DO YOU HAVE DRY EYES?  TAKE THE 'DRY EYE SURVEY' AND SEE.

Check out the very informative new "Dry Eye Educational Video" at the Systane website.

Background
Dry Eye Syndrome (DES)
is a break down of the tear film and is one of the most common conditions affecting the eyes.  Approximately 33 million Americans in all age groups experience some symptoms of dry eyes.  Most people don't realize how extremely important tears are in providing comfortable eyes, clear  vision, and protection from infections.

DES is a result of:
1. not enough tears being produced because of tear gland (lacrimal gland) dysfunction (see diagram below), and/or 
2. poor composition of any, or all of the 3 layers (see diagram at right) that make up tears.  
Both conditions result in the tear film breaking down.  This break down causes dry areas on the front part of the eye (cornea) and results in dry eye symptoms.


Symptoms
Symptoms of  DES can vary greatly and range from mild to severe.  Symptoms include:  general irritation, burning, foreign-body sensation (feels like there's something in your eyes), itching, excess tearing, eye pain or soreness, fluctuating vision, mucous discharge, redness, contact lens discomfort etc.  These symptoms are often amplified or made worse by smoking, wind, heat, low humidity, or prolonged use of the eyes (e.g. computer use or reading).

Causes
There are many conditions and factors which can contribute to causing DES.  Like most eye conditions, dry eye syndrome is often related to other health conditions in the rest of the body.  These systemic health problems include digestive imbalances, and autoimmune conditions such as rheumatoid arthritis, Sjogren's syndrome and lupus erythematosus.

Dry eyes are very common problem for women and seem to be a result of fluctuations in hormone levels.  Pregnant women, women who use birth control pills, and post-menopausal women on hormone replacement therapy often suffer from dry eyes.

Contact lens wear is probably the most common cause of DES.  A contact lens is an unnatural piece of soft plastic that is placed on the cornea, that can potentially disrupt the natural tear film on the front surface of the eye.  If your eyes do not react well with the contact lens material or they do not produce enough tears, you may not acquire comfortable and clear vision and your wearing time may be reduced significantly.  Additionally, long term contact lens wear may cause a reduction in corneal sensitivity.  The sensitivity of the cornea determines how many tears your eyes produce.  Less sensitivity means less tears.

The next most common cause is the natural aging process.  As you age, your tear production decreases.  By the age of 65, tear production is reduced to about 60% from age 18.  Obviously, this is quite a significant reduction that results in increased discomfort.

Several medications can lead to dry eyes: birth control pills, antihistamines, decongestants, codeine, morphine, heart medications, and even eye drops like Visine.

Treatment Options
Artificial Tears - The first line of treatment should be to supplement the eyes with Artificial Tears.  Generally, artificial tears are used one to 4 times a day, or on an "as needed" basis.  The newest artificial tear on the market is called "Refresh Endura" by Allergan®.    The company says, "Refresh Endura is the first lubricant eye drop for dry eye that treats all three layers of the tear film.  Clinical studies show that patients who used Refresh Endura on an average of 2 to 3 times each day saw significant improvement in symptoms."  When instilled, the Refresh Endura formula delivers oil to the tear lipid layer (to minimize evaporation), water to the tear aqueous layer (to keep the eyes wet) and gel to the tear mucin layer (to keep the cornea lubricated). 
"Refresh Tears" by Allergan®, "Tears Naturale" by Alcon®, and "Bion Tears" by Alcon® are three other excellent artificial tear lubricants available at any drug store over the counter.  For those patients who wear contact lenses and experience dry eye symptoms, "Refresh Contacts" by Allergan® and "Clerz" by Alcon® are two effective artificial tear drops that can provide increased comfort.

Punctal Plugs - In more serious cases of DES where discomfort is unbearable and/or contact lens wearing time is reduced to the point of being impractical, Punctal Plugs are recommended.  A punctal plug is a small collagen or silicone cylinder that is inserted into the punctum (tear drainage hole - see diagram below) to reduce the drainage of tears from the front surface of the eyes.  With each blink, your eyelids coral the tears from the lateral surface of your eye towards your punctum, which is the start of your eye's drainage system.  If you reduce the amount of tears that are draining, then more tears remain on the surface of your eyes and do their job to coat, comfort, and protect.



Procedure - First of all, DES is considered a medical condition, and thus, some medical insurance companies will fully cover the procedure.  There are two types of Punctal Plugs:  temporary and permanent.  The difference between the two is the type of material the plugs are made of.  The temporary plugs are used diagnostically (on a trial basis) and made of collagen that dissolves over a given time period (weeks to months).  The permanent plugs are made of a silicon-based material that do not dissolve and are meant for long-term use.  Though they are called 'permanent' plugs, we can very easily remove them if necessary.  If Drs. Berke or Ryan decided with you to insert punctal plugs, they would first insert a pair of diagnostic temporary plugs to determine if they help your condition.  If we find after the trial period that they do significantly increase your comfort, then we would proceed to insert the permanent plugs. 
The newest temporary Punctal Plugs on the market are plugs that last 4-6 months and then dissolve.  We will soon have these in our office and will be able to perform this very helpful procedure.

PREVENTION
Diet plays probably the most significant role in dry eye prevention.  Some types of foods increase the risk for dry eyes, while others can decrease the risk.

Increasing the Risk of DES:
1.  Consuming large amounts of sugar and/or artificial sweeteners has been linked to dry eye syndrome.  Avoid certain things like sodas, as well as some processed foods that have hidden sugar in them like cereals, ketchup and salad dressings.
2.  Toxic fats found in commercial red meats, dairy products, fried foods, and hydrogenated oils (such as margarine and shortening) can disrupt proper metabolism of essential fatty acids in the body and can indirectly lead to dry eye symptoms.

Reducing the Risk of DES:
1. Flaxseed oil/n-3 fatty acids - Cynacon/Ocusoft is a company that has recently introduced Hydrate Essential, a new dry eye medication that contains flaxseed oil, which is an n-3 fatty acid.  The company reports, "Many reports have linked flaxseed oil to increased comfort when used to manage dry eye.  Researchers suggest that in general, most individuals could benefit from a diet that includes more n-3 fatty acids.  Such therapy may also benefit a person's skin, mucosa, cardiovascular system and central nervous system."  Along with flaxseed oil, Hydrate Essential is combined with evening primrose oil (which has a high amount of a rare essential fatty acid, gamma-linolenic acid), and bilberry extract, which fights inflammation.  We are currently looking into obtaining samples from Cynacon/Ocusoft for our office.  Depending on your location, you may be able to find these in drug stores right now.  However, we do know that flaxseed oil is available in capsule form at Trader Joe's.
2. Vitamin A - this very important vitamin is needed for the health of all epithelial (surface) tissues; it is found naturally in the tear film of healthy eyes and is key to the production of the mucous layer of the tears.  Using drops with vitamin A can help protect the eyes from free radicals, toxins, allergens, and inflammation.  Try a daily dose of 10,000 I.U. of vitamin A and 25,000 I.U. of beta-carotene.  Note: if you have a thyroid condition, please consult your physician before starting a regimen of vitamin A.
3. Vitamin B6 - this vitamin helps in the proper absorption of magnesium, which in turn, aids the body in producing prostaglandin E-7, which is necessary for tear production.
4. Vitamin C - is found in higher concentrations in the tear film than that found in the blood.
5. Potassium - is usually very low in dry eye patients.  This is usually found in conjunction with low consumption of folic acid, vitamins C and B6, and high consumption of sugar.  Increase your potassium intake to at least 500mg/day by consuming more fruits and vegetables (one banana contains 400mg).

Links
If you want more information on Dry Eye Syndrome, check out the following links:

http://www.healthlinkusa.com/Dry_Eyes.htm

http://www.eaglevis.com/patients.htm


http://www.altdryeyes.com/dryeyes.htm

If you have any further questions, by all means, feel free to contact us.