Alamo Optometry Blog

May 6, 2010

Dry Eyes

Filed under: Uncategorized — gkblog @ 8:54 am

Dry Eyes

(As appeared in Alamo Today, May 2010, pg. 24)

            Dry eyes seem to be affecting everyone these days.  Whether the cause is allergies, medications, age, or contact lenses, the resulting irritation, redness, and overall scratchy feeling are both visually and cosmetically disruptive.  Sometimes the remedy is easy and sometimes it is complex, but it can be attacked by several different means.

            Dryness can be caused by several reasons but the two most common are insufficient tear production and poor tear film quality.  Most patients are unaware that one of the major causes of poor tear production is medication-induced.  The leading contributors are antihistamines, antidepressants, and any hormone therapy or changes in hormone levels.  This time of year antihistamines are popular to treat seasonal allergies. However, from an ocular standpoint, these drugs help alleviate allergies but contribute to dryness. 

Since the tears are made up of 5 layers, a defect in any layer can cause an unstable tear film.  The most common layer for disruption is the outermost layer called the lipid layer.  This layer helps limit tear evaporation and is produced by the glands on the edge of our eyelids.  Any lid or eyelash irritation or infection can cause these glands to not work properly.  When this happens, the tears evaporate too quickly into the air which gives a burning and stinging feeling.

            Now that we know some of the causes of dryness, the big question is how to treat it.  I tell my patients that depending on the severity, there are many options.  The most common is artificial tears.  These are good for augmenting tear volume, but do not help restore function or increase production.  For mild cases, a drop in each eye once or twice a day generally improves comfort.  The main thing to remember is to use non-preserved or sterile tears as preservatives tend to sting and therefore make the eyes redder.

            For more advanced cases, I have found that Restasis works very well.  This is a medicated drop used twice a day that augments tear production.  It can take up to 2-3 months to reach full effect, but after that period, most patients notice an improvement in comfort.  These patients might still feel the need to use tears, but the frequency will be less.

            Another treatment option that is used by severe dry eye sufferers is punctal plugs.  In each eye we have a “faucet” that makes the tears called the lacrimal gland and 2 “drains” that remove the tears from the eye and drain into the back of the nose and down the throat.  A plug is put into one of these drains to help keep the tears on the eye longer.  It is usually only necessary to plug one in each eye.  They are easy to put in and last as long as needed.  Patients that also have allergies should not do this because the allergens in the tears now stay on the eye longer and cause more havoc.

            In addition to these remedies, some lifestyle changes will also help reduce eye dryness.  The first one is to stay hydrated and reduce caffeine intake.  Remaining hydrated will help with overall tear volume and since caffeine is a diuretic, it will make a dry eye situation worse.  When we do sustained up-close work like computer use and reading, we tend to stare.  Obviously, when you stare you don’t blink, and therefore leads to the tears evaporating into the air.  I always advise taking breaks every 20-30 minutes to rest the eyes and to make it a point to blink during long sessions at the computer.  Also, it is best to keep your monitor a little below eye level, and that will force your upper lids to lower a little and leave less surface of the eye exposed to the air. 

            Obviously, dry eyes are more complex than can be discussed here.  However, after your examination and depending on your individual situation and needs, a personal treatment plan will be recommended to you.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear.  He can be reached at 820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo.  Visit our website at: and become a fan on our Alamo Optometry Facebook page.

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