|
 |
Dry Eye: Often Ignored
Many people experience an inadequate tear film or eye discomfort
some time in their lives. In may be in an airplane, a dry, overheated
room or a dusty workplace. But there may be more than 10 million
Americans who have a significant dry eye condition that may be
related to other symptoms.
The classic Sjogren's-Associated dry eye affects up to two
percent of the population. This triad of symptoms includes: dry
eye, dry mouth and arthritis. Dry eyes can be caused by medication,
dehydration, inflammation of the eyelids and/or skin, previous
eye surgery, systemic diseases such as rheumatoid arthritis,
thyroid disease, lupus, sarcoidosis and even poor blinking habits
(such as staring at a computer).
Tears at not just water. They have three separate components:
1.) Oil (from the Meibomian oil glands in the eyelids); 2.) Mucous
(from the goblet cells deep inside the eyelid); 3.) watery tears
(the "aqueous" tears from the lachrymal gland and accessory
lachrymal glands located in the conjunctiva of the eyelids).
The innermost layer of tears in direct contact with the eye
is the mucous layer, which is also call mucin. The mucin
coats the surface of the cornea. The middle layer is the watery
tears, which stick to the mucin and keep the eye moist. The outer
tear layer is composed of oil from the Meibomian glands; it is
deposited like an oil slick on the outside of the watery tears
to slow their evaporation from the surface of the eye. Every
time you blink you sweep the tears across the cornea and into
the drainage ducts called puncta.
The tear film can be evaluated by the use of vital dyes, breakup
time, measurement of tear production (Schirmer test) and even
some very fancy measurements of thickness and chemical constitution
of the tear film. However, your symptoms will often be your best
guide.
The symptoms include irritation, burning, redness, mucous accumulations,
itching and even light sensitivity. In fact when cells fall off
the cornea, it can be downright painful. Having mild eye muscle
problems or having inadequate reading glasses may make the symptoms
worse. A routine eye examination will exclude other causes of
irritation such as conjunctivitis, faulty glasses or contact
lens trouble.
It is important to recognize that this low-grade, chronic
irritation is actually a medical problem, so you should begin
getting help.
Therapy is directed at supplying wetting drops, reducing inflammation,
improving your environment and evaluating your drugs and diet.
- Use artificial tears: These may be non-preserved (sometimes
expensive and inconvenient); minimally preserved or fully preserved.
See the Dry Eye chapter in "The Eye Care Revolution"
for more details. There are some new types of artificial tears
that give patients more options Thera tears has been well-received
by many patients. Similsan is a homeopathic eye drop. Cyclosporine
A is a new anti-inflammatory drop that attacks the inflammatory
nature of some peoples' condition. Researchers are looking at
estrogen and essential fatty acids as other ways to fortify the
tear film. Ointments at bedtime are often helpful in reducing
morning symptoms.
- Punctal plugs: These will reduce tear loss. Every
time you blink, tears exit through the little holes (puncta)
in the inner corner of your eyelids. By plugging the exit route,
the tears you make or supplied by eye drops, will remain longer.
Many companies make these removable plugs, which can be tried
for either short or long periods.
- Environment: Take a careful look at your home (especially
bedroom) and workplace. Is it too dry? Is there any humidity?
Are there plants? If you suffer from dry eye symptoms especially
in the winter, place a humidifier in your bedroom. Any changes
in your environment, such as adding a humidifier to your heating
system will be helpful.
- Evaluate your diet: Are you drinking enough water?
Drink at least six to eight glasses of water a day, and limit
sodas, caffeine and alcohol. Include fish, soy and other legumes,
and seeds such as flaxseed in your diet. These provide essential
fatty acids to protect cells and stabilize the tear film. Green
leafy vegetables and to a lesser extent meat supply the B vitamins.
Those supplements that are good for arthritis appear to be build
up other membranes such conjunctiva, mouth, nose and ears. Omega-3
and -6 fatty acids, which come from plants (such as flaxseed,
oil of evening primrose, borage) or from cold water fish (such
as salmon, mackerel, sardines, halibut and cod) are loaded with
these good fats. A good supplement is approximately 500 mg of
DHA (fish oil), or flaxseed oil twice daily with meals. People
also report that glucosamine sulfate, chondroitin sulfate and
gelatin have also helped their eyes, in addition to their arthritis.
Promote good digestion through water intake, exercise, lactobacillus
and even digestive enzymes if necessary.
- Medications: Check out your current medications. Common
drugs for intestinal problems, depression, allergy and colds
may dehydrate sensitive tissues in your body. If they are necessary,
you may have to compensate for this dehydration by drinking more
water. Ask you pharmacist or doctor if any of your current medications
may cause dry eye.
- Remember to blink. Many of us stare at computers and
get lost in our work and simply forget to blink. Other people
have weak lower lids, which do not contribute the necessary 20
percent to completing a blink. Your or your eye doctor may notice
that the lower lid doesn't move with a routine blink. Fortunately,
with a forced or voluntary blink, you can close the eye. Inadequate
eye closure while sleeping may also contribute to dry eye symptoms.
- Treat associated problems: Conjunctivitis or blepharitis
(inflammation of the eye lid) will contribute to symptoms and
can be treated with a program of short-term antibiotic therapy.
Recognize that many people who have dry eye will experience headaches,
neckaches and other generalized complaints and may not recognize
that the dry eye problem is fundamental to their constellation
of symptoms. Be aware, take a minute to think about it, and determine
if you suffer from this condition. Dry eye may be a hidden cause
of your headache and discomfort.
Dry eye syndrome is a frustrating condition that may involve
more than your eyes. There are many ways that you can help yourself
and numerous suggestions that can be made by your eye doctor.
Be specific about your complaints, the time of day you experience
them, and whether they are aggravated by reading or other activity,
and other non-eye symptoms that may not seem to be related. If
you are ever intending to undergo eye surgery be sure dry eye
problems have been addressed ahead of time.
Back to top
|
