OPTIMIZE YOUR HEALTH
Protecting Your Vision

Dry Eye Syndrome
By Sue Kim-Saechao, RN, MSN, CRNP, and Jannet Huang, MD, FRCPC, FACE, ABHM

Dry Eye Syndrome is also referred to as Keratitis Sicca or Xerophthalmia. Many have experienced dry eyes on occasion. But for some individuals, dry eyes can be a chronic condition associated with significant discomfort and even interfering with optimal vision.

Dry eye syndrome is an extremely common condition, thought to affect approximately 60 million Americans. The cause is usually unclear, but there appears to be an imbalance between tear production and tear volume drainage via the nasolacrimal ducts. The tear film is made up of a mucous layer against the eye, a middle aqueous (water) layer, and an outer lipid (oily) layer. All three components are critical to a normal tear film. If any of the three layers of the tear film are deficient, the eye may suffer symptoms of dry eye.

People with dry eye syndrome usually present with complaints of burning, stinging, redness of the eyes, and tearing. The tearing seems paradoxical at first, but is explained by the fact that an underlying dry eye may become irritated, causing increase production of tears. This response is physiologically equivalent to the presence of a foreign body, such as a hair, in the eye. Tearing that becomes symptomatic usually occurs in conditions that more rapidly evaporate tears from the eye, such as being outdoors in the wind. Heat, low humidity, and the presence of smoke may compound the problem.

In most cases the cause of dry eye syndrome is unknown. Dry, dusty environments, contact lens use, incomplete closure of the eyelids when sleeping, and decreased blinking are common aggravating factors. Certain other disease states as well as medications may be associated with dry eye. Patients who present with dry eye and dry mouth may have a condition known as Sjogren's syndrome. Other systemic conditions associated with dry eye syndrome include rheumatoid arthritis, lupus, scleroderma, sarcoidosis, amyloidosis, and thyroid diseases; deficiency of vitamin A; and the use of medications including antihistamines, nasal decongestants, tranquilizers, and anti-depressant drugs. In addition to environmental and disease conditions, according to the American Academy of Ophthalmology, hormonal changes make older women twice as likely as older men to develop dry eye and accompanying symptoms such as eye irritation and blurred vision. In fact, it is not uncommon for perimenopausal/menopausal women to have dry eye as part of their symptoms.
 
The severity of dry eye syndrome generally dictates the course of treatment. In most cases, the patient is recommended to use artificial tears in the eye on a regular basis. For those patients who fail to improve with the use of artificial tears, or have a severe dry eye presentation, occlusion of the puncta (tear drainage openings) located in each of the four lids may be completed. This usually entails simple insertion of a punctal plug into one or more of the tear drainage duct openings. The tiny plugs, usually made of silicone or other inert material, can be inserted with little or no discomfort and are rarely felt by the patient afterwards.

Androgens (male hormones) appear to play a complex but important role in tear production and studies are underway to determine if topical application of certain of these hormones may improve tear production and symptoms. Restasis (cyclosporin), an immunosuppressant agent, is now available for patients with dry eye syndrome. The anti-inflammatory effect of topical Restasis may improve overall tear function and/or production. The drug is administered twice daily as an eyedrop and requires two to four weeks of therapy, plus daily maintenance, for a maximum benefit.

Strategies can also be used to reduce environmental aggravators of dry eye. Wear sunglasses with foam or other seal at the sides to reduce exposure to sun, wind, and dust. Indoors, an air filter can filter dust and other particles from the air. A humidifier in the home, especially next to the bed at night has been found to be particularly helpful for many patients. Due to "hard" tap water in most areas, however, distilled water is usually required. "Hard water" in many areas will create an airborne mineral dust, which may make the humidifier less effective for this intended purpose. 

Certain nutritional supplements, such as omega-3 fatty acids, can decrease dry eye symptoms. A 2003 study found omega-3 to decrease risk of developing dry eyes and other studies have found that gamma-linolenic acid (GLA) improve dry eye symptoms.

At The Center for Optimal Health, we approach the symptoms of dry eyes with a whole-person approach, first ruling out systemic diseases and identifying medications, which may be the underlying cause. We then recommend nutritional supplements and lifestyle strategies to optimize eye health.

—August 2007

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