Symptoms

Dry eye is frequently under-diagnosed.  The symptoms often develop subtly and are often overlooked until the problem is severe.  Dry eye affects women much more frequently than men. Typical symptoms include:

• Watery eyes
• The feeling of sand or grit in your eyes
• A burning sensation, worsened by heated rooms or air conditioning
• Vision that becomes blurred after periods of reading, watching TV, or using a computer

Causes

• Aging
• Diseases including Sjogren’s Syndrome, rheumatoid arthritis, Parkinson’s and diabetes
• Hormonal changes, particularly after menopause
• Certain prescription medications
• Hot dry or windy conditions
• Reading, using a computer or watching TV
• Some types of eye surgery, including LASIK can aggravate dry eye

Treatment

General measures: Dry eyes can be exacerbated by smoky environments, dust and air conditioning, and by our natural tendency to reduce our blink rate when concentrating. Purposefully blinking, especially during computer use and resting tired eyes are basic steps that can be taken to minimize discomfort. Using a humidifier, especially in the winter, can also help by adding moisture to the dry indoor air.

Artificial tears   For mild and moderate cases, supplemental lubrication is the most important part of treatment. Application of artificial tears at least 4 to 6 times per day can provide temporary relief.  Mineral oils in artificial tears thicken or replace the lipid layer of the tear film to increase tear stability and tear break up time. With each blink of the eye, it re-lubricates to provide prolonged relief.

Artificial tear ointments.   Lubricating tear ointments such as Retaine PM can be used during the day, but they generally are used at bedtime due to poor vision after application. Application requires pulling down the eyelid and applying a small amount inside. Depending on the severity of the condition, it may be applied from every hour to just at bedtime.

Omega 3s Consumption of dark fleshed fish containing dietary omega-3 fatty acids is associated with a decreased incidence of dry eye syndrome. Alternatively, dietary supplements of Fish oil capsules can be taken daily to provide the recommended intake necessary to relieve dry eye.

Prescription Dry Eye Drops  Different medicated eye drops such as Restasis, Xiidra and Cequa can be used twice daily with added effect. Topical cyclosporine A is an immunosuppressant that decreases surface inflammation. Usually, 1 drop of Restasis is instilled in each eye twice a day. The effects of Restasis on dry eyes do not occur immediately, but an overall relief in dry eye symptoms is most often achieved at 3 to 6 months after the start of Restasis treatment.

Punctal plugs  In each eye, there are little openings that drain tears into the tear ducts called puncta. There are methods to partially or completely close the tear ducts. This blocks the flow of tears into the nose, and thus more tears are available to the eyes. Punctal plugs are inserted into the puncta to block tear drainage, mainly for people who have not found dry eye relief with eye drops.

Punctal plug insertion is a painless procedure. Sometimes temporary punctal plugs are placed initially, where a plug that will dissolve quickly is inserted into the tear drain of the lower eyelid. This can be done to determine whether permanent plugs can provide an adequate supply of tears.

If temporary plugging of the tear drains works well, then silicone plugs may be used later on. The plugs will hold tears around the eyes as long as they are in place. Many patients find that the plugs improve comfort and reduce the need for artificial tears.