DRY EYE DISEASE

What is Dysfunctional Tear Syndrome (DTS)?

DTS, also known as dry eye syndrome, is one of the most common problems that eye doctors see.  It occurs when the eyes do not produce or retain enough tears to keep its surface moist and comfortable.  It is a very common, often annoying condition that, if not treated, can be serious. 

What are the symptoms of DTS?

The usual symptoms include burning, aching, scratchiness, stringy mucus in or around the eyes, irritation from smoke or wind, and difficulty wearing contact lenses.  Symptoms tend to be worse in dry and windy conditions, after prolonged eye use from reading or computer use, as well as late in the day.  Using a hair dryer may exacerbate symptoms as may air conditioned and/or heated rooms.  Many patients complain of watery eyes and are surprised to learn that their problem is dryness.  The dryness is irritating to the surface of the eye, which then causes the tear-producing gland to secrete a large volume of tears.  This overwhelms the tear drainage system and causes excess tears to overflow from the eye.

What causes DTS?

The most likely cause of DTS is that the eye does not produce enough tears.  Tear production normally decreases as we age.  Although DTS can occur in both men and women at any age, women are most often affected, particularly postmenopausal women.  A wide variety of medications, both prescription and over-the-counter, can reduce tear production.  Diuretics, beta blockers, antihistamines (Claritin, Zyrtec, Allegra), sleeping pills (Ambien), “nerve pills” (Prozac, Zoloft, Effexor), and pain relievers can all cause symptoms of DTS.  DST can be related to some medical conditions, including rheumatoid arthritis, lupus, Sjogren’s syndrome, as well as dermatologic conditions, such as rosacea and seborrhea.  DTS may also be caused by excessive tear evaporation, as may happen if you do not blink frequently enough or if your eyelids do not close well, especially when you sleep.

How is DTS diagnosed?

An ophthalmologist is usually able to diagnose DTS by examining the eyes.  A new test is now available which can help diagnose dry eye in the office.  The TearLab device is a non-invasive test which analyzes the tears and helps quantifiy the severity of dry eye.  

How is DTS treated?

Although there is no cure for DTS, there are several treatments that can relieve the discomfort associated with it:

       1.     Artificial Tears

Eye drops called artificial tears add moisture to the eyes, but are temporary and must be used often.  Some drops are thicker and more viscous than others, and the more viscous the drop, the longer the drop is retained on the eye.  However, the thicker the eye drop, the more it may blur vision.  Preservative free tears are more advantageous than preserved tears because many people have a sensitivity to preservatives.  Artificial tears are available over the counter without a prescription.  There are many different brands, and each patient can find the best one for their individual symptoms.  The tears should be used several times a day, even every hour if necessary.

2.               Support Measures

Simply increasing fluid intake (at least 6-8 tall glasses of fluid daily) and avoiding alcohol may improve dry eye symptoms.  Also, if the air is dry (winter), increasing the humidity in your living and working areas can significantly improve eye comfort.

3.               Nutritional Supplements

in many cases of dry eye, the tears evaporate too quickly,

leaving dry areas on the eye surface.  In such cases, the

oily portion of the tear film is not functioning properly. 

Incorporating essential fatty acids in the diet or through

supplements may increase the oily portion of the tears,

reduce evaporation and quiet inflammation associated

with dry eyes.   

4.     Prescription Medications

If a patient has been using artificial tears with little success, he/she may want to consider Restasis, the first and only prescription ther­apy for DTS.   Restasis is both an artificial tear to treat symptoms in the short term, combined with medicine to treat the disease in the long term. It helps patients make their own natural tears, something an artificial tear cannot do by itself. Restasis is used twice a day—one drop in each eye, approximately 12 hours apart. It is available only by prescription. 

Patients that are prescribed Restasis will usually notice more comfort and moisture within 2-4 months.  Restasis may sting momentarily and this is normaVl.  A second medication is usually prescribed with Restasis for the first month, and the combination of the 2 medications work very well together to improve dry eye symptoms. 

5.               Punctal Plugs

Another simple non-surgical procedure that provides long-term relief for some patients is inserting "plugs" into the punctum, the tiny eyelid openings that drain tears into the tear ducts and nose.  Once occluded, more tears are available on the eye surface.  Punctal plug insertion is quick, painless, and very safe.  They last indefinitely, are easily removable by the doctor for rare instances of allergy or infection, and rarely become dislodged.  If plugs are to be placed, we initially place dissolvable temporary plugs in one eye as a test to see if this will work.  After several days, the collagen plugs will dissolve, but prior to dissolving, they should provide significant relief in dry eye symptoms.  If effective, the patient returns in 2 weeks for placement of plastic punctal plugs which will not dissolve. 

6.               Permanent Occlusion

If none of these treatments help, the punctum can be permanently closed to prevent losing what little moisture is left. This procedure usu­ally involves heat cautery. Afterward, patients still may need to continue using eye drops.

None of these treatment options are mutually exclusive, and Dr. Chu may recommend a combination of these treatments, depending on the severity and the unique circumstances of each patient.



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