dry eye syndrome, also referred to as keratoconjunctivitis sicca (KCS).
- The most superficial layer is a very thin layer of lipids (fats or oils). These lipids are produced by the meibomian glands and the glands of Zeis (oil glands in the eyelids). The main function of this lipid layer is to help decrease evaporation of the watery layer beneath it.
Dry eye syndrome (DES) is a common disorder of the tear film, affecting a significant percentage of the population, especially those older than 40 years of age. The estimated number of people affected ranges from 25-30 million in the United States. Worldwide, the incidence rate closely parallels that of the United States. DES can affect any race and is more common in women than in men.
DRY EYE SYNDROME CAUSES
DES is a common disorder of the normal tear film that results from one of the following:
- Decreased tear production.
- Excessive tear evaporation.
- An abnormality in the production of mucus or lipids normally found in the tear layer.
Aqueous (watery) tear deficiency is caused by either poor production of watery tears or excessive evaporation of the watery tear layer.
- Poor production of tears by the tear glands may be a result of age, hormonal changes, or various autoimmune diseases, such as primary Sjögren syndrome, rheumatoid arthritis, or lupus.
- Evaporative loss of the watery tear layer is usually a result of an insufficient overlying lipid layer.
- Some medications, such as antihistamines, antidepressants, beta-blockers, and oral contraceptives, may decrease tear production.
If blinking is decreased or if the eyelids cannot be closed, the eyes may dry out because of tear evaporation.
- When you read, watch TV, or perform a task that requires close attention with your eyes, you may not blink as often. This decreased blinking allows excessive evaporation of the tears.
- Certain conditions, such as stroke or Bell's palsy, make it difficult to close your eyes on your own. As a result, your eyes may become dry from tear evaporation.
Abnormal production of mucin by the conjunctiva may occur.
- This can result from chemical (alkali) burns to the eye or as a result of different autoimmune diseases, such as Stevens-Johnson syndrome and cicatricial pemphigoid.
- This abnormal production of mucin leads to poor spreading of the tears over the surface of the eye. The surface of the eye can dry out and even become damaged, even though more than enough watery tears may be present.
Insufficient lipid layers are the result of meibomian gland dysfunction, as with rosacea or as a result of taking oral isotretinoin medication.
- Meibomian glands are the oil glands in the eyelids that produce the lipid layer.
- If the oil glands become blocked or if the oil is too thick, there may not be enough oil to cover the watery tear layer to prevent its evaporation.
- Also, if an infection is present along the eyelids or the eyelashes, called blepharitis, the bacteria may breakdown the oil so there may not be enough oil.
DRY EYE SYNDROME SYMPTOMS
If you have DES, you may also experience the following symptoms:
- Dry, gritty/scratchy, or filmy feeling in the eyes.
- Burning or itching in the eyes.
- Redness of the eyes.
- Blurred vision.
- A sensation of having a foreign body in the eyes.
- Light sensitivity.
Symptoms seem to worsen in dry climates, in windy conditions, with higher temperatures, with lower humidity, with prolonged use of your eyes (for example, reading, watching TV), and toward the end of the day.
Sometimes a symptom of DES may actually be intermittent excessive tearing with DES. When your eye becomes slightly dry and irritated, it may initiate reflex tearing with production of a large amount of tears all at once to try to get moist and comfortable again. Unfortunately, your eye can only handle so many tears at any one time; the rest pour over your eyelids and down your cheeks. Those tears that pour down your cheeks do not help your eyes and are wasted. A short time later, your eyes will become slightly dry and irritated again, and the whole process may repeat itself.
MEDICAL ATTENTION
You should seek medical attention if you routinely experience any of the following symptoms, you should probably see your ophthalmologist (a medical health care provider who specializes in eye care and surgery):
- Eye pain.
- Excessive tearing.
- Dry, gritty/scratchy, or filmy feeling in the eyes.
- Burning or itching of the eyes.
- Redness of the eyes.
- Blurred vision.
- A sensation of having a foreign body in the eyes, or light sensitivity.
See your health care provider if you have dry eyes. It may be a symptom of a more serious condition, such as rheumatoid arthritis or lupus. Also, constant irritation to the eye as a result of dryness can result in injury and damage.
QUESTIONS FOR YOUR HEALTH CARE PROVIDER
Is there a specific cause for my dry eyes?
What is the most effective way to treat my dry eyes?
Is there anything I can do to decrease the need for eyedrops or artificial tears?
EXAMS & TESTS
During your eye examination, your ophthalmologist will most likely be able to diagnose DES just from hearing your complaints regarding your eyes. As part of your eye examination, the following tests may also be performed.
- The front of your eyes are examined using a special microscope, called a slit lamp.
- The amount and thickness of the tear film are inspected.
- The stability of the tear film is assessed by checking the tear break-up time.
- The conjunctiva is examined to determine if it is too dry.
- The cornea is checked to see if it has dried out or become damaged.
Different dyes may be used during your eye examination.
- Fluorescein is a yellow dye that stains the cornea where the epithelial (surface) cells have been worn away because of the lack of an adequate protective tear film.
- Rose Bengal is a red dye that stains the cornea and the conjunctiva where the cells are dead or dying as well as where healthy cells are inadequately protected by the tear film.
- Lissamon Green is a green dye which likewise can help differentiate between normal and abnormal surface cells of the cornea and conjunctiva.
Schirmer tests measure the amount of tears produced by your eyes. Your ophthalmologist places the end of a thin strip of filter paper just inside the lower eyelid. After a minute, the filter paper is removed and the amount of wetting is measured. Less wetting of the filter paper is more indicative of DES.
The osmolarity (salt content) of the tears may be measured. This is a newer test which has been developed to aid in the diagnosis of DES.
If autoimmune diseases are suspected as a cause of DES, blood tests may be performed. These blood tests check for the presence of different autoantibodies that may be associated with DES.
Rarely a biopsy of the salivary glands may be performed. Certain disease processes affect both the salivary glands, which produce saliva in your mouth, and the lacrimal glands, which produce tears.
DRY EYE SYNDROME TREATMENT RECOMMENDATIONS
These recommendations are given as a home treatment to help alleviate your symptoms of DES.
Drink at least 10 glasses (80 ounces) of water every day. Steam-distilled or quality bottled water is best.
Hot or Warm compresses can be used to relieve dry eyes. Soak a washcloth in hot water and place it over your eye for 10 minutes two times a day. This method may stimulate your glands to produce more oil by warming the oil in the oil glands, making it flow more easily, which will keep your tears from evaporating as quickly. Eyelid scrubs or massages with a baby shampoo help by providing a thicker, more stable lipid layer. This is especially helpful if you have meibomian gland dysfunction, rosacea, or blepharitis. The massaging action helps to get the oil of the glands. The cleansing action decreases the number of bacteria that break down the oil.
If your tear ducts are swollen, add more calcium to your diet and avoid processed foods.
Use a humidifier to add moisture to the air in your home or workplace. Lack of humidity may be the source of your dry eyes. Get a hygrometer to measure the humidity, then add the humidifier to raise the level. With more moisture in the air, your tears evaporate more slowly, keeping your eyes more comfortable. Both furnaces in the winter and air conditioning in the summer decrease the humidity in the air.
Wear wraparound glasses on windy days. Excessive air movement dries out your eyes. Avoid having excessive air movement by decreasing the speed of ceiling fans and/or oscillating fans.
Avoid cigarette smoke and other types of smoke. Large amounts of dust or other particulate matter in the air may worsen the symptoms of dry eye. In those situations, an air filter may be helpful.
Avoid products that claim they can "get the red out". Some over-the-counter drops used to relieve red eyes contain vasoconstrictors that can further dry your eyes, especially if used for an extended period of time.
Limit your use of hair dryers. Allow your hair to dry naturally. Shield your eyes from direct heat blasts from hair dryers, open ovens and other heat sources.
Computer use, watching television, reading or other close work where you need to concentrate can cause or exacerbate dry eye syndrome. When you concentrate you do not blink as often and therefore your eyes are not being lubricated. Try to blink more frequently and take frequent breaks to allow your eyes to rest and become moist and comfortable again. Closing your eyes for 10 seconds every 5 to 10 minutes will also increase your comfort.
Contact lenses are another possible cause. Use a eye lubricant specially made for contact lenses or talk to your eye care provider.
Artificial tears are safe and effective for keeping the eyes moist. Choose a product that is preservative-free, such as Cellufresh (Refresh Plus) from Allergan, Dry Eye Therapy from Bausch & Lomb, or Tears Naturale from Alcon. Artificial tears and lubricating eyedrops and gels (available OTC) help provide more moisture and lubrication for the surface of your eye. They are typically used about 4 times a day, but they can be used as often as needed. Preservative-free solutions are recommended if you wish to use artificial tears more than 6 times daily. There is no single eye drop product that is best for everyone. Each individual will determine which drop provides the most relief from symptoms. Some drops may have a longer effect than others. If you wear contact lenses, be sure to read product labels before using. You may have to remove your contacts before using the eye drops or get a product that states it is safe for contact lenses. Always follow package instructions for proper use.
Lubricating eye ointments are much thicker than eyedrops and gels. Because ointments are so thick, they last much longer than eyedrops and gels. However, because of their thickness, ointments may blur your vision if used during the day. Therefore, they are typically used to lubricate the eyes overnight while you are asleep. If you wear contact lenses, be sure to remove them before using an ointment and follow the package instructions for proper use.
Similasan Eye Drops #1 and #2 are soothing homeopathic eyedrops containing Belladonna, Euphrasia, and Mercurius sublamitus and Apis mellifica, Euphrasia, and Sabadilla, respectively.
CONSIDERATIONS
In some cases, an ophthalmologist may perform a procedure to close the internal tear ducts, through which some tears drain from the eyes into the nose, to conserve tears and keep the eyes moist.
Contact lenses made of a material called sulfoxide hydrogel may hold promise for people who currently cannot wear contact lenses because they are prone to dry eyes or frequent eye infections. The new material holds more water than current lens materials. It is currently being tested in clinical trials.
Sjogren's syndrome is a disorder that can cause dryness in the eyes.
DES cannot be prevented. If you develop DES, you can help decrease its effects through some of the self-care suggestions listed above.
MEDICAL TREATMENT
Although no cure exists for DES, many treatments are available. Treatment is dependent on the cause and severity of DES. You may only require a humidifier or occasional eye drops, or you may require surgery to help treat DES. Over-the-counter lubricating eyedrops, commonly referred to as artificial tears, may help relieve your dry eyes. Some examples of these products include 20/20 Tears, Celluvisc, Comfort Tears, Dry Eyes, Murine, Refresh, and Tears Naturale. Your ophthalmologist may also prescribe medications to help with DES.
PRESCRIPTION MEDICATION
Certain prescription medications may help with DES. Eye lubricants may be prescribed, such as Lacrisert, an artificial tear insert. The insert is similar to a contact lens and is inserted one to two times per day. Cellulose is contained in the insert and acts to stabilize and thicken the film of tears over the eyes and to prolong the time the tear film works. The artificial tear insert must be properly inserted, otherwise corneal abrasion may occur.
Cyclosporine A 0.5% (Restasis) helps decrease any inflammation on the surface of your eye. This inflammation is thought to decrease the ability of your eyes to maintain a healthy tear film. Used twice a day, cyclosporine 0.5% helps you make healthier tears on your own.
Corticosteroid drops (Lotemax, Alrex, FML, Vexol), either alone or used in conjunction with Cyclosporine, reduce signs and symptoms of dry eye. Although the FDA has not yet approved this group of drops for the treatment of DES, they are being successfully used by many ophthalmologists. Corticosteroid drops, if used in excess, may have some side effects, but new formulations with fewer side effects have become available. Like all medications, these should only be used under your health care provider's supervision and according to her or his instructions.
Nonsteroidal anti-inflammatory drops (Voltaren, Acular, Nevanac, Xibrom) likewise reduce the inflammation associated with DES.
Antibiotics are used if you have blepharitis or meibomian gland dysfunction. Antibiotic ophthalmic ointments, such as erythromycin and bacitracin, among others, are used at night for about seven to 10 days to decrease the number of bacteria that break down the lipid layer of your tear film. These ointments also lubricate your eyes overnight. Oral antibiotics, particularly tetracycline and doxycycline, not only help to decrease the number of bacteria but also help to make the oil more fluid so it flows out of the oil glands more easily. This is often used if you have rosacea. There are many people who have rosacea of the eyelids and do not have the typical changes of rosacea on the rest of the face.
SURGERY
Different minor surgical procedures may help in the treatment of DES.
Near the inner corner of each eyelid are small openings, called punctae, that are the beginning of the normal tear drainage system. A procedure known as punctal occlusion can help by decreasing the normal drainage of your tears off the eye and down the tear drainage system, into the back of your nose, and down your throat. This occlusion is usually a very simple office procedure and only takes a few minutes.
- Different punctal plugs or lacrimal canalicular plugs can be placed at or just inside these openings to block the normal drainage of tears down the tear drainage system. Just like a stopper that you put in the drain of a sink to keep the water from flowing down the drain, these plugs keep the tears that you have from flowing down the tear drainage system. Therefore, your eyes stay more moist and comfortable, even if you have fewer tears. These plugs can usually be removed very easily, if necessary.
- Sometimes, in severe cases of DES, these openings are permanently closed, usually by cautery (burning) or laser. This accomplishes the same thing as the plugs, but it is very difficult, if not impossible, to reverse.
If you have difficulty closing your eyes for any reason, your eye may dry out because of tear evaporation.
- Lateral tarsorrhaphy is a procedure during which the lateral (outside) one-third of your eyelids are sewn together to decrease the ability of your eye to open widely and to help your eye close more easily.
- If stroke or nerve damage keeps your eyelids from closing properly, a small gold weight may be implanted into your upper eyelid to help it close.
OTHER THERAPY
Sometimes, people sleep with their eyes slightly open. If you do sleep this way, you might want to actually tape your eyes shut at night.
Moisture chambers are plastic shields (similar to swim goggles) that help keep the eyes from drying out by decreasing the evaporation of tears off the eye. The moisture chambers may be used just at night if you sleep with your eyes slightly open, or they may be used all day, if necessary.
MEDICAL FOLLOW-UP
If you have mild DES, you may only need annual follow-up examinations with your ophthalmologist. If you have more serious DES, more frequent follow-up appointments are required, based on the severity of your disease.
PROGNOSIS
Most people with DES have nothing to worry about more than an annoying inconvenience. Although your symptoms might make activities of daily living (for example, reading, watching TV, driving) miserable for you, no long-term vision loss is to be expected. For those with more severe DES, significant drying of the surface of the eye can lead to an increased risk of serious infections. Ultimately, scarring, thinning, and even perforation of the cornea may occur. As a result, vision, or even the eye itself, may be permanently lost.
SUPPORT & COUNSELING
Support groups and counseling for people with DES are available through various organizations specializing in eye care.
HOLISTIC RECOMMENDATIONS & NUTRITION
NUTRITIONAL SUPPLEMENT RECOMMENDATIONS
The following nutrients are important for healing once appropriate local treatment has been administered. Unless otherwise specified, the following recommended doses are for those over the age of 18. For a child between 12 and 17 years old, reduce the dose to 3/4 the recommended amount. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended amount.
DRY EYE SUPPLEMENTS & PRODUCTS
Information, supplements and products for dry eye syndrome, a condition which occurs when tear ducts do not produce enough fluid to sufficiently moisten the eyes, causing irritation and burning.
Beta Carotene (Natural Dunaliella Salina), 100% Natural, Nature's Way, 25,000 IU, 100 Softgels
Nature's Way Beta Carotene is 100% all natural from Dunaliella Salina.CamoClear Soothing Eye Wash, Herbal Eye Wash, CamoCare, 10 Single Use Droppers
CamoClear Soothing Herbal Eye wash gives you instant, natural and long lasting relief for dry, tired or irritated eyes, due to dust, pollen, pollution, smoke irritants, sun glare, wind, swimming, air conditioning/heating and computer work.Clear Eye Herbal Tea, 20 Tea Bags
To nurture the eye and pacify the nervous system, protect retina, and improve eyesight.Clear Eye & Sharp Ear, TCM Formula, Shanze Xiaozhi, 60 Caps
Clear Eye & Sharp Ear Chinese Formulas are made of extracts from astragalus root, pueraria root, seashore vitex, common peony root, cimicifuge, phellodendron, licorice, cnidium, Chinese angelica root (Dong Quai) and ginseng.Digestive Enzymes, 750 mg, 100 Caps
Since cooking destroys many of the digestive enzymes in food, taking plant fiber-based digestive enzymes aids in digesting even the heaviest meal.Dry Eye Relief Eye Drops, Homeopathic, 0.33 fl. oz.
Eye Doctor recommended Similasan Eye Drops for dry, red eyes stimulate the eye's natural ability to fight dryness and clear redness due to smog, stress, age, contact lens wear, etc.Essential Fatty Acids, By Deborah Lee
"Woodland Health Series". Describes the benefits and functions of the three essential fatty acids, linoleic acid, linolenic acid and arachidonic acid.EyeFactor HAÖ for Healthy Vision with HA, Hyalogic, 120 Count
Hyaluronic acid makes up 95% of the fluid inside the eye. Acts as a shock absorber for the eye and also serves to transport nutrients into the eye.Eye Support Formula With Bilberry, Lutein & Antioxidants, NOW Foods, 60 Caps
NOW "Health Care Provider Recommended" Eye Support Formula eye supplement offers a full range of antioxidant nutrients which may aid in maintaining some visual functions with Lutein and Bilberry.Fisol Fish Oil Supplement, EPA DHA, Enteric Coated, Nature's Way, 500 mg, 90 Softgels
Fisol, enteric coated, fish oil supplement delivers 30% EPA and 20% DHA. The unique coating withstands stomach acid so Fisol dissolves in the small intestine and maximizes the body's absorption of Omega-3 Essential Fatty Acids.Magnesium Citrate Complex, Nature's Way, 250 mg, 100 Caps
Nature's Way Magnesium Citrate is an advanced chelate from which enhances absorption of magnesium by providing excellent solubility.Nature's Way Ginkgold Eyes Plus Lutein, 20 mg, Vegetarian, Eye Supplement, 60 Caps
Nature's Way Ginkgold eye supplement supports visual function and is the only Ginkgo extract shown to stimulate activity in all areas of the brainNeuromins DHA Supplement (Docosahexaenoic Acid), Nature's Way, 100 mg, 60 Softgels
Neuromins brand high quality DHA Supplement is sourced from microalgae and fortified with Vitamin C and E.Once Daily Multi-Vitamin With Iron, All Natural, Lactose Free, Nature's Way, 100 Tabs
Nature's Way Daily Multi Vitamin with Iron provides many of the essential nutrients that modern diets may lack. They are useful for protection, growth and maintenance of body systems as they age.Selenium, 100% Natural, 200 mcg, 100 Caps
Selenium is an essential component of glutathione, the body's most potent natural antioxidant system. It is a popular choice in many antioxidant regimens.Synthovial Seven, Pure Hyaluronic Acid, Hyalogic, 1 oz.
Hyaluronic Acid (HA) has been proven by numerous medical studies to alleviate pain and suffering from arthritis of the knee and other joints.Taurine, Free Form, NOW Foods, 500 mg, 100 Caps
Taurine is a conditionally essential amino acid which is not utilized in protein synthesis, but is mainly found free in most tissues, especially throughout the nervous system.Visi Clear With Lutein, Bilberry, Zeaxanthin & Lycopene, 60 Caps
Visi Clear Eye Vitamin with Lutein and Bilberry is one of the few products that provide both lutein and whole kale and Zeaxanthin, another powerful carotenoid, to maximize antioxidant activity.Vision Formula With Lutein & Bilberry, Eye Supplement, 60 Caps
Vision formula with Lutein & Bilberry Eye Supplement supports normal eye function by utilizing Lutein, a key carotenoid found in fruits and vegetables, which protects the retina by blocking harmful blue light.Vitamin A, 100% Natural, Nature's Way, 100 Softgels
Nature's Way Vitamin A is 100% natural from fish liver oil. It contains no artificial ingredients or preservatives.Vitamin B-12 Supplements & Products
An assortment of various B-12 products.Zinc Chelate, 100% Natural, Zinc Supplement, Nature's Way, 30 mg, 100 Caps
Nature's Way chelated Zinc supplement is 100% natural chelated with an advanced amino acid complex for superior absorption.
HerbalRemedies: Dry Eye Syndrome Supplements, Information & Products
HerbalRemedies: Dry Eye Syndrome Information
HerbalRemedies: Eye Problem Information
Aging Eyes: The Eye Digest - Dry Eye Treatments - List of Commercial DES Products & Ingredients
FOR MORE INFORMATION
American Academy of Ophthalmology
655 Beach Street
Box 7424
San Francisco, CA 94120
415-561-8500
Website: American Academy of Ophthalmology
RELATED ONLINE LINKS
Dry Eye Syndrome
How to Relieve Dry Eye Syndrome
Dry Eye Syndromes Fact Sheet
Dry Eyes In Winter
Mayo Clinic: Dry Eyes
American Optometric Association: Dry Eye
Focus on Dry Eye - Chronic Dry Eye
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member (such as a child) is having problems distinguishing colors or find colors confusing. This member may need to be tested for color blindness.
You or a family member are having problems with vision and/or you suspect an infection. Call your health care provider immediately if you experience severe eye pain or a sudden change in your vision, such as loss of vision or double vision.
You have any increase of symptoms. You may need frequent changes in your eyeglass prescription. If you have blurred or double vision that develops slowly; are having a problem seeing because of daytime glare or have difficulty driving at night because of glare from headlights, you need to see your health care provider.
You have any unexpected or unusual symptoms. There may be underlying health issues that need to be addressed.
Are having vision problems that are affecting your ability to perform daily activities.
Call your child's health care provider if your baby does not look directly at or respond readily to faces or large, colorful objects by age 2 to 3 months or if your child scowls, squints, or shields his or her eyes more than expected when in sunlight, or light seems to hurt your child's eyes.
You and your family members should have your eyesight checked regularly by your health care provider to rule out any problems and to receive a prescription for contacts or eyeglasses, if they are needed. Preserve you vision... it is very important.
TYPES OF EYE PROBLEMS & DISORDERS
Maintaining Healthy Eyes
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MoonDragon's Health & Wellness: Nutrition Basics - Vitamin A
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Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
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Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
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Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
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The Complete Guide to Natural Healing
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