Dry Eye Syndrome

What is dry eye syndrome?

This occurs when the production of tears is not adequate to wet the eyes. Decreased tear production is seen with maturation and is worsened in dry, windy environments.

What are the symptoms of dry eyes?

A foreign body sensation or the feeling as if something is in the eye is very common. Tearing or watering is another very common finding. Blurred vision that clears with blinking is also frequently seen.

Why do eyes water when they are dry?

There are two tear systems. The first lubricates the eye constantly and these glands reside in the far recesses of the eyelids. The second flushes the eye when an irritant contacts the eye, one becomes emotionally upset or the first tear system does not work adequately. It is the latter case that causes the second system to become active in dry eye syndrome. This system produces tears so rapidly that the tear drainage system cannot keep up. As a result, tears run over the eyelids in a manner similar to rain over running the gutter during a heavy rain.

Does anything make dry eye syndrome worse?

Yes. Low humidity, wind, air travel, forced heating, air conditioning, reading, increasing age, hormonal changes, certain medication, conditions that make symptoms worse either decrease production or increase loss through evaporation.

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Can dry eye syndrome be cured?

No, but it can be treated and controlled much like hypertension or diabetes mellitus.

What treatments are available?

There are several methods of treating dry eye. The mainstay is artificial tears to supplement a person's natural tears. Here, over-the-counter tear supplements are used every 2-12 hours or as needed. There are many brands with different strategies for approximating natural tears. I recommend trying an inexpensive brand and switching to a different type if that is not effective. If artificial tears do not work adequately or the frequency of drop application is inconvenient then punctual plugs are an alternative. Here one or more of the drainage holes are plugged with a piece of silicone. There is one drainage hole in each of the upper and lower eyelids. We usually start with the lower lid and plug the upper lid only if there is extreme dryness. This process is reversible in that the plug may be taken out at any time. This office procedure takes less than a minute and is relatively painless. Sometimes we start with a dissolvable collagen plug trial before placing the more expensive silicone plug. Restasis (cyclosporin) is a prescription drop that has proven to be effective in restoring natural tear function. It requires twice a day use and may take several months to show effect.