Dry Eye in NYC
The most common form of ocular surface disease is dry eye syndrome. Patients with dry eye may complain of eye stinging, burning, foreign body sensation, sandy or gritty sensation, tearing, itching, redness, irritation, pain, light sensitivity, and difficulty wearing contact lenses. These symptoms often worsen at the end of the day or after focusing for a prolonged period on a near task. Often, vision fluctuates or to becomes blurry as a result of dry eye.
At the Dry Eye and Ocular Surface Disease Clinic, Dr. Pamel and his associates use of the most comprehensive and advanced diagnostic tools to target the cause of dry eye, only then can the treatments and management be tailored to each individual’s needs. With this advanced personalized treatment we can reduce or eliminate discomfort and improve the quality of life.
Understanding the Tear Layer and its role in Dry Eye
The tear layer is eye’s first defense. It is composed of three layers: a lipid layer, an aqueous layer and a mucous layer. Each layer must be present and healthy to provide lubrication, comfort, protection, and visual clarity. A deficiency in any layer can create a problem leading to the symptoms above.
- Lipid Layer: The purpose of the lipid layer is to maintain tear quantity and fight evaporation. This lipid layer is produced by the meibomian glands that are the tubular glands that line the inner lid margin. These lipid secretions should be thin and easy flowing, but many individuals suffering from dry eye and ocular surface disease have glands that are clogged, or in some severe cases have atrophied or scarred over leading to evaporative dry eye.
- Aqueous Layer: The aqueous layer or the “watery layer” of the tears contains water, enzymes, and proteins to help protect the eye. This layer is secreted by small glands in the conjunctiva as well as the lacrimal gland. The aqueous layer makes up the bulk of the volume of tears and is responsible for tear spreading. Tear production tends to diminish with age, various medical conditions, or as a side effect of certain medications. Some systemic diseases such as Sjögren’s Syndrome can cause a severe reduction in the volume of aqueous layer produced.
- Mucin Layer: The mucin layer works to hold the tear film to the eye. It coats the eye and allows for even distribution of tears across the ocular surface. This layer is produced by goblet cells found in the ocular surface. Deficiencies in the mucin layer are most caused by diseases that involve mucus membranes such as Stevens-Johnson Syndrome and ocular cicatricial pemphigoid.
Causes of Dry Eye Syndrome:
The definition of dry eyes has evolved over the last twenty years. In 2007, the Definition and Classification Subcommittee of the International Dry Eye Workshop (DEWS) classified dry eye as a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance and tear film instability, with potential damage to the ocular surface.
The DEWS definition also states that dry eye is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface. These features lead to the dry eye cascade of visual degradation, epithelial cell damage and discomfort. Osmolarity is the relationship between the water in the tear film and the solutes (chemical substances) that make up the tear film. In the dry eye condition, the loss of water from the tear film alters the ratio and results in an increase in osmolarity.
Females are affected more than males and most individuals with this condition are female, over the age of 30. According to the Women’s Health Study, the prevalence of dry eye affects more women as they age.5 Although the prevalence increases in men as they age, it is not as common as in women. Also, women who used hormone replacement therapy (HRT) had a 69% greater risk of developing dry eye syndrome. If estrogen therapy was combined with progesterone/progestin, the risk went up another 29%. The risk of dry eye increased 15% for every three-year interval that the women remained on HRT. Many patients develop a dry eye condition over years and decades before it is recognized.
Many factors can cause dry eye or exacerbate an existing dry eye condition. These include:
- Extended visual tasks, such as prolonged computer use.
- Systemic medications that have drying side effects, including antihistamines, hormone replacement therapy, diuretics, antidepressants and antianxiety medications, cancer treatments and some sleep aids.
- Excessive consumption of alcoholic beverages.
- Long-term exposure to dry air, as found in the desert Southwest, for example, or windy climates. Also, dryness increases in the winter months as the humidity decreases with falling temperatures.
- Use of forced-air heat or air conditioning.
Dry Eye FAQs
What are the most common symptoms of dry eye disease?
Common symptoms of dry eye disease include the following:
- Chronic sensation of dryness, itching or burning in the eyes
- Sensitivity to light
- The feeling of a foreign object stuck in the eyes
- Blurry vision
- Persistent eye fatigue
- Discomfort when wearing contact lenses
Why are my eyes dry all the time?
There are two primary reasons why you may develop dry eye disease: either your eyes do not produce enough tears, or the tears they do produce evaporate off the ocular surface too rapidly.
Insufficient tear production can occur because of advancing age, the use of certain medications, untreated underlying medical conditions or environmental factors (e.g., exposure to dry, arid or windy climates). Prolonged digital device use can also interfere with tears spreading across the ocular surface, because blink rate naturally slows down when looking at a computer or smartphone screen.
Poor tear quality usually occurs due to a problem with the eye’s meibomian glands. Obstructions can build up in the glands, preventing them from secreting oils that are crucial to the tear film. Without adequate oils, the tears do not “stick” to the ocular surface as they should, and the eyes dry out.
How is dry eye diagnosed?
Dr. Pamel diagnoses dry eye after a comprehensive eye examination, an evaluation of your tear production and an analysis of your tear film composition. He will also inquire about your medical history, current medications and any behavioral or environmental factors that could be contributing to dry eye disease.
My eyes water constantly and don’t seem dry. Why have I been diagnosed with dry eye?
If your tears do not contain enough oil, they will evaporate too rapidly to properly lubricate your eyes. Your eyes may overcompensate for this lack of lubrication by producing an abundance of poor-quality tears.
What happens if I do not seek dry eye treatment?
Leaving dry eye untreated can have serious long-term consequences, because your eyes rely on sufficient moisture to ward off infection and injuries. Eventually, the lack of moisture can lead to corneal ulcers, scarring and other problems.
What is the best dry eye treatment for me?
The best dry eye treatment for your case depends on the underlying cause and severity of your symptoms. Some mild cases of dry eye can be treated by discontinuing the use of a medication that dries out the eyes, addressing an underlying health issue or using artificial tears.
More severe symptoms will require other medications or procedures to reduce tear loss, stimulate tear production or restore balance to the tear film’s composition. You may need treatment to clear obstructions within your meibomian glands, helping them to resume oil secretion.
Are there any lifestyle changes I can make to improve my dry eye symptoms?
Making certain conscious decisions in everyday life may result in an improvement in your dry eye symptoms. For instance, adding omega-3 fatty acids to your diet may benefit your tear production and quality. Blinking frequently and taking breaks during prolonged digital device use is usually recommended. Other measures, such as applying a warm compress to the eyelids or gently massaging them, may also help.
Dr. Pamel will review these and other steps you can take on your own to control dry eye symptoms.
For an appointment at the Dry Eye and Ocular Surface Disease Clinic, please call (212) 355-2215.
