Chronic Dry Eye Treatment Explained

The eyes are constantly lubricated by the tears formed by the body. These tears also perform other functions like keeping the moisture content of the eye at the correct level and protecting the eye from infections through the presence of antibodies in their composition. A chronic dry eye condition can be extremely disconcerting to the patient, while also having the potential to cause some serious and long lasting damage. The basic reason why people suffer from dry eyes is when the tears formed by the body evaporate too quickly or are just not formed in large enough volumes.  

This can be caused due to a number of reasons ranging from being a side effect to some prescription medication or an indication of a deeper underlying syndrome.

Causes Of Chronic Dry Eye

Let's take a look at the most common causes of chronically dry eyes.

• Aging: The function of the tear producing Lacrimal glands undergoes an age associated decrease causing the dry eye syndrome to be much more common in older individuals. It is also seen in a higher percentage of post menopausal women.
• Side effect of Medication: Medication that affects the secretion of certain enzymes and hormones like H2 blockers, contraceptive pills can cause a reduction in the tear formation. Other medicines known to cause dry eyes include anti hypertensive drugs, antidepressants and drugs used in the treatment of Parkinson’s disease.
• Autoimmune diseases: Dry eyes are found as part of the symptoms associated with autoimmune diseases like Sjogren Syndrome, Arthritis and Lupus. It is not yet known with certainty why some people or even races are more prone to developing auto immune diseases with possible reasons being genetic or the presence of an environmental trigger or even a combination of the two.
• Environmental causes: Our eyes dry out faster in a windy, dry climate. People who wear their contact lenses for too long are also more likely to develop dry eyes, while being inside air conditioned and dry climates like the ones found in airplanes can also cause this condition.
• Tear instability: Our tears are composed of three components produced by three different glands. The major component in the watery part formed by the Lacrimal glands. The others consist of an oily component (Meibomian glands) and the mucus content (Globular cells).

Any disruption between the proper ratio and balance of these components will lead to the tears being unable to perform their desired function and instead be evaporated much sooner than normal.

Symptoms Of Dry eyes

1. Pain
2. Constant irritation and an itchy feeling in the eyes
3. Increased sensitivity to light
4. Redness
5. Blurring
6. Watery eyes ( caused by the overstimulation of the lacrimal duct in response to dryness)

Dry Eyes: Diagnosis

While in most cases the diagnosis for dry eyes is made on the basis of clinical observation and the patients history, sometimes the doctor may want to physically measure the amount of tears being produced by your body. One common method used is by the Shirmer method involving filter paper being placed under the lower eyelid.

Treatment Of Dry eyes

One of the things that need to be understood is that there is no "cure" for a chronic case of dry eyes. That means that the underlying imbalance between tear production and its composition will continue to be the same in most cases, however this condition can be treated by a number of different methods.

Tear Replacements

The use of artificial tears sold over the counter all over the world is the primary and the most effective treatment for the large majority of people suffering from chronic dry eye syndrome. The exact composition of these tears varies from company to company but they all mimic the components found in naturally formed tears. They all contain hyaluronic acid, carboxy methyl cellulose, and polyvinyl alcohol.

Patients might have to experiment with a few different brands before they find the best fit for their needs.

Punctal Occlusion

This is based on the simple premise that if the ducts draining away the tears from the surface of the eyes are blocked, then the tears will last for longer, thus providing comfort to the patients. The sensible way is to first test the waters with the use of an absorbable, temporary plug.

While these permanent plugs do not cause any trouble in the large majority of the patients, they can be removed quite easily by the surgeon if the need arises.

Unclogging The Glands

There are medical devices that are available now which attempt to improve the functioning of the glands producing the tears by the use of heat and pressure. These act on the surface of the eyelids.  Their use has shown mixed results in patients with some reporting an increase in comfort while others showing no change.

Cyclosporin

A cyclosporin emulsion for use in the eyes is currently the only drug that has been approved for use in chronic dry eye treatment that helps  an increase in the amount of tears being produced by the body.  

Topical Steroids

Eye drops containing topical steroids are used to help reduce the inflammation that is often associated with chronic dry eye patients. While this does not help increase the lubrication by itself, it does help make the patient feel more comfortable.

Nutritional Supplementation

Recent reports have suggested that patients suffering from chronic dry eye syndrome will benefit with the use of Omega-3 fatty acid supplementation. There is no harm in trying this method however more research needs to be undertaken in this field to be absolutely sure of the various effects it might have.

READ Ocular Migraine: Eye Migraines or Ophthalmic Migraine