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Dry Eye – Causes and Treatment

Dry eye is not as simple as it sounds, and it can be a lot more than just a minor annoyance. Caused by various health conditions, medications, and environmental factors, it affects millions of people, especially as one gets older.

Common symptoms include: Burning, stinging, redness, watery eyes, scratchy sensation, crusties in the morning, dull ache, light-sensitivity, and the list goes on…

There are two kinds of dry eye: aqueous-deficient and evaporative. Most of the time, both are involved.

In aqueous-deficient dry eye, the lacrimal (tear) glands don’t produce enough tears. Sometimes an underlying disease damages the glands, but age alone can cause the ducts to narrow.

In evaporative dry eye (the most common form) there are often two culprits:

  1. Meibomian Gland Dysfunction (MGD) – The oil glands in our lids, called meibomian glands, are critical to making good tears. These glands produce the outer, lipid (or oil) layer of the tear film, which keeps tears from evaporating too quickly. In MGD, the gland openings narrow and the oil, or meibum, gets clogged inside. This makes a person more prone to styes, and causes the meibum to get thicker, until it cannot get secreted at all. At this point the glands begin to wither and stop producing oil.
  2. Low Blink Rate – Whenever we concentrate, there’s a tendency to blink less often. Today’s emphasis on device use makes this a real issue, and an even bigger one in the future. Think of the eventual effect on kids spending hours a day, every day, for years on end!! The act of blinking squeezes oil out and spreads it across the surface. So, with less blinks, there’s less oil to spread and more time for tears to evaporate.

What can be done?

Dry eye is a chronic condition: the key to treating it is consistency. Try to incorporate the following into your daily routine:

  1. Warm Compresses – Heating the lids for 10 minutes twice a day is a great way to treat MGD. This softens the oils, opens the ducts, and improves blood flow to the glands enhancing their health and function. We and our patients love the Bruder Mask. Special beads in the mask absorb moisture from the atmosphere and will provide 10 minutes of peaceful warmth following just 20 seconds in the microwave, unlike a washcloth which cools very quickly.
  2. Artificial Tears – Lipid-based, mildly preserved artificial tears, such as Systane or Soothe, dosed 2-4 times a day, can be very effective. If needed more often, Preservative-Free versions are recommended to reduce chemical contact with the eyes’ sensitive surface. When feasible, try a drop right before an eye-drying activity like computer use. When the eyes already feel dry, drops only help for a short period.
  3. 20/20/20 Rule and Blinking Exercises – Blinking releases and spreads the tear’s oil film, but computer work reduces blinking. To get around this, we recommend the 20/20/20 Rule! Every 20 minutes, take a 20-second break, and look 20 feet away. This will automatically make you blink and break the focus lock which can be straining on the eyes. Better yet, add a blinking exercise – gently close the lids, squeeze, then open. Try to do this 5 times a day for best results.
  4. Omega 3 (Fish Oil) – Many studies have proven the effectiveness of fish oil for dry eyes. This is partly due to its anti-inflammatory properties, and partly due to how it naturally increases the meibomian glands’ oil secretions. The best dosage for dry eyes is 1000mg twice daily by mouth. Quality matters though!! We recommend Nordic Naturals Pro-Omega 2000 with vitamin D
  5. Diet + Hydration – Increasing omega-3 intake naturally also improves the meibomian gland function. Foods high in anti-inflammatory fats, such as fish, nuts, flaxseeds, olive oil, and leafy green vegetables are good for the eyes, and good for the rest of the body, too. Also important is limiting the intake of pro-inflammatory omega-6 fatty acids, such as processed foods, vegetable oil, and red meats. Above all, stay hydrated! You can’t produce good quality tears if your body doesn’t have enough water.

If your dry eye symptoms persist despite following these recommendations, you may need extra help. Come in and we’ll see if a more advanced treatment may be indicated, such as:

  1. Punctal Plugs – Your tears naturally drain into a small opening in the lower lid called the punctum. Blocking that opening with a small, cylindrical collagen plug keeps the tears from draining so quickly, allowing them to remain on the ocular surface longer.
  2. Prescription Eye Drops – Restasis and Xiidra are two prescription eye drops approved for dry eye. Both are used twice a day long term to reduce inflammation. IMPORTANT: Prescription drops supplement but do not replace the 5 home therapies listed above. Dry Eye is a chronic condition with lots of causes – We’ve got to hit it from lots of angles to keep it under control!!
  3. New treatments keep being developed and becoming available, so check in with us often!