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What Is Dry Eye Syndrome?

Dry eye syndrome is one of the most common ocular conditions.  Between 16 and 49 million Americans have dry eyes.  Symptoms range from something as simple as redness to burning, itching, tearing, irritation, blurry vision, and watering.  Many people confuse dry eye with ocular allergies if their eyes are itching. Many also confuse needing new glasses with dry eye, since dryness can make the vision blurry or fluctuate.   Dry eyes can be caused by a number of reasons, but usually, the tear film of the eye is disrupted.  The tear film is made of 3 layers (fatty oils, aqueous fluid, and mucous).  A problem with any of these 3 layers can cause dry eyes.   Patients are always asking me , “What is the cause of my dry eye?”  This is a hard question to answer because so many different factors can cause dry eyes.  Some of the most common medications that can dry the eyes are blood pressure medications, allergy medications, and depression medications.  Other common causes are sleeping with ceiling fans, heat or air conditioning blowing in the eyes, staring at a computer screen (decreased blinking), hormone changes, autoimmune disease, and inflamed eyelid glands.    One main cause is decreased tear production which is when the eyes cannot produce enough water or aqueous fluid.  Another main cause is increased tear evaporation which is when the oil film produced by the glands lining the eyelids becomes clogged.    Thankfully, there are many tests available to diagnose dry eye syndrome and also treatments available to help manage the condition and increase the quality of life for patients who suffer from this eye disease.  Metrolina eye has the latest technology to help diagnose dry eye syndrome.  Eye doctors use a machine called a slit lamp to check patients’ tear break-up time and to check for something called superficial punctate keratitis (SPK) which can both be involved in dry eye syndrome.  A decreased tear break-up time would be anything less than 10 seconds, however, 5 seconds is marginally low.  Metrolina eye also has something called a tear lab which checks the osmolarity of human tears and aids in dry eye diagnosis.    What has always been interesting to me with dry eye syndrome, is that some patients present with barely any complaints or none at all, however under the slit lamp their eyes appear extremely dry and have a lot of (SPK).  Others present with extreme symptoms and have no SPK and barely look dry.  What I have learned is that you always have to go by both patient complaints and what the eye looks at under the slit lamp, and not just one or the other.   Treatments for dry eye vary depending on the severity. With any type of dry eye, I always recommend that patients stop sleeping with a ceiling fan.  For very mild dry eyes, without many symptoms, artificial tears can be used.  My favorite teardrops are the preservative-free kind which is in vials including Systane or Refresh.   If the patient has mild to moderate dry eyes (but depending on the type), a steroid drop, punctual plugs, a long-term prescription eye drop, a Bruder mask, omega 3 eye vitamins, and procedures called I lux and IPL can be used, amongst many others.  Sometimes these treatments are used alone, and sometimes together. Every patient is different in what his/her dry eye responds to.  Some of the treatments involve trial and error.  There are three long-term dry eye drops, including Restasis, Xiiadra, or Cequa and they are all dosed twice a day. They are not used together and each is tried one at a time.    After 15 years in practice, and much experience with dry eye, I consider myself a dry eye specialist.  I would be glad to help manage and treat your dry eye or assist with any of your eye care needs at Metrolina eye.
Stacy Schorner, OD, FAAO

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