Dry eyes, often referred to as Dry Eye Syndrome, is the most frequent patient complaint to eye doctors. About 33 million Americans in all groups experience varying degrees of dry eye syndromes. Like most eye conditions, Dry Eye Syndrome is often related to health conditions in the rest of the body. It is commonly associated with dryness of other mucous membranes, interior body surfaces such as joints and brittle nails. It can also be a sign of digestive imbalances or of more serious systemic autoimmune diseases, such as rheumatoid arthritis, Sjogrens syndrome or lupus erthematosus.
The proper production of tears basically takes place at three layers:
1. The Mucus Layer - is the closest layer to the corneal epithelium. It is produced by the conjunctival goblet cells, and is absorbed by the corneal surface glycoproteins, creating a hydrophilic corneal surface.
2. The Aqueous Layer - is between the Mucous and Lipid Layers, and comprises 90% of the tear film's thickness. It is secreted by the lacrimal gland and incorporates all water-soluble components of the tear film (slightly alkaline at pH of 7.4).
3.The Lipid Layer - is the most superficial layer. It is produced by the Meibomiam glands with minor contribution from glands of Zeis and Moll. The secretion is a sebaceous material which is fluid at body temperature, and retards evaporation of the acqueous layer and lowers surface tension thereby allowing tear-film to mold itself to the eye's surface.
The Blink renews the tear film by delivering aqueous and lipid to tear film and sweeping away debris. The normal blink interval is every 5 seconds. Tear film is typically stable for about 10 seconds.
Symptoms
The typical symptoms include dryness, grittiness, irritation, difficulty reading for long periods of time, burning and even the seeming contradiction of excessive tearing or watering.
Causes
Any disruption in the tear production process as desribed in the Overview.
Blepharitis can often cause dry eye symptoms due to inflammation of the eye lid margins, which is caused by a bacterial infection (Staphylococci). This condition can compromise the quality of the tear film causing tears to evaporate more quickly. The bacteria produce waste material that can cause a mild toxic reaction leading to chronic red, irritated eyes. Click Blepharitis for treatment.
Computer Users tend to blink much less frequently (about 7 times per minute vs. a normal rate of around 22 times/minute). This leads to increased evaporation along with the fatigue and eye strain associated with staring at a computer monitor. Ideally, computer users should take short breaks about every 20 minutes to reduce this factor. Also, adjusting the monitor so that it is below eye level will allow the upper lid to be positioned lower and cover more of the eye’s surface, again to reduce evaporation.
LASIK surgery temporarily disrupts the ocular surface/lacrimal gland unit. Also, during LASIK, roughly 60-70% of the superficial nerve fibers in the cornea are severed, which impacts sensation and affects acqueous tears. With compromised sensation, the blink rate can slow to the point where the tear film breaks up before the next blink can reconstitute. This may result in mild to severe dry eye syndrome for many months after surgery. This condition usually eventually clears up.
Diseases that may be associated with dry eyes include Rheumatoid Arthritis, Diabetes (especially when the blood sugar is up), Asthma, Thyroid disease (lower lid does not move when blinking), Lupus, and possibly Glaucoma.
Age - Tear volume decreases as much as 60% by age 65 from that at age 18. Dry Eye Syndrome affects 75% of people over age 65.
Hormonal changes for women can cause decreased tear production brought on by pregnancy, lactation, menstruation, and post menopause.
Other including too much coffee drinking, smoking, wearing contact lenses, air-conditioning or heat.
Drugs that can cause dry eye symptoms (see "Drugs That Harm the Eyes" for a list of harmful drugs:)
Antibiotics
Blood pressure medications
Antidepressants
Diuretics
Over-the-counter vasoconstrictors (i.e. Visine)
Antihistamines
Birth control pills
Appetite suppressants
Ulcer medications
Conventional Treatment
Artificial Tears: Some form of over-the-counter artificial tears is usually recommended. Although they may provide temporary relief, they merely palliate the symptoms. Worse, the preservatives can aggravate the condition, and can even kill corneal cells. Tears that promise to “get the red out” will reduce circulation in the eye, decrease production of the tear film, and worse, eventually make your eyes even drier.
Punctal Occlusion: Punctal occlusion is a procedure used to help dry eye patients by closing the tear drainage canals with silicone plugs, which keep most of the fluid from the surface of the eye. This may provide long-term relief.
- Tests that can be performed by an eye doctor include the following:
- Rose Bengal staining pattern
- Tear film break-up time (<10 seconds)
- Schirmer tear test
- Tear Osmolarity
- Tear protein levels (lactorerrin and lysozyme)
- Evaluation of debris in tear film
- Conjunctival impression cytoloty
- Presence of corneal filaments
Holistic Treatement
Holistic treatment first begins with identifying the most probable causes of dry eyes in each based on each individual case. Each person is unique with different underlying causes for dry eyes. The most commonly seen causes are dehydration, hormonal imbalances, post-lasik surgery, allergies, autoimmune conditions, acute/chrinic infections, medication, enviromental exposure, perscription medication, etc. Perhaps eye drops may help, but it will only act like a “band-aid” until the underlying problem is identified and corrected. Identifying the underlying cause requires inquiry, testing and checking blood work.
Unfortuantely most ophthamologists are not looking at blood work in order to find the cause for dry eyes. Why? I can’t answer that, but I do know that I can count on one hand the number of eye patients I’ve seen over the last 15 years who’s eye doctor reviewed their blood work. EVAUATING BLOOD WORK IS CRITICAL FOR IDENTIFYING THE CAUSE OF YOUR DRY EYES! Just hypothesizing and persribing eye drops is poor medical practice.
Every pateint that I see has blood work in order to identify the underlying cause. We use food, supplement, lifesyle recommenations and acupuncture/acupressure in order to incrase the blood flow and fluid supply to the eyes. We also work on regulating the underlying imbalances and reduce eye inflammation if that is an issue. Our success rate is astonishingly well over 80%!
We achieve these great result are because we take the time to identify the undwerlying cause of your dry eyes. Typically, the 20% of cases who do no have either major autoimmune conditions and/or surguries or trauma to the eye that is beyond repair. Some of these cases can be improved significantly, but results are less with these kinds fo cases. Also, patients who are certain medications indefinitelly may not have the great results because the meds may be so dehydrating and pro-inflammtory that they overide anything we can do. These cases represet a very small pecentage of the population and most of our patients experiene great relief within a few days to a few weeks of treatment.
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