A PATIENT’S GUIDE TO DRY EYE BY NEEL R. DESAI, M.D.
What is Dry Eye Syndrome? Dry Eye Syndrome (DES), also known as keratoconjunctivitis sicca, refers to the clinical signs and symptoms that occur when the surface of the eye is not nourished by a healthy tear film, or layer of lubricating tears. This can occur when the quantity or quality of the tears is deficient. Often times, Dry Eye Syndrome is a part of an extensive group of ocular surface diseases with wide-ranging symptoms. More than 20% of the U.S. population, including 3.2 million women of all ages, suffers from chronic Dry Eye Syndrome. It is estimated that less than half (45%) of those suffering from dry eye know it or have been properly diagnosed. It is important to understand that the tear film is not as simple as it might seem. In fact, normal tears are composed of an intricate mixture of not just water, but naturally produced oil and mucous secretions, as well as over 120 complex proteins and enzymes that are produced by dedicated glands around the eye. Hence, proper management of Dry Eye Syndrome requires a keen understanding of the complexities of both the normal and abnormal physiology that may exist on the ocular surface. A complex recipe of ingredients is responsible for maintaining the health of our ocular surface, our eyes’ comfort, and our clear vision. When the specific balance of these components is disturbed by any one of many predisposing factors, Dry Eye Syndrome can result. If unrecognized by your eye care provider, or if left untreated, Dry Eye Syndrome can result in chronically irritating symptoms, increased risk for infection, and decreased quality of vision.
What are the Symptoms of Dry Eye?
Symptoms may vary for each person depending on the cause, severity, and stage of the disease.
Early Symptoms of Dry Eye Syndrome: An irritating stinging, burning, or scratchy sensation A gritty or sandy sensation in your eyes Fluctuations in the quality of vision Eye “fatigue” with prolonged reading, computer or television use Excessive watering of the eyes with tears that don’t lubricate Sensitivity to light Discomfort in contact lenses As Dry Eye Syndrome worsens, the associated symptoms may change. Patients may no longer notice the physical effects of dry eye, like burning, due to the subtle nerve damage that is a consequence of chronic Dry Eye Syndrome. Eyes that were once excessively watery, may become devoid of tears. Fluctuating vision may give way to consistently blurry vision that is not improved with changes in glasses or use of over the counter eye drops. Eyes may become persistently red or produce a mucous discharge. Recurrent scratches, erosions, or infections may also develop.
What Causes Dry Eye Syndrome?
There are many predisposing factors that can lead to various forms of Dry Eye Syndrome. The common link among the causes is that they all result in inflammation within tear producing glands of the eye and on the ocular surface. This inflammatory response is disruptive to the delicate balance within normal healthy tears and results in a decline in the quantity and quality of tears produced.
Causes of Dry Eye Syndrome: • Environmental factors (heat, air conditioning, fans, smoke) • Allergic factors (dust, pollen, pets) • Functional (prolonged reading, computer or television use) • Normal aging • Hormonal changes associated with menstruation and menopause. • Other Ocular Surface Diseases • Diseases of the Eyelids and Eyelashes (Blepharitis) • Medical Conditions (eg. Rheumatoid arthritis, Sjogren’s Syndrome, Rosacea, Sarcoidosis, Thyroid disorders, Sleep Apnea) • Common medications (eg. antihistamines, diuretics, antidepressants) • Contact lens use and previous ocular surgery Irritation Subclinical Ocular Damage
Decreased Tear Production/ Increased Evaporation THE DRY EYE INFLAMMATORY CYCLE
Clinical Ocular Damage
Development of Signs & Symptoms
How is Dry Eye Syndrome Diagnosed? An experienced and knowledgeable eye care provider specializing in dry eye management will be able to help you determine if your symptoms are attributable to Dry Eye Syndrome. Your doctor should start by making a detailed review of your entire medical history, including an assessment of other medical conditions and medications, as well as environmental contributors. A comprehensive eye exam can then reveal the stage and severity of your condition. Your eye doctor may initially utilize several non-invasive tests to assess the quality and quantity of your tears. These tests include Schirmer tear testing which quantifies the rate of tear production, while corneal staining employs the use of special dyes to assess the quality of tears and the condition of the ocular surface. Your doctor should also measure the “Tear Break-up Time� which reflects the stability of the tear film. In some cases of severe Dry Eye Syndrome, your dry eye specialist may request laboratory tests to look for underlying medical conditions that can cause chronically dry eyes.
You may also visit www.eyespecialist.com to take a self-assessment survey that may help you evaluate your symptoms in the comfort of your home.
How is Dry Eye Syndrome Treated? Unfortunately, there is no cure for chronic Dry Eye Syndrome. However, an experienced dry eye specialist will be able to provide patients many effective options for relieving and managing the symptoms that accompany the condition. Since, the underlying causes of dry eye have often been present for many years, the treatment of Dry Eye Syndrome is by no means an overnight process, but rather, should be considered a long-term course of therapy. Many patients have already tried various forms of treatment and grown understandably frustrated by the lack of apparent benefit. Such treatment failures are often the result of therapies pursued in a disadvantageous order or therapies that were prematurely discontinued. Your eye care provider may refer you to a dry eye specialist for further evaluation and treatment.
DRY EYE TREATMENTS
Artificial Tears and Lubricants Environmental Modification Anti-Inflammatory Medications Eyelid Disease Management Tear Duct Plugs Nutritional Supplements Specialty Compounded Drops Autologous Serum Drops Advanced Surgical Therapy
For many years the mainstay of therapy for mild Dry Eye Syndrome consisted almost exclusively of over-the-counter artificial tears or lubricants. There are hundreds of brands and formulations of artificial tears which can be quite confusing for patients. However all these drops are not the same. A dry eye specialist will be able to identify your specific form of dry eye and recommend a brand and formulation of tears ideally suited for you. For patients with more than just mild or temporary symptoms, over the counter artificial tears alone do not constitute adequate treatment. Some over the counter remedies can actually worsen the condition.
Environmental modification is a frequently overlooked but important part of reducing dry eye symptoms. Patients can try to limit direct exposure to dry air from vents, fans, and other sources. Whenever possible, dry eye sufferers should also avoid allergens like dust, smoke, pollen and pet dander. Room humidifiers and moisture goggles that are worn at bedtime can also be useful. Severe Dry Eye Syndrome is likely to initially require more intensive therapy to break the cycle of inflammation. Your eye care professional may recommend a short course of various anti-inflammatory eye drops to start you on the road to recovery and to break the cycle of irritation, inflammation and worsening dryness. Other prescription drops, such as Restasis (Cylcosporin 0.05%), may be recommended. Restasis is effective by simultaneously improving the quality of tears, restoring the balance of tear film components, and increasing the natural production of healthy tears. Several other agents promoting healthy tear production are currently under study. Dry eye management would not be complete without an assessment of, and treatment for, eyelid diseases. Many of the important glands contributing to tear production are located on the edge of the eyelids and are prone to inflammatory disruption. Warm compresses, specialized eyelid cleansers, and, if necessary, prescription medications can reduce the eyelid inflammation, called blepharitis, that frequently accompanies Dry Eye Syndrome. Tear duct plugs come in various forms and can be painlessly inserted by your eye doctor only after ocular surface inflammation has been adequately treated. These microscopic plugs, commonly made of dissolving collagen or longer-lasting silicone, comfortably reduce the drainage of tears away from the eye’s surface, thus retaining moisture where it is needed most. Some patients may also benefit from nutritional supplements such as Flax Seed Oil, Fish Oil, and other dietary modifications rich in essential fatty acids, such as Omega-3, Omega-6, and linoleic acid, which may aide healthy tear production.
Dry Eye-Q Test Take this self-assessment survey to determine your risk for Dry Eye Syndrome. Check all items that apply to you or your symptoms. Do you have these problems? Redness Sandy or Gritty Sensation Itching Burning Excess Mucous/Excess Watering Blurry or Fluctuating Vision Thyroid Abnormalities Rheumatoid Arthritis Asthma Sjogren’s Syndrome Glaucoma Lupus Other Auto-Immune Conditions Are you over 50? Are you post menopausal?
Do you use these medications? Artificial Tears Redness Reducing Eye Drops Antihistamines Decongestants Blood Pressure Medication Diuretics Beta Blockers Anti-Depressants Thyroid Hormones Oral Contraceptives Chronic Pain Medications
Are your eyes sensitive to these conditions? Smoke/Air Pollution Light Wind Computer Screens Heaters/Air Conditioning Contact Lenses
If you checked 5 or more of the above items, you may have Dry Eye Syndrome. You should discuss your symptoms with your eye care professional or a Dry Eye Specialist.
Choosing a Dry Eye Specialist Because your sight is vital to maintaining the highest quality of life, choosing a qualified eye specialist who has the proper training and experience is essential. If your eye doctor provided you with the valuable information contained in this brochure, you should be reassured that you are in the hands of a knowledgeable professional with your best interests in mind. They have already started you on the path to relief from Dry Eye Syndrome. If it becomes apparent that your individual case of Dry Eye Syndrome is moderate or severe, your eye doctor may refer you to a local specialist for further evaluation and treatment. Dry Eye Specialists are physicians specializing in Ophthalmology that have pursued additional advanced training in diseases of the cornea and ocular surface. As a member of your eye care team, a Dry Eye Specialist will work closely with your current eye care provider, family doctor, and other medical specialists to provide you the highest level of treatment.
About the Author Dr. Neel R. Desai is the Cornea, Cataract, and Refractive Specialist at The Eye Institute of West Florida. He is a fellowship-trained ophthalmologist specializing in state of the art surgery techniques. He was a top graduate of the Pennsylvania State University College of Medicine and completed his fellowship in Cornea, Cataract and Refractive Surgery at the Wilmer Eye Institute at Johns Hopkins Hospital. He is one of only 100 surgeons worldwide able to perform advanced corneal transplants and other complex cataract, corneal and refractive procedures. Dr. Desai is the Medical Director of the International Sight Restoration (ISR) Eye Bank which serves 85 countries including the U.S. Through his work with ISR, Dr. Desai also helps train surgeons in advanced surgical techniques throughout the world. He holds pending patents to surgical instruments and techniques of his own design. Dr. Desai has authored numerous books and articles in scientific journals, received prestigious awards for his research contributions, and is a guest speaker on several international lecture circuits. He is the proud founder of three non-profit medical organizations serving the indigent around the country.
Dr. Desai is available to new patients for consultation. Ask your eye care provider for a referral or call directly to schedule an appointment at one of our locations.
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FOR MORE INFORMATION: Discuss your symptoms with your eye care professional and visit these helpful websites.
www.eyespecialist.com www.focusondryeye.com www.tearfilm.org/dewsreport
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