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"DRY EYE" SYNDROME: The Dry eye syndrome is a common condition, especially among women and elderly patients, and is often accompanied by dryness of the mouth (leading to problems with chewing and swallowing food) and excessive vaginal dryness (leading to painful or uncomfortable sexual intercourse and recurrent vaginal infections)
Tears are not just something shed with emotions, such as pain, joy, or sorrow; they have other important functions:1: They lubricate the surface of the cornea to ensure the smooth movement of the eyelids over the eyeball.
2: They mechanically flush out any debris on the cornea.
3: They contain anti-bacterial agents that help protect the eye against infections.
4: Tears also create a smooth optical surface on the cornea and so help ensure that your vision is always crisp and clear.
The tear-layer on the eye should be stabile for these functions to adequately take place. The normal blinking process of the eyelids contributes to the even spreading of the tears.
Normal tears consist of three layers:
Fan outer lipid layer to prevent excessive evaporation,
Fa middle layer of watery fluid
Fand an inner layer of mucinous fluid that adheres to the corneal surface;when there is an abnormality of the lipid or mucinous layer , the tear-layer evaporates quickly and causes areas of dryness on the corneal surface, and this stimulates the oversecretion of tears to "compensate".
We will cover the following aspects of the dry eye syndrome:
first we will cover the most common symptoms,
second the predisposing or aggravating conditions associated with dry eyes,
third, the complications and finally the methods of treatment.The typical symptoms of the dry eye syndrome include the following:
1: It is important to remember that patients seldom complain of dry eyes as such; usually they complain of burning, irritable or scratchy eyes, with transient blurring of vision, often with a foreign body sensation or a feeling of "heavy" eyelids.
2: Contact-lens wearers often suffer chronic or recurrent low grade infections to the eyelids or eye itself, due to the abnormal tear-film in dry eye syndrome.
3: Patients may often paradoxically complain of watering eyes, due to the fact that there are dry spots on their corneal surfaces that stimulate tearing reflexively.
These dry spots occur due to the instability of the abnormal tear-film.
Conditions that may predispose to dry eyes or be associated with it, include the following:
1: Rheumatoid arthritis.
2: Certain medications such as some diuretics, some anti-hypertensives,
some of the drugs used for the treatment of psoriasis and other skin diseases,
hormonal treatment such as some of the contraceptive pills,
and anti-depressants and some sedatives.3: Normal ageing is a major factor.
4: Auto-immune diseases such as systemic lupus.
5: Inflammatory conditions of the eyelids such as chronic blepharitis.
6: Air conditioners and heaters affect the humidity levels of the surrounding atmosphere, leading to excessive evaporation of tears.
7: Vitamin A deficiency causes extreme dryness.
8: Decreased blinking (for example when you read or concentrate for prolonged periods of time)
also leads to increased evaporation and incomplete spreading of the tears on the cornea.9: Scarring of the mucous membranes of the eye (for example after radiation therapy for a skin cancer) creates abnormal surfaces and decreased tear secretion.
The complications of dry eye syndrome include :
1: An increased susceptibility to infections.
2: Difficulty with contact-lens wear.
The treatment of dry eyes is a long-term endeavor, with many frustrations and relapses along the way!
Methods of treatment include the following:
1: The environment in which one lives can be changed.
(for example the use of humidifiers indoors when heaters are used, or avoiding overheated rooms or wearing protective spectacles to prevent undue evaporation.)2: Tear substitutes are the mainstay of treatment of the dry eye syndrome.
They include drops and ointments that must be used as often as needed - the main guideline being the severity of the symptoms. It may be necessary to use them as frequently as every hour to every half hour, especially since their duration of action is quite short.
It is important to realize that you should experiment with the various preparations available until you find the correct combination that gives you maximum relief. Some patients may develop an allergic reaction to the preservatives in their artificial tears, but there are many different preparations on the market to accommodate these patients.
3: One can also reduce the drainage of tears, resulting in an increase in local tear volume.
This can be done by occlusion of the little openings in your eyelid edges through which tears normally drain, either temporarily with little plugs, or more permanent with cautery, stitches or laser treatment. This treatment works best in the most severe cases or in the elderly, whom already have decreased tear secretion.
4: Other possibilities include the treatment of any associated diseases such as Rheumatoid arthritis or blepharitis, or using alternative medications to eliminate the side-effects.
Medications should only be changed on the advice and consent of your doctor.
In summary, dry eye syndrome is a common ailment, the symptoms of which can be controlled with the right treatment.
If you have any further questions regarding dry eyes, please consult your eye specialist.