Allergies, lack of sleep, contact lens wear, extended computer use – all of these are things that can lead to dry, irritated eyes. Dry eye is a common condition, especially in our North Texas climate. Approximately 12 to 20% of the population suffers from dry eye symptoms. The likelihood of developing dry eye is statistically higher in women and the elderly. Knowing what elements make up your tear film helps you to understand dry eye. The tear film is composed of three different layers: the lipid layer, the aqueous layer and the mucin layer. These complex layers have to work together to provide a healthy tear film. A deficiency in any of these layers will affect the others.
The lipid layer is the outermost layer of the tear film. It is produced by the meibomian glands located on the lid margins of the upper and lower eyelids. The lipid layer, with its oily consistency, prevents evaporation of the aqueous layer. The health of the meibomian glands is directly responsible for a healthy lipid layer. If bacteria are present on the eyelid margins, they could produce secretions that would alter the consistency of the oils needed for healthy tears. Bacteria in or around the meibomian glands can also cause inflammation. Inflammation reduces the quality of the oils that are produced by these glands and usually will result in a thick, red appearance around the base of the eyelashes.
The aqueous layer, mainly composed of a watery substance, is the middle and thickest layer of the tear film. It also functions as a defense mechanism, fighting against eye infections with its natural antibacterial properties. Some inflammatory conditions such as Sjogren’s syndrome or Rheumatoid Arthritis can affect the aqueous layer resulting in an insufficient production of tears. Certain medications such as anti-histamines, anti-depressants and diuretics can also compromise the aqueous layer. If the above mentioned lipid layer is compromised, the aqueous layer will be affected by evaporating more quickly than when a healthy normal lipid layer is present.
The mucin layer lies directly beneath the aqueous layer and lines the surface of the eye. The eye’s surface is hydrophobic (water repelling), similar to a freshly waxed car that repels water by causing it to bead up on the surface. The absence of a healthy mucin layer would disable the tears from forming an even, intact layer over the surface of the eye. As you can see, the lipid, aqueous and mucin layers are all critical to the importance of a healthy tear film.
At Clarke EyeCare Center, we strive to educate patients about steps they can take to lessen the effects they feel from insufficient tear film health. One of the first things we normally discuss with patients is water intake. We all know that we should consume 5 to 8 glasses of water per day, but few people realize the direct effect it can have with regards to dry eye. It is critical that you stay hydrated.
People who spend long hours in front of a computer will often experience dry eye symptoms, as well. Studies indicate that you blink less while working at a computer, and a reduced blink rate exposes the ocular surface longer, allowing the tear film to evaporate. Complaints related to computer use typically include eye strain, fatigue, soreness in or around the eye, and discomfort.
Artificial tears are commonly used to treat initial symptoms of dry eye, but most people find the need for repeated dosage to be inconvenient. Treating chronic dry eye with artificial tears is often a band-aid, masking the symptoms and only providing short term relief. Unfortunately, there are usually major differences between name brand and generic store brands, most commonly being the preservatives contained in the artificial tears. Additionally, over-use of an over-the-counter rewetting drop, typically considered more than 4 times a day, can result in an increase of dry eye symptoms due to too much exposure of the preservative agent to the eye.
Deposits consisting of flakes of dry, dead skin can build up at the base of the eyelashes often irritating the lid margin and clogging the meibomian glands. Examination of the lid margin for evidence of any thick, red areas is extremely important. As the doctor, I assess the fluidity and color of the secretions from the meibomian glands to ensure a healthy lipid layer is present. The oils that are emitted should be clear and fluid, resembling that of vegetable oil. Oils appearing any different than that may indicate that the glands are not functioning properly. Eyelid hygiene directly affects the health of the meibomian glands and therefore the quality of tear film as discussed earlier in this article. People who seem to have reoccurring eyelid disease should be educated as to what “proper eyelid hygiene” entails. A cleansing routine with a commercial product, such as OcuSoft Foaming Eyelid Cleanser, will help the lids regain their normal appearance by removing the deposits from the lashes. As a doctor, I recommend the commercially available cleaners as they are specifically formulated for the deposits and bacteria found in and around the eye. Sometimes an antibiotic is also needed to help control the development of bacteria that are likely causing much of the debris seen at the base of the eyelashes.
Omega-3 fatty acids, commonly referred to as fish oils, are now also being suggested by eye care practitioners to help manage dry eye and lid margin disease. Two to four grams of Omega-3 fatty acids are recommended daily to help promote healthy meibomian gland secretions. It often takes 6 to 12 weeks to produce noticeable results.
With chronic dry eyes, often the ocular surface becomes inflamed. Restasis, a medication that many people recognize from commercials and magazine ads, was initially developed and approved as an agent that aids the eye in producing more of its own tears. It has also been found to be effective as an anti-inflammatory which further enables Restasis to help restore a healthy ocular surface. Controlling inflammation is an important component to treating dry eye and the introduction and use of Lotemax, also an anti-inflammatory, in conjunction with Restasis has proven to provide much needed relief for many dry eye sufferers.
Punctal plugs are medical devices that are designed to keep tears on the ocular surface. As their name implies, these devices are used to plug the punctum. The puncta are barely visible, but located nasally, on both the upper and lower eyelid. They act as a drainage system, allowing the tears to drain into the back of the nose and throat. Blocking the puncta will allow more tears to stay on the ocular surface.
When meibomian glands are clogged, the addition of heat and lid massage can break up the obstacles and help restore the glands to their normal function. Doctors used to recommend heating a sock filled with rice, or a washcloth moistened with hot water to create a rudimentary hot compress. These improvisations were often messy and didn’t maintain the heat needed long enough to be very effective. A new product, Tranquileyes, is now available that has made this much needed dry eye regimen easier for patients. Tranquileyes, a soft, flexible goggle, provides all-natural, restorative care for your eyes. They work with plain water, or your choice of 3 botanical waters, to form a moist, humid environment, preventing the evaporation of natural tears while also moisturizing the delicate skin around the eyes. They also give alternative options for multiuse: heat therapy for dry eyes; cold therapy to reduce puffiness. They are constructed out of FDA approved materials so that people with sensitivity to certain fabrics can use them without irritation. The botanical waters that provide the humidity are formulated with a pH level matching our own tears so that it won’t irritate or burn even the most sensitive eyes. There are also unscented versions for people who prefer to not have the botanical extracts. The heat is more consistent than the old-fashioned methods and can be maintained for up to 30 minutes.
With all of the research and development into treating dry eye, there is no reason to continue suffering from a dry eye condition. If you’re experiencing dry eyes, pain, itchiness, redness, or light sensitivity, call 940-691-5645 and ask about our Dry Eye Clinic – we can help!
