Dry Eye Types And Treatment

by CRfan

According to recent studies, almost 50% of adults experience dry eye symptoms. Women are more likely to suffer from dry eye than men.

A very common complaint when people visit an eye doctor, along with allergies of the eyes, is dry eye.

The symptoms range from minor irritation to causing devastating, severe problems to the cornea–the eye's front surface.

Tears are part of good vision, and they consist of three distinct layers that nourish eyes. Light strikes tears first while traveling to the retina.

Layers of the Tear Film

  • An inner mucous or mucin layer that goblet cells secrete.
  • The watery layer, or aqueous, which the lacrimal gland in the eyelid secretes.
  • An oily layer, or outer lipid layer that is secreted by the eyelid meibomian glands.

Symptoms of Dry Eye

Common symptoms of dry eye are burning, scratchy, dry sensations that persist. This is mainly all an eye doctor needs to diagnose dry eye. The feeling that a foreign body such as dust or sand is in the eye is another sensation that accompanies dry eye.

It is ironic that a common occurrence with dry eye syndrome is excessive tearing. Because the eye feels dryness, it overreacts and begins to produce an overabundance of tears.

If dry eye becomes severe, the cornea can develop dry spots that may become infected. The cornea can also develop a keratin layer, which is the same hard layer of your skin that is meant to repel water. This condition can lead to scarring and corneal ulcers.

The Cause

Tears bathe the eye and serve other important functions, such as providing oxygen, nourishing the eyes and protecting them from pathogens and bacteria. They also make a smooth film for light that enters the eye so it has a straight path to the retina and is not scattered.

As we age, the production of tears decreases. Producing tears is also closely tied to the effects of medication as well as hormones. This is one reason women may suffer more from dry eyes than men, especially postmenopausal or even during menopause. In addition, common medications such as birth control pills, blood pressure medication, antihistamines and antidepressants interfere with tear production as a side effect.

Dry eye is also caused when systemic autoimmune diseases affect the lacrimal gland. Varying degrees of dry eye may be caused by such diseases as Sjogren's syndrome, rheumatoid arthritis, acne rosacea and lupus. Dry eye from such causes may be harder to treat.

Another link to dry eye is contact lenses because they may decrease sensitivity in the cornea. The eye does not produce sufficient tears without the correct feedback from the cornea. Contacts have improved and are now are made to allow the cornea to receive more oxygen. This promotes better corneal feedback and results in better eye health. Some contact lenses are made to have a higher content of water, which may sound as though the increased water is better. It actually may have an opposite effect if the contacts absorb tears from the eye in order to keep the contacts themselves hydrated.

Dry Eye Types

Generally there are two types of dry eye, which are evaporative dry eye and aqueous deficiency dry eye.

Evaporative Dry Eye - The Meibomian glands of the eyelids secrete a lipid layer. Most of the tears' thickness is made up of the aqueous, or watery layer and the outer lipid layer prevents it from evaporating. Sometimes the smooth film the lipid glands provide does not have sufficient secretions of good quality and that leave holes in the smooth film. In that case, tears quickly evaporate. Your doctor can judge the quality of your tears by performing a TBUT—tear breakup time—test. An inferior lipid layer is sometimes caused by an eyelid inflammation called blepharitis.

Aqueous deficiency - Underneath the upper eyelid is a lacrimal gland that secretes the watery middle layer of tears. In aqueous deficiency dry eye, the productions of watery tears is insufficient to keep the entire eye surface coated. Patients with lupus, rheumatoid arthritis or other autoimmune diseases are most likely to have this insufficiency. The eye doctor can perform a phenol red thread test or a Schirmer test to determine the tear production.

There is another type of dry eye that results from eye injuries or chemical burns, but this is more rare. It is diagnosed when the mucous layer, or inner mucin, is insufficient. This layer usually produces a smooth foundation for the other layers of tears.

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Dry Eye Treatment

Dry eye is often not curable and becomes a chronic condition. If medication side effects have caused the dry eye, sometimes if the medication is stopped the problem will clear on its own.

Artificial tears is the mainstay treatment for dry eyes. These lubricant eye drops are applied three or four times during the day. Your doctor can advise you how frequently to use these drops and which are the best ones for you. The thicker drops can provide more lasting results, but they may blur vision. Therefore, it is best not to use them before driving. 

A prescription medication called restasis reduces inflammation, which is often the underlying cause of certain dry eye conditions. 

Lacrisert is another prescription option. It comes in the form of a tiny bead-shaped insert that you place in the lower eyelid. As it melts slowly, a viscous lubricant is released and it lasts for several hours.

Small pieces of silicone or collagen can be inserted into the eyelids' drainage canals are called punctal plugs. This plugs the drainage tubes and keeps the tears in your eyes for a longer period. They are mainly used with aqueous deficient dry eye, but can help with any kind of dry eye.

In the case of severe dry eye, the puncta–the drainage holes for tears–can be scarred shut surgically for difficult cases that resist every other treatment.

Dry eye may also be relieved by proper nutrition. Taking flaxseed oil or Omega-3 fish oil helps to promote lipids of good quality by the Meibomian glands. This will to reduce the tears' evaporation.

Generally, having dry eye prevents people from being good candidates for LASIK, as having dry eye is a common complaint after LASIK surgery. Having LASIK could aggravate dry eyes.

Updated: 07/09/2012, CRfan
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