Dry Eye Syndrome

Dry eye syndrome, clinically known as Keratoconjunctivitis sicca (KCS), occurs when the eye produces fewer or poorer quality tears reducing the lubrication of the eye. A constant flow of tears is essential for good eye health and eye comfort. Tears not only wash away dust and foreign matter, they also ensure the eye is moist and lubricated. They are produced by the lacrimal glands, located under the upper eyelid. The meibomian glands also help keep the eye moist by preventing the tears on the surface of your eye from evaporating.  They do this by producing an oily film over your tears.  Dry eye syndrome can develop due to a problem with the quality or the quantity of tears.  There are a few reasons for the cause such as the eye may not produce enough tears, or the quality is poor and the tears either do not spread well or they may evaporate too quickly.  Unusual as it may seem, one of the most common signs of dry eye syndrome is the production of too many tears or watery eyes.

Dry eye syndrome can occur in one or both eyes and symptoms can include:

• A feeling of sand or grit in the eye
• burning
• scratchiness or irritation
• red eyes
• dryness
• blurred vision 
• an inability to wear contact lenses

Many factors contributing to dry eye syndrome are:

• Lengthy periods spent in air conditioning such as an office or supermarket
• Prolonged periods of time at a computer or watching television (as you do not blink as often when looking at a monitor for extended periods)
• After laser surgery you will experience this however you will be given lubricating drops after the procedure to alleviate this
• Prolonged wearing of contact lenses which prevents the required amount of oxygen to enter through the cornea
• Travelling on an aeroplane
• Windy, dry weather conditions
• As we age due to a reduction in tears being produced
• Menopause
• Some medications may decrease tear production 
• Irritants such as dust, smoke or chemical exposure

Before an ophthalmologist is able to diagnose whether a patient is suffering from dry eye syndrome they will carefully examine the eye as well as collecting a full medical history.  They will check the cornea to determine if there is any damage as well as diagnosing the extent of the dryness. Tests may be performed to determine the underlying cause. 

Treatment for dry eye syndrome 

It is usually a long-lasting condition that commonly comes and goes with varying severity.  There is currently no cure for dry eye and therefore the treatment has been directed at the management of symptoms in order to increase patient comfort rather than cure the disease.  Management of all stages of dry eye includes moisture replacement using preservative-free  artificial tears as well as lubricating ointment at night; as often blurred vision is observed for a short period of time. In the event of moderate to severe dry eye the use of cyclosporine A drops or a surgical procedure may also be necessary. 

Cyclosporine A drops are commonly used to help increase your eyes' natural ability to produce tears. Cyclosporin, through its dual role as an immunomodulator and an antiinflammatory agent which can help restore the ocular surface of the eye. One drop, twice a day, with continued use can help you naturally produce more of your own tears. 

Punctal occlusion is a surgical procedure that your ophthalmologist may recommend as a treatment for dry eye. A tiny plug is inserted into the puncta, a small drainage hole in both the upper and lower eyelids of each eye. The punctal plugs prevent the tears draining away too quickly and keeping moisture in the eye. Plugs may be either temporary or permanent. If made from collagen the effect is temporary as the collagen plug will dissolve after a period of time. If the plugs are silicone they are a permanent fixture but can be easily removed by your ophthalmologist at any time. The punctal plugs can be inserted in either the upper and lower puncta or the lower ones only. Occlusive punctoplasty is when it is necessary for the lacrimal glands; which produce tears, to be permanently closed. This procedure is not reversible.

Lateral tarsorrhaphy is a surgical procedure that may be required in the event of severe dry eye. Upper and lower punctal plugs may be recommended and as a result of this the eyelid may not close properly. A lateral tarsorrhaphy involves sewing the outside 1/3 of the upper and lower eyelids together. This may easy the dry eye condition.

There are simple measures to ease the symptoms of dry eye

• Blink frequently when working at the computer/watching television/reading. Take regular breaks to rest your eyes
• Drink 8 – 10 glasses of water per day to keep the body adequately hydrated
• Consult your ophthalmologist/general practitioner if a change in medication appears to cause side effects. However in some cases the benefits of the medications may outweigh the side effects of dry eye
• Good lid hygiene such as using SteriLid to gently wash and remove and product build up and bacteria around the eyelashes.
• Wearing sunglasses outside to protect against harsh UV rays as well as forming a protection from wind and dust
• Avoid environments that contribute to dryness such as overly warm rooms or smokey conditions
• Avoid rubbing and aggravating the eyes

Your ophthalmologist will recommend a treatment plan according to the severity of your symptoms.