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About Dry Eyes

Dry Eye Syndrome affects millions of people worldwide. While many people associate the thought of dry eyes with various symptoms of ocular discomfort such as dryness, grittiness or burning, most people do not realize that in order to have normal vision, it is critical to have a sufficient quantity of healthy tears on the surface of the eye at all times. Dry eye is an eye condition in which there is a deficiency of the tear film due to either an insufficient production of one's own natural tears or an excessive evaporation of tears.

Insufficient Tear Production
There are a number of factors that can cause you to produce an insufficient quantity of tears. Certain systemic conditions such as Sjogrens's Syndrome or autoimmune connective tissue diseases such as Rheumatoid Arthritis and Lupus Erythematosis may decrease the quantity of tears that you produce.
Patients with Sjogren's Syndrome not only have dry eyes but also may have dry mouth and arthritis as well. Any disease or inflammation of the tear gland, called the lacrimal gland, will cause patients to produce too few tears to maintain a normal and healthy tear film. These may include factors such as long term contact lens wear, past eye infections, certain allergies and even vitamin deficiencies.

Excessive Evaporation of Tears
There are a number of factors that can cause your tears to evaporate too quickly. This can include environmental factors such as being exposed to forced hot air heat, dry climates in general, air travel, reduced blinking from contact lens wear or looking at a computer screen for long periods of time, and air pollution.

Your tears may evaporate too quickly if you suffer from low-grade eyelid inflammation. Within your eyelids are tiny glands called meibomian glands. Any inflammation of the eyelids such as from blepharitis or ocular rosacea can cause the meibomian glands to stop secreting their oily film. This oily film is required as an outer layer of the tear film to prevent evaporation. Without it, you will almost certainly experience quick evaporation of tears and dry eyes. This is especially noteworthy for perimenopausal women as it is believed that 75% of women in this age group have some degree of facial rosacea. This along with the general hormonal changes occurring during this time, make perimennopausal woman particularly susceptible to dry eyes.

Finally, your tear film may evaporate too quickly if the tears are not properly distributed and replenished over the surface of the eye because of inadequate eyelid movement. This may be due to improper or incomplete closure of your eyes during sleep, certain eye "bulging" conditions that may be related to thyroid problems, or a loss of tone or shape of the eyelids so that they turn in or turn out.

Dry Eye Diagnosis and Treatment
During a dry eye examination and consultation, Drs. Berger, Howard and Kessler are able to evaluate your tear production by using a specialized microscopic technique to observe the height of the tear film in addition to using a clinical test called a Schirmer Test that allows them to actually measure the rate at which you produce natural tears. They will also use specially formulated eye drops that contain dyes to help investigate the functioning of the various layers of the tear film. Based on their findings they will be able to make a proper diagnosis as to the particular cause of your dry eye syndrome and prescribe the necessary tear substitutes, eye drops and/or options to help restore your tear film back to normal and make you more comfortable.

The specific treatment options that Drs. Berger, Howard and Kessler may prescribe will really depend on the likely cause and the severity of your dry eyes. For those patients with mild to moderate dry eyes the first course of treatment may be artificial tears. Depending on the nature of your tear film deficiency, the doctor may have you use a specific type of artificial tear that has different characteristics in terms of salt content and viscosity. Follow these instructions carefully. In addition, Drs. Berger, Howard and Kessler may counsel you on environmental factors that need to be modified. Sometimes, if the oily layer of the tear film is deficient, they may suggest that you increase your consumption of oily fish or even take flax seed oil as a dietary supplement. Most likely you will be asked to drink plenty of water.

If these approaches do not work, then Drs. Berger, Howard and Kessler might suggest the use of a prescription eye drop called Restasis, or the insertion of tiny punctal plugs that will slow down the drainage of tears from the eye. Restasis works by suppressing a type of inflammatory cell from entering the lacrimal gland and thus allows the lacrimal gland to function more effectively so that you can actually make more of your own natural tears. If your physician decides that you need punctal plugs, these plugs are easily and comfortably placed in the lacrimal puncta in the eyelids. This procedure is painless and it only takes a few minutes.

Occasionally there are some cases that may not respond to the above sequence of treatment options because of some underlying low-grade inflammatory or infectious process. In these cases it may be necessary to also prescribe an oral antibiotic such as a tetracycline or an anti-inflammatory eye drop such as a corticosteroid eye drop.

As you can see, the diagnosis and treatment of dry eyes is complex and requires patience and persistence. With careful diagnosis and a systematic therapeutic approach, sufferers of dry eye syndrome can most often experience considerable improvement.

The physicians and staff of Litchfield Hills Eye Physicians will use every necessary diagnostic procedure to help identify the source of your dry eyes and offer you the best possible solution. Please feel free to ask us about a dry eye consultation.

333 Kennedy Drive
Connecticut 06790

p. (860)496-0799
f. (860)482-9927

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form of clinical evaluation, diagnosis or treatment recommendation.
Only after a consultation at Litchfield Hills Eye Physicians, P.C. can a medical diagnosis and treatment of eye problems be rendered.