Dry eye syndrome is a chronic condition in which there are not enough tears to lubricate the eye. This insufficiency can be due to a decreased production or an increased evaporation of the tears.

The tears are made up of three layers. All of the layers must work properly for the eye to stay moist.

The outermost layer of tears is made of an oil component that helps decrease evaporation. The middle layer is an aqueous or watery layer that moisturizes the eye. This layer also has lysozymes that help protect the eye from infection. And the inner layer is composed of mucus to help evenly spread the tears over the surface of the eye.

An imbalance of any of these components can produce keratitis sicca, the medical term for dry eyes.

Patients with dry eye may experience several different symptoms. These symptoms include redness, a gritty or scratchy sensation, itching, light sensitivity and blurred vision.

Although this may sound contradictory, some patients even have watery eyes. When the eye is not getting enough lubrication, a signal is sent to the brain to produce more tears. In response, the eye is flooded with tears. The problem with these tears is they are mainly made on spikes, but not constant, so there is no protection at all times.

Dry eye is mainly caused by a tear production deficit from the lacrimal gland or by an irregular tear composition that increases evaporation. There are several reasons for these issues to occur.

The natural aging process causes dryness because tear production decreases with age. Women are more likely to develop dry eyes because of hormonal changes during pregnancy and menopause. Dryness is a side effect of many medications, including antihistamines, decongestants, antidepressants, some blood pressure medications and oral contraceptives.

Some systemic diseases such as lupus, rheumatoid arthritis, diabetes, thyroid disease, ocular rosacea and Sjögren’s syndrome can produce dryness. Sjögren’s syndrome is an autoimmune disorder in which patients experience a triad of symptoms, including severe dry eyes, dry mouth and arthritis.

Other factors like environmental conditions can also affect dryness. Dry air from air conditioners and heaters or dry, windy climates can exacerbate dry eye symptoms. Insufficient blinking, which occurs while staring at a computer screen all day, can cause dry eye, as well.

Long-term contact lens wear is a cause of keratitis sicca. The most common complaint among contact lens wearers is problems with dryness. This is due to a continuous cycle of dry eye syndrome causing the contact lenses to feel uncomfortable and the lenses themselves to rub against the eye, causing dryness.

Patients may have several of these causes contributing to their dryness.

There are several treatments for dry eye that include adding tears, conserving tears and increasing tear production. The amount of treatment depends on the level of dryness. Some people may only need one treatment regimen, while others may need a combination of all of them.

Artificial teardrops, gels and ointments may all be used to add tears to the eye. The more severe the dryness, the more viscous the tear needs to be. Artificial tears are our first line of defense against dryness. These tears are available over the counter.

Patients with chronic dry eye should use the tears even when the eyes do not feel dry to aid in lubrication. Also, if the eyes dry out more while sleeping, an ointment can be used during the night.

To help conserve tears, punctal plugs may be inserted into the tear ducts or drainage system of the eye. This allows the tears that are produced to stay on the eye longer. This is a painless, in-office procedure that is designed to improve the comfort of the eyes.

There is no maintenance required with the plugs, and they are designed to be permanent. However, if the plugs need to be removed, this can easily be done by your doctor.

There are two ways to increase or stabilize tear production. Taking nutritional supplements high in omega-3 fatty acids, specifically fish oil and flaxseed oil, helps stabilize the oil component of the tears, preventing evaporation.

There is also a prescription eye drop that is FDA approved to treat chronic dry eye. With continued use, this eye drop helps the eyes increase their own tear production. This is the only prescription drop of its kind.

Special goggles to create a moisture chamber may also alleviate some symptoms.

All of these treatments working together should help improve the comfort of the eyes and the quality of the vision.

For a dry eye consultation, visit us at UltraVision, or contact our office at 210-308-5550 to make an appointment.

This article was reviewed by Tomy Starck, M.D.