"Dry Eye":

• Are your eyes itchy, burning, red, painful, or tired?
• Do you feel like there's something in them, like sand, or a hair or a dirty contact lens?
• Do you get frequent eye infections?

You could have "dry eye", blepharitis, or both.

WHAT IS "DRY EYE"?

Tears are responsible for keeping the ocular surface smooth. If the surface becomes dry, the irregular, "bumpy" contour of the cornea interferes with the proper focusing of light. You may have bumpy, semi-transparent windows in your bathroom which diffuse light in the same way.

The tear film consists of three layers: oily watery mucus

The outermost "oily" layer prevents evaporation, which stabilizes the tear film and allows us to see what we're doing between blinks. This oil is produced in glands at the eyelid edges. The watery layer is produced by the lacrimal gland under the eyebrow. The water helps to flush away foreign material. The innermost "mucus" layer is formed by specialized cells on the surface of the eye called "goblet cells." Mucus allows the tear film to spread evenly over the eye without beading up and rolling off. When the tears are scant in volume or when the delicate balance of oil, water, and mucus is upset, the eye is not lubricated properly and symptoms of dry eye result.

SYMPTOMS OF DRY EYE

• Itchy, burning eyes
• Foreign body sensation (e.g. of hair or sand in the eye)
• Mucous discharge
• Easy irritation on windy days
• Shorter daily tolerance of contact lenses
• Shorter tolerance of computer use or reading
• Frequent "eye infections" especially when the diagnosis is unclear
• Frequent watering
  

BUT MY EYES CAN'T BE DRY.   THEY WATER ALL THE TIME.

Paradoxically, dry eyes water. When the normal "baseline tears" are not produced in the proper amount, irritation results. This results in reflex tearing, which is a discharge of water, and water only, from the lacrimal gland. This upsets the normal balance of oil, water, and mucus, thereby irritating the eye further. People attending funerals may therefore have red eyes due to excess watery tears, which don't lubricate the eye properly. In a way, their eyes are actually dry.

WHAT SHOULD I DO?

Artificial tears help, but are not the only answer. Artificial tears mimic the body's natural balance of oil, water, and mucus. The preservative in the bottled tears may cause irritation with frequent instillation. In this case, we recommend preservative-free artificial tears. Preservative-free artificial tears come in individual, disposable, twist-off packets for one-time use. They cost more, but there is no such thing as an overdose. Some people need to use them hourly or more frequently.

I USE TEARS OFTEN, BUT THEY'RE DISRUPTIVE AND SOMETIMES I FORGET.  ISN'T THERE ANYTHING ELSE I CAN DO?

Yes, there is. We can conserve what tears you do have by closing the "punctum" in one or more eyelids. The tears drain away into the nose through a small opening called the punctum. When the eyes are dry, the last thing one needs is for the tears to slip away down into the nose as they ordinarily do. Instead, we seek to retain the tears on the surface of the eye by closing this hole, usually by inserting a tiny plastic plug into that opening

The placement of punctual plugs is a comparatively benign in-office procedure, involving minimal or no discomfort and taking only seconds to perform. There is ordinarily no bruising or interference with daily activities. Patients can expect to drive themselves home afterward, since sedation is not required and the vision is ordinarily unchanged. There is a small risk of infection or irritation from the plug, which is why it is nice that these plugs are removable. In addition, the plug may fall out spontaneously and then need to be replaced by a larger size. Otherwise, the plugs can be left in place permanently. Another option is permanent closure of the punctum by cautery. Feel free to ask Dr. Mack about the risks, benefits, and alternatives to the various approaches to dry eye treatment.

In any case, it is not normal to go through life being conscious of your eyes any more than it is to be conscious of your elbows or your toes. With the proper treatment, satisfactory ocular comfort and optimal functioning can almost always be restored to patients with dry eyes.

Return to Dry Eye

ABOUT YOUR BLEPHARITIS

Blepharitis is a very common inflammation of the eyelid edge. The eyelid has oil glands which produce the oily component of the tears. This is what helps keep your tears from evaporating. Your tears also have a mucus layer and a water layer, which are important for the proper lubrication of the eye. The oil, water, and mucus must all exist in a proper balance. Too much of one and not enough of the other can lead to dry, itchy, burning eyes and disturbances in vision.

The oil glands at the edge of the eyelid get backed up in many people. The bacteria which normally inhabit the skin then overgrow in this oil and produce compounds which are irritating to the eye. Patients with blepharitis often experience dry, itchy, burning eyes or the feeling that hair or sand is in the eye. Many times they complain of difficulty reading and words blurring together after several minutes of reading, much like patients with truly dry eyes.

There are several ways to keep blepharitis under control, although it cannot be cured entirely forever. It is more like dandruff, which comes and goes throughout life.

• Warm soaks.
  The simplest and most common treatment is to soak the eyelids with a warm, wet washcloth for several minutes in the morning and at night. Be sure the eyes are closed and that you re-warm the washcloth as it cools. One must hold the warm compress to the lids. If the water runs down your elbows and makes a mess, you know that you are doing it right. For some reason, splashing your face in the shower or swimming do not seem to work.
  
  
• Lid scrubs.
  For more difficult blepharitis, we may ask you to use either commercial eyelid scrubs or a diluted baby shampoo. With a cotton ball or gauze pad, wipe the eyelid edges, right at the base of the lashes. Do this to each eyelid for several seconds immediately prior to soaking.
  
  
• Oral antibiotics.
  We often use an oral antibiotic in the tetracycline family, such as doxycycline. Low doses of these drugs taken at bedtime can help to keep symptoms under control. Use of these antibiotics increases your sensitivity to the sun and tanning beds, and can lead to easy burning. If you are using these medicines, it is important to stay out of the sun, wear protective clothing, and/or use sunscreen. They can also lead to vaginal yeast infections in some women.
  
  
• Steroid antibiotic ointments.
  
  We may use steroid and/or antibiotic drops of ointment to help keep symptoms under control. It is best to limit the use of steroids, effective though they are because they can lead to cataracts and glaucoma. Still, sometimes symptoms cannot be relieved without them. If you have some of these medications left over from earlier treatment, please remember to only use them at your doctor's recommendation.
  
  
• Artificial tears.
  Many times the use of artificial tears, in conjunction with the blepharitis treatment, helps to relieve symptoms.