The term “dry eye” refers to a wide spectrum of ocular conditions.  The most common symptoms are dry, red, gritty, and even watery eyes.  It often feels as though there is something foreign on your eye. Every time we blink, tear glands within the eyelid secrete tears.  These tears lubricate the eye and help prevent infection. A healthy tear film consists primarily of a delicate balance of three layers.  A thin outer oily layer reduces evaporation of the tears.  Below the outer oily layer is a watery layer called the aqueous layer, which makes up 98% of the tear film.  It helps rinse and clean the front surface of the eye.  Below the aqueous layer is a thin layer of mucous that makes the cornea more wet-able. Normal tears nourish and refresh the eyes.

When the normal tear film breaks down, the eye begins to dry out.  When that happens our eyes begin to burn and often the tear gland releases watery tears.  These tears normally are only released to rinse out a foreign body or during emotional crying.  They cause inflammation and irritate the eyes.  That’s why dry eyes leads to red, burning, irritated eyes just like crying does.

Dietary intake of omega fatty acids helps with dry eye conditions. Because of the benefits to vascular, cardiac, cholesterol, skin and dry eyes, most clinicians suggest 2g to 3g per day of high-quality OTC fish oil capsules or flaxseed to patients with dry eyes.. 

 There are three basic causes for dry eye, although in most cases there is considerable overlap in the cause for a particular person.

1.  Anatomical - In this case the tear drainage system is too efficient and the normal tears are drained away too rapidly.

  • Punctal plugs can often almost instantly make a persons with this problem feel much more comfortable.  The plugs prevent the tears from draining away so the eye is not so dry.  It is a simple pain-free procedure that takes only minutes.  

2.  Aqueous Deficient - This is a reduction in the water volume of the tears. It may be due to an autoimmune syndrome called Sjogren's syndrome, hormonal deficiencies, or a side effect of certain medications. 

  • OTC lubricant drops are the most common treatment used for dry eyes and are often enough for mild dry eye cases.  The prescription drugs, Restasis © (cyclosporine 0.05%, Allergan) and Xiidra © (lifitegrast ophthalmic solution 5%, Shire) may be especially beneficial for those who suffer from aqueous deficient dry eyes

3.   Oil Deficient - There are about 80 Meibomian oil glands within the eyelids of each eye. When they become deficient the oily tear layer is not adequate and the normal tears rapidly evaporate away resulting in a dry eye. This is called Meibomianitis or Meibomian Eye Disease (MED). Recent research indicates that over 80% of dry eye cases relate to reduced Meibomian oil production.

  • Warm compresses can soften up the oil in the glands and allow it to spread over the tears more completely. Several companies make moist heat masks that make the treatment much easier than it used to be with warm washcloths.
  • Lid scrubs help to remove oil, bacteria and debris, as well as to stimulate the eyelid oil glands. Baby shampoo has historically been recommended to patients with seborrheic forms of lid disease. But even though the bottle says "No Tears", it often irritates the eyes. OcuSoft (OcuSoft) and SteriLid (Advanced Vision Research) are bactericidal OTC products available in pharmacies. These products may be less irritating to the conjunctiva than shampoo or soap. 
  • Steroid or tetracycline medication.  Short-term use of these prescription medications will reduce the inflammation in and around the Meibomian glands and will help to restore the free flow of oil.   Lotemax gel, Azasite and Doxycycline are the medications used most often.
  • Meibomian gland expression is a procedure the doctor performs to squeeze oil from the oil glands.  It can be done as a diagnostic procedure to determine the condition of the oil.  Oil that is clear with little color indicates healthy Meibomian glands. Thick or discolored oil indicates Meibomian gland disease. Therapeutic expression is a more complete expression of the glands and can increase quality oil production and decrease dry eye symptoms.

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