No More Tears by Elvira Maricic With treatments available, there's no sense in crying over dry eye print article      send to a friend

"Dry eye is an extremely common eye condition which is becoming increasingly common because, to a great extent, it's age related, and our population is aging," says Donald Perlmutter, OD, an optometrist with practices in Cleveland and Twinsburg, Ohio.  "Complicating that are environmental factors. The use of computers, of course, is on the increase and as people stare at computers they tend not to blink as much and their eyes get drier as a result," he says.

What's in a name?

Dry eye is medically termed ocular surface disease or keratol conjunctivitis sica, which generally means dry eyed.  "It's important to understand tears," says Dr. Perlmutter. "Tears are a complex fluid, they're not just salt water. There are elements in tears that give nutrition to the surface of the eye. They have an antibiotic property, they have various elements that prevent infection in the eye, and they create a nice smooth surface for optical purposes.  You have to have a nice smooth surface on the eye in order to see clearly.  So if there's insufficient tearing, as a result you're going to be more at risk for eye infection, vision may be reduced, and you certainly won't be as comfortable," he says. 

While symptoms of dry eye include burning, stinging, itching, sensitivity to light, and crusty mucus discharge, teary eyes are surprisingly also a symptom of the condition. "Patients will frequently have something called paradoxical tearing," notes Dr. Perlmutter. "Their eyes might water profusely sometimes and that might sound backwards, but it's paradoxical because the basis is that the eye is dry and becomes irritated because it's dry.  And then there's a reflex type of tearing where there's overflow tearing.  People who have dry eye typically don't complain of being dry; they just have these other symptoms," he says.

Who's at risk?

If you're a 40-something, contact-lens-wearing computer user living in an arid area like the Southwest, you can pretty much figure that you'll be suffering from dry eye at some point. But don't feel picked on; eventually, dry eye happens to almost everybody.

Typically, by their mid-40s, most people have some degree of dry eye. Also, people who frequently use computers are susceptible to dry eye because their blink rate is reduced and their eyes dry out more. Dry weather, both in hot and cold temperatures, dries out eyes by depriving them of lubricants. Contact lens wearers tend to be more susceptible than eyeglass wearers, as are people who spend time around cigarette smoke, fumes, dust, and airborne particles. If you've had refractive surgery, you might experience dry eye as a side effect. Add to the list people on medication for high blood pressure, antidepressants, antihistamines, muscle relaxants, diuretics, and acne medications, and you've pretty much covered the entire US population.

Finally, as if giving birth weren't bad enough, women seem to be more at risk for dry eye than men are. "To a certain (extent), it's related to hormones; menopause will aggravate dry eye.  Women actually have smaller lachrymal glands, so their eyes are a little drier to begin with.  But the hormonal changes related to menopause can make it worse," says Dr. Perlmutter.  Fortunately, in most patients, dry eye is not related to systemic disease.

Treatment options in store

Because there is no cure for dry eyes, treatment is an ongoing project. There are some things you can do for yourself to minimize the symptoms. For starters, try to humidify your environment. If you find that you spend most of the day staring at the computer screen, try to break away every 20 minutes, even if it just means looking away or closing your eyes. And now you have yet another reason to kick your smoking habit.

Also, be careful about what you put in your eyes. "You'll see a lot of things in the market that claim to be artificial tears and many of them are bottled and have preservatives in them and they can really aggravate the problem rather than relieve," Dr. Perlmutter cautions.

"Of course, there are things you can put in your eyes--lubricants, artificial tears--to avoid preservatives. Many of these come in little single tube-type format, just a little tube where you have to break off the tip and use it as a dropper. There's no preservative in it, so it won't keep. You just have to use it up and throw it away," he adds.  Dr. Perlmutter notes that these remedies can be purchased over-the-counter.

Newer techniques to treat dry eye include punctal occlusion. "A lot of people aren't aware of this, but punctal occlusion actually involves putting a little tiny plug in the tear duct. Tears are being produced and then being drained away and these little tear ducts are at the inside corner of the eye and they drain into your nose. You basically block the drain by putting a little plug in there. You can retain tears that are being produced longer and your eyes will be moister as a result," says Dr. Perlmutter.

Punctal occlusion is a noninvasive procedure. "It's a little tiny silicone plug that's placed in the tear duct (and) that's not visible to the casual observer. You don't feel it when it's in, but the eyes do remain more moist and it's the closest thing to a permanent fix that you can get," he says. Best of all, because dry eye is a medical diagnosis, it's a recognized medical condition. If there's a diagnosis that will justify the procedure, then major medical insurance will pay for it.