One of the most important parts of the eyes, yet one of the most overlooked, is the quality and quantity of our tears. A good tear film not only protects the eyes from infection, but is crucial in providing us with clear vision. However, as we age, we naturally produce less tears and this can lead to dry eye. Dry eye can also occur when your eyes do not make the right type of tears. In the United States, dry eye syndrome is one of the most common ophthalmic diseases.
The tear film is composed of 3 layers: an oily layer, a water layer, and a mucus layer. Each layer of the tear film serves a unique purpose and is made in a separate set of glands within the eyes. Sometimes, the eyes do not make enough tears or something affects the health of one or more layers of the tear film. In those cases, we end up with dry eyes. There are many causes of dry eyes, including certain systemic diseases (rheumatoid arthritis, Sjogren’s syndrome, etc.), eyelid anatomy, increased computer/screen use, using contact lenses for a long time, or taking certain medications (diuretics for high blood pressure, allergy pills, antidepressants, etc.).
At Stahl, we conduct a thorough eye exam to examine your eyelids, the surface of the eye, the quality/thickness of your tears, and how you blink. Depending on your exam, we may also measure how quickly you produce tears and the osmolarity (concentration) of your tears.
Given the prevalence of dry eyes, it is not surprising that there are many different effective treatments for this condition. The most common treatment is the use of commercially available over the counter artificial tear drops.
If the use of artificial tears is insufficient, then we can choose a complementary option. Just as we have a gland which produces our tears, our eyelids also have drains which take those tears into the nose. Because this happens at such a slow rate, many of us are not even aware of this. But for our dry eye patients, we frequently want to close the drain so that the tears we make and the supplemental tears we use remain on the eye for longer periods of time. Therefore, we may suggest closing your tear drains. This in-office procedure takes less than a minute to complete and is covered by health insurance plans and Medicare. Finally, we may also suggest starting a prescription eye drop medication to help your eyes make more of their own tears. If there is an issue with the oil-producing glands in your eyes, we may suggest warm compresses, eyelid massage, or certain eyelid cleaners.
Lastly, some of our patients have a concurrent condition called conjunctivochalasis, which is an age-dependent loosening and wrinkling of the conjunctiva – the clear tissue that covers the white of the eye. Symptoms such as foreign body sensation, pain, redness, and tearing are common and happen when the eyelid causes excessive friction during a blink due to lack of lubrication in the eyes. At Stahl, we perform surgical ocular surface reconstruction with amniotic membrane to restore a healthy tear reservoir,
In summary, there are many different causes of dry eye and ways in which we can improve your symptoms. Your doctor at Stahl will thoroughly assess your individual condition and decide with you the most appropriate way to proceed.