Dry eye is one of the most common issues that I see in my practice. Patients often have symptoms like burning, itching, red eyes; sensitivity to light; and significant tearing. In fact, because their eyes are tearing, patients don’t believe they have dry eyes. The tearing occurs due to lack of good basic tears needed to lubricate the eye. The body recognizes this, and reflex tears are secreted to try to make up for the lack of good tears. Hence, the feeling that the eye is tearing. The reflex tears don’t lubricate the eye properly and dry eye persists.
Arid Desert Climate Exacerbates Dry Eye Conditions
Living in the desert exacerbates the condition because of the dry arid conditions, as does aging and especially menopause. Many medications can lead to dry eye including antihistamines, diuretics and birth control pills. In the office we diagnose the condition in a variety of ways. The Schirmer test is the most common and measures how many tears someone produces. A small piece of paper is placed in the interior eyelid touching the eyeball and the amount of wetting on the strip of paper measures tear production. A low score means there is a deficiency in aqueous production. Similarly, a tear osmolarity test measures if there is enough water in the tears. If the concentration of tears is too high, it means that there is a dry eye condition. We also place yellow dye in the eye and examine the cornea to see if there is staining because in dry eye the cornea will show punctate staining because there are not enough tears to lubricate the surface.
Options for Treatment of Dry Eye
The early treatment of dry eye includes over the counter lubricating eye drops. Sometimes tear ointments are used because they are thicker and last longer.
In surgical options, punctal occlusion is a great choice because it works immediately and no further treatment is necessary. All the tears that we make go from the eye into the nose; that is nature’s way to drain the excess tears. If someone has dry eyes there is no excess and all of the tears need to stay in the eye. We can block this drain with a plug, preventing the tears from leaving the eye and draining into the nose. This is a simple procedure done in the office and it is reversible and painless.
Another option is the medication Restasis, which helps glands make more and better tears. The only major downside to Restasis is that it takes a few months before it starts to work, but it is an effective long-term option. Recently, steroids have taken a role in the treatment of dry eyes. It seems there is an inflammatory component to this disease. Steroid eye drops help to improve symptoms and reduce inflammation so tears work more efficiently.
Dr. Wallace Goldban is a board-certified ophthalmologist specializing in Lasik surgery and cataract removal. He has over 20 years of experience and is a graduate of the Albert Einstein College of Medicine. He has office locations in Palm Springs and Palm Desert and can be reached at 760.320.8497.