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Kelly Kinney Nichols, OD, MS
Dry eye syndrome is a commonly
diagnosed clinical disorder of the front surface of the eye
characterized by dry, irritated, stinging eyes. While the mild to
moderate cases rarely cause sight damage, the disease does affect a
large portion of the population. Current estimates indicate that over 10
million people in the United States suffer from dry eye syndrome. Recent
studies in Canada, Australia, and the United States have shown that
approximately one in four people report experiencing dry eye symptoms,
while one in 225 report severe dry eye symptoms. These findings indicate
dry eye is one of the most common disorders of the front of the eye
encountered by eye care professionals throughout the world.
Dry eye syndrome is also more
prevalent in women and in the elderly. In a small town in Maryland,
10.5% of adults over the age of 65 years routinely purchase and use
lubricant eye drops to relieve dry eye symptoms. This indicates that a
large percentage of people voluntarily purchase over-the-counter
treatments to alleviate ocular discomfort and pinpoints a group that
would benefit from a greater understanding of the disorder. With the
aging United States "baby-boomer" generation, it is expected that the
prevalence of dry eye will increase as will the number of patients with
dry eye symptom.
Diagnosis
In 1995 a group of researchers
came up with the following definition of dry eye (the National Eye
Institute/Industry report on dry eye):
"Dry eye is a disorder of
the tear film due to tear deficiency or excessive tear
evaporation which causes damage to the interpalpebral ocular
surface and is associated with symptoms of ocular discomfort. "
What this means is that dry eye is
defined as the presence of dry eye symptoms and microscopic damage to
the front surface of the eye. Therefore, in the examination for dry eye
the eye doctor asks questions about symptoms of dry eye, performs tests
to determine how much tears the eyes produce, and looks closely at the
front surface of the eye for damage. The following is a list of
questions your doctor might ask:
1. Do your eyes
ever feel dry?
2. Do you ever
feel a gritty or sandy sensation in your eyes?
3. Do your eyes
ever have a burning sensation?
4. Are your eyes
ever red?
5. Do you notice
much crusting on your lashes?
6. Do your eyes
ever get stuck shut in the morning?
Treatment
There are numerous treatments for
dry eye. Usually, artificial tears (also called lubricant eye drops) are
the first treatment tried for dry eye. Artificial tear drops come in two
types of containers, individual unit dose containers and in bottles. The
individual unit dose drops do not contain preservatives, while most of
the bottled drops do have preservatives. Recently, several new
artificial tears have come on to the market which have a hydrogen
peroxide-based preservative that turns to water when it contacts the
tear film of the eye and air. Therefore, bottled tears act like
unpreserved tears, and may be more comfortable with frequent artificial
tear usage. Examples are GenTeal (CIBA) and Refresh Tears (Allergan).
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Some artificial tear drops
are more viscous, or thick, and are recommended for night time
use such as Allergan’s Celluvisc and Ocucoat. Often, a
humidifier is used in the bedroom, especially if an individual
does not adequately close their eyes, commonly referred to as
"sleeping with your eyes open." There are also lubricant
ointments available.
If artificial tears are
ineffective, or if using the drops is cumbersome, the next step
is to consider punctal plugs. Punctal plugs are small pieces of
soft silicone-plastic, which are inserted in the tear drainage
canals. They act as a "dam" in preventing what tears the eye
produces from draining or evaporating too quickly. The procedure
is performed in the office with minimal discomfort. Punctal
occlusion is not effective for all dry eye patients, and often
artificial tears are used in conjunction with punctual
occlusion.
New treatments are
currently in development, including a drop called Restasis. This
drop contains the drug cyclosporin, which reduces the
inflammatory response thought to accompany dry eye. Other
treatments, including topical androgen drops, are also in the
development phases. Doctors and patients alike are anxiously
awaiting new treatments for dry eye to better aid patient with
dry eye symptoms.
The following web pages
may be helpful if you would like to read more about dry eye:
http://www.eri.harvard.edu/htmlfiles/dryeye.html
The home page for Schepens
Eye Research Center, answers dry eye questions
http://www.dryeye.org/
A site written by an
optometrist in Texas about dry eye
http://www.theratears.com/
One of the numerous
lubricant eye drops for dry eye and also information on dry
eye.
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