What is happening to the eye?
There are several different pathways that can cause the signs and symptoms of dry eye syndrome. A loss of homeostasis (or balance) in our tear film and ocular surface is the core cause of discomfort. Our tears of made of two layers: a muco-aqueous layer that is secreted by the lacrimal gland under our eyebrow and goblet cells on the surface of the eye, and an oil or lipid layer that is secreted by Meiboiman glands which run vertically through our eyelids. Every time we blink, these oils are expressed onto the surface of the eye. The majority of people who have dry eye syndrome have problems at both tear film layers with tear production and secretion. Effective treatment will address all layers of ocular surface dysfunction and irritation, and will require the incorporation of several products into your daily routine.
What are the most common causes of this condition?
The medications we take and the environment we live and work in all play a major role:
- Computer or device use: Blinking is the way that tears spread over the eye, and we blink much less often when we look at digital screens
- Medication side effects: Anti-histamines, diuretics, decongestants, birth control, antidepressants, beta blockers, and acne medications all commonly cause dry eye side effects. If the prescription or over-the-counter medication you take mentions side effects including blurry vision or dry mouth, it is decreasing tear production levels in your body and contributing to chronic dry eye syndrome.
- Systemic conditions: Diabetes, Thyroid conditions, and inflammatory conditions like arthritis, Sjogren’s Syndrome, and rosacea are all commonly associated with dry eye.
- Aging and hormone changes: Tear production is very tied to a delicate balance of hormones and inflammatory factors in our body, and the prevalence of dry eye increases with aging. Women are especially impacted during periods of hormone changes associated with pregnancy or menopause.
- Eyelash growth serums, false lashes, eyeliner, makeup, and other cosmetic products and procedures can all block and damage the meibomian glands and cause dry eye side effects.
- Over the counter artificial tears with quality ingredients that mirror our natural tear film can boost ocular comfort when used 2-4 x a day, every single day.
- Our eyes heal overnight as we sleep, but if you wake up with your eyes feeling dry, or if you experience sharp pains at night, that means your eyes are too dry overnight to properly heal, and could even become injured if the dry corneal cells stick to the eyelid and cause recurrent abrasions. Gel or thicker, more viscous overnight artificial tears and ointments can help your eyes properly hydrate and heal overnight.
- Nutritional supplementation to improve your natural tear production. Studies show anti-inflammatory omega 3 and 6 fatty acids and vitamin D can improve tear production and quality of tears.
- Moist Heat Compress. At home microwaveable heat masks help unclog congested Meibomian glands and improve oil gland secretion. Use nightly for 5 minutes with a gentle massage to eyelids to promote gland flow.
- Avenova eyelid cleanser: Medical grade eyelid cleansers reduce bacteria and parasitic mite colonies called Demodex commonly found along the eyelash roots that contribute to redness and irritation with dry eye.
- Punctal plugs are small collagen or silicone cylinders that are inserted into the puncta, an existing drainage opening of the eyelid where tears drain down into the nasolacrimal duct. When we “plug” the puncta, tears are collected onto the eye for a longer period of time.
- Prescription medicated drops used 2 x a day improve tear production and tear quality, and reduce inflammation. These include Restasis and Xiidra
- Prescription nasal spray Tyrvaya stimulates the trigeminal nerve to release tear film at every layer.
- In office Thermal 1-Touch treatment is a medical grade heat treatment that targets clogged meibomian glands to melt blockages and improve gland expression. After heat is applied for 10-15 minutes, the doctor will manually express congested glands to remove any residual blockages. Nightly at home heat masks will still be needed following this office procedure to prevent glands from re-blocking with time.
Amniotic membranes are stem-cell based treatments for wound healing. If the cornea is persistently scratched, these membranes can help the eye heal more completely.