Dry Eyes

What is dry eye?

The surface of a normal eye is always coated in layers of tears. These layers or “tear film” is necessary for the eyes to remain healthy and comfortable. When the eye fails to produce enough tears, the condition is termed dry eye. Dry eye can also result from the eye producing the wrong kind of tears.

The act of blinking causes tears to spread over the surface of the eye. The tear film is needed to keep the surface of the eye smooth and clear—which is necessary for good vision.

The tear film is made up of three layers, each with a specific purpose:

  1. Oily layer – outer layer, keeps the tear surface smooth and stops tears from evaporating too quickly.
  2. Watery layer – middle layer, cleans the surface of the eye by washing away anything that does not belong.
  3. Mucus layer – innermost layer, helps to spread the watery layer and allows tears to stick to the eye surface.

Good quality tears will have all three layers. If for some reason, the eye starts producing tears without one or more of these layers then dry eye develops.

Dry eye symptoms

Some of the symptoms of dry eye includes:

  • Stinging or burning sensation
  • Scratchy eyes
  • Gritty feeling, like something is in the eye
  • Strings of mucus or pus in or around the eye
  • Red or irritated eyes
  • Painful to wear contact lenses
  • Eyes are constantly tearing

Many patients look confused, rightfully so, when they are told that their “watering” eye is a symptom of dry eye. It sounds contradictory but it is not. In addition to the normal production of tears, the eyes will produce tears in response to irritation. Irritation of the eyes can be caused by dry spots on the surface of the eyes. If the tears being produced cannot ‘fix’ the dry spots causing the irritation, the eyes will continue to produce tears in attempts to remedy the problem. This causes the eyes to constantly water.


What causes dry eyes

As we age, we produce less tears. Both men and women can develop dry eye. However, the condition occurs most frequently in women and more so in women who have undergone menopause.

The American Academy of Ophthalmology lists numerous causes of dry eye:

  • Certain diseases, such as rheumatoid arthritis, Sjogren’s syndrome, thyroid disease, and lupus.
  • Blepharitis (when the eyelids are swollen or red)
  • Entropion (when eyelids turn in); ectropion (eyelids turn outward)
  • Being in smoke, wind or a very dry climate
  • Looking at a screen for a long time (reduced blinking)
  • Using contact lenses for a long time
  • Having refractive eye surgery, such as LASIK
  • Using some eye drops and artificial tears with preservatives
  • Taking certain medications, such as:
    • Diuretics (water pills) for high blood pressure
    • Beta-blockers, for heart problems or high blood pressure
    • Allergy medicines (antihistamines)
    • Sleeping pills
    • Anxiety medications

What are the treatments for dry eyes?

Adding tears – Dr. Emmel might tell you to use artificial tears. These are manufactured tears that matches the makeup of our natural tears. Some artificial tears contain preservatives, with frequent use these preservatives overtime can cause irritation of the eyes. Preservative free artificial tears are without preservatives and can be used as often as necessary.

Conserving tears – In some instances, Dr. Emmel might recommend blocking your tears ducts (this is where tear from the eye drains). In blocking the tear duct tears will remain in the eye longer. The tear duct is blocked using small silicone or gel plugs called punctal plugs. The plugs are removable.

Increasing tears – Restasis and Xiidra are two eye drop medications that helps your eye produce more of your own tears. In some instances, Dr. Emmel might recommend the use of such products.

Prevention of dry eye

Some forms of dry eye caused by systemic health conditions such as lupus, rheumatoid arthritis, and Sjogren’s syndrome are not directly preventable.

In general, the American Academy of Ophthalmology recommends the following prevention tips:

  • Try not to use a hair dryer, if possible
  • Stay away from very warm rooms. In the winter, add moisture to the air with a humidifier. Or put a pan of water near your heater or radiator.
  • Protect your eyes from drying wind by wearing wrap-around glasses outside.
  • If you wake up in the morning with dry and scratchy eyes, try artificial tear ointment or thick gel eye drops just before you go to bed.


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