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DRY EYE
SYNDROME
WHAT OUR TEARS ARE SAYING
Dby Cory Collier, MD “Dry eye syndrome is
ry eye syndrome (DES) affects up to 30 percent of the a common condition
population over the age of 50. DES can be a chronic leading to significant
and in some cases debilitating condition impacting our physical and visual
comfort, vision and quality of life. ”discomfort for many
DES typically presents with symptoms of dryness, burning, people.
tearing, blurry vision, fluctuating vision, or a sandy or gritty
sensation in the eyes. Some patients may have no symptoms at all quantity, observation of oil glands located along the eyelid as well
or may incorrectly attribute these symptoms to other conditions as topical dyes that allow for the assessment of inflammation and
affecting their eyes. irritation on the surface of the eye.
Age is a major risk factor for DES. Females are more commonly These tests help distinguish the two major forms of DES;
affected than males especially those women on hormone aqueous deficient and evaporative dry eye. In aqueous deficient
replacement therapy. Additional risk factors include low humidity dry eye, the production of the water layer of tears is generally low
environments, prolonged reading or computer use, and poor dietary resulting in minimal tears. In some individuals the eye responds
habits. to an initial lack of tears by attempting to over compensate with
excessive tear production. Unfortunately these tears are of poor
At the center of any discussion on DES are tears. Tears are quality and generally full of inflammatory molecules that do little
made of three primary layers including an outer lipid or oil layer, to address the underlying deficiency. In contrast, evaporative dry
a middle aqueous or water layer and a layer of sugary proteins eye is centered on poor production or composition of the oil layer.
known as mucins. In reality these components exist in a much The oil layer helps maintain tears on the eye by preventing their
more dynamic and continuously mixing environment than the premature evaporation. With an imbalance in the oil layer, tears
layer model suggests. evaporate from the eyes quickly. Clinically many patients exhibit
signs of both forms of dry eye.
The diagnosis of DES is made after consideration of patient
symptoms and a thorough eye examination. Diagnostic tools The treatment of DES varies depending on the type and severity
include symptom questionnaires, assessments of tear quality and of DES. Tear supplementation with artificial tears is a staple in the
management of DES.Other first-line options include oral Omega-3
supplements, warm eyelid compresses and eyelid cleansers. In more
advanced cases, prescription medications including Restasis TM,
other topical anti-inflammatories and oral medications may be
employed. Punctal occlusion, a process by which the tear drainage
system is closed to allow for the accumulation of our own tears, is
often performed when topical therapies fail to provide relieve.
Dry eye syndrome is a common condition leading to
significant physical and visual discomfort for many people. If you
are experiencing symptoms, talk to your eye care provider for an
individualized treatment approach.
20 Life in Naples | December 2015
