Though the condition takes its name from the underproduction of tears, it also includes situations where the composition of the tears is inadequate to lubricate and protect the eye. In this case, tear production may be excessive, but counterproductive.
Tears are composed of three layers that help coat and protect the cornea. The outer layer is more oily, preventing evaporation and protecting against outside conditions, while the inner layer interacts directly with the surface of the eye.
The middle layer is the salty aqueous layer. When there’s a problem with excess production in the tear film, it’s typically with the middle layer component. The salt in the tears dries out the surface of the eye, despite the overabundance of fluid. When your eyes are irritated, your body responds by producing more tears, whether the tear film is balanced or not.
Almost anyone may experience dry eye conditions from time to time. The air on airplanes or in air-conditioned rooms is often quite dry and, despite the oily outer layer, enough evaporation can occur to irritate the eyes. Similarly, long exposure to computer or other digital screens tends to reduce your blink rate, which also reduces tear volume.
However, increased tear evaporation is usually a temporary condition. There are situations where dry eye is the symptom of another condition and may not be as easy to relieve. Some conditions cause decreased tear production. These conditions include diabetes, thyroid disorders, lupus, rheumatoid arthritis, and Sjogren’s syndrome — the condition that causes Dr. Charap’s dry eyes.
In other cases, medication is the culprit. Decongestants, antihistamines, and hormone replacement therapy are just a few drugs that may cause dry eye.
Tear film imbalances may arise due to clogged oil ducts, which often occur in patients with blepharitis, rosacea, and other skin disorders, resulting in inflammation of the pores of the eyelids.
Typically, treating the underlying condition relieves dry eye symptoms. Dr. Charap is a specialist and is equipped to analyze the composition of your tears in greater detail than general ophthalmologists -- an analysis that’s often crucial to the accurate diagnosis of your dry eye. He may even prescribe medications, including anti-inflammatories, tear-stimulating drugs, and artificial tears.
In the past, ophthalmologists and other eye care professionals treated dry eye in ad-hoc, or “lets try this, and if that doesn’t work try something else” approach. Often this approach had unfortunate consequences. For example, if the the tear secretions contain inflammatory proteins, inserting plugs into the tear drainage sites (punctal plugs) only kept the inflamed tear around longer, worsening the condition. With newer technology, we can isolate the components of the tear film, or note its absence, and treat in a more rational fashion, addressing both lid and aqueous tear problems.
Artificial tears, topical and systemic antibiotics, specialized medicine such as steroids, cyclosporine, and the newest drug called Xiidra®, all have their place in the treatment regimen. Various forms of lid hygiene, from simple lid heating and cleaning pads to more advanced lid heating and draining devices are available, if needed. Punctal plugs still have their benefits once inflammation is under control.
Changes in medication -- including androgens, sedatives, antihistamines, pain relievers, and especially retinoids -- can produce immediate improvement. Obviously some of these medications are necessary to treat other conditions, but when possible, we work with your doctors to see if medication substitution is an option.
To learn more about dry eye treatment, please click here.
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