Dry Eyes

Chronic Dry Eye: A Closer Look

Despite its prevalence, Chronic Dry Eye (known by doctors as keratoconjunctivitis sicca) is among the least understood eye conditions that affect large numbers of people. Many people mistake the dry eye symptoms for allergies, climatic conditions or just “eyestrain”. While all of these may aggravate Chronic Dry Eye symptoms, they are not the cause.

Your eyes need a constant layer of tears — called the “tear film”— to maintain and protect the ocular surface. In Chronic Dry Eye, underlying changes to the health of the tear-producing glands can result in a change in the quantity and quality of the tears you make. This results in a tear film that can no longer provide enough nourishment or protection to the surface of your eye. This can lead to damage of your eye’s surface, which, in turn, can lead to the symptoms of Chronic Dry Eye.

The symptoms of dry eye vary

Different patients describe their dry eye symptoms in different ways: itching, irritation, light sensitivity, blurred vision and even too much tear production. Coping with any, or some of these symptoms is a challenge to millions of Americans. While many sufferers believe it is a condition that they must simply “learn to live with,” the truth is that untreated, Chronic Dry Eye can lead to more serious vision problems.

Causes of Dry Eye

Chronic Dry Eye is often caused by problems with the body’s system responsible for making your tears and keeping a healthy “tear film” on your eye’s surface. The system is called the lacrimal functional unit. It includes the lacrimal gland, meibomian glands and goblet cells of the conjunctiva. The lacrimal glands are responsible for producing the watery part of the tear film called the aqueous. The meibomian glands are responsible for producing lipids which keep the tear film from evaporating. Finally, goblet cells are responsible for producing mucin which allows the wetting of the ocular surface as well as stabilizes the tear film. Together, all components of the tear film maintain and protect the ocular surface.

When the glands found in the lacrimal functional unit don’t work properly, tear film composition is altered leading to a declining quality and quantity of tears production and ultimately the symptoms of Chronic Dry Eye. To hear actual patients talk about their dry eye symptoms click here.

Hormonal changes due to aging and menopause, thyroid problems and vitamin deficiencies can contribute to Chronic Dry Eye. Some diseases and conditions – like rheumatoid arthritis, lupus and Sjögren’s Syndrome – also cause Chronic Dry Eye in many patients. On the other hand, activities like reading or working at the computer are not a root cause of Chronic Dry Eye; they can just make the symptoms worse. Wearing contact lenses can also worsen Chronic Dry Eye symptoms.

Reference:
Stern ME, Gao T, Siemasko KF, et al. The role of the lacrimal functional unit in the pathophysiology of dry eye. Experimental Eye Reseach 78. 2004:409-416.

Chronic Dry Eye: A Closer Look

Tear Quality of Healthy Eyes

pflugfelder_screenshotHealthy eyes produce tears that contain natural nutrients and lubricants that create a film that cleanses, protects and moisturizes the surface of your eye.

A normal tear film contains a complex mix of over 200 electrolytes, proteins, nutrients, growth factors and antimicrobial factors that protect and nourish the eye surface.

Click on the “Healthy Tear Film” and “Chronic Dry Eye” buttons in the illustration below to see how the tear film is affected by Chronic Dry Eye.

Electrolytes

Electrolytes help maintain a moist, lubricating, protective and healthy tear film over your eyes.

Proteins

Normal tears contain a mixture of proteins that help protect your eyes from infection and maintain general eye health.

Immunoglobulins and Cytokines

Immunoglobulins trigger your immune system to defend your eyes when needed.

Cytokines help your eyes fight microorganisms that may cause infection as well as other threats and irritants.

(Sometimes Cytokines cause the wrong signals to be sent to the tear-producing lacrimal gland, which can lead to a malfunction in that gland and in the quantity and quality of tear production – and Chronic Dry Eye.)

Growth and wound-healing factors

Growth factors in the tear film help to stimulate the development of new cells for the cornea. When your eyes are injured, wound-healing factors are activated, speeding tissue growth and regeneration.

Chronic Dry Eye: A Closer Look

Possible Long-Term Effects of Chronic Dry Eye

When the production of natural, healthy tears is reduced, Chronic Dry Eye can cause serious irritation of the front of the eye, particularly the cornea, which requires the presence of a healthy tear film for its own health.

Besides creating a healthy eye surface on the cornea and lubricating the entire eye, a natural tear film works to fight infection, provides important nourishment and is vital for clear vision. When tear production is reduced over a long period of time, there is the likelihood of permanent damage and scarring to the front of the eye. Increased risk of infection and serious visual impairment may result in cases where a severe dry eye condition has gone untreated over time.

Chronic Dry Eye: A Closer Look

Diagnosing the Condition

Dry eye condition test Only a doctor can determine if your dry eye condition is actually Chronic Dry Eye. To make this diagnosis the dry eye specialist will ask you to describe your dry eye symptoms and the impact that they have on your daily life. Does reading or working at the computer present a problem? Do you regularly experience itching, burning or the feeling there’s a foreign body in your eye? You can help your doctor by bringing with you a completed copy of the Chronic Dry Eye questionnaire from this Web site.

Once the two of you have reviewed your answers to the questionnaire, the dry eye specialist may perform a series of simple tests to evaluate the tears you are producing naturally. Factors such as the evaporation rate and the actual quantity of tears you make will be taken into consideration. He or she also may use diagnostic eye drops for dry eyes that can reveal damage to the ocular surface otherwise invisible to the naked eye.

Common Diagnostic Tests for Dry Eye Conditions

  • Schirmer test – uses paper strips under eyelid to measure the wetness that collects over a specific period of time.
  • Staining – uses special dyes to highlight areas of possible damage to the eye surface.
  • Slit lamp examination – a special, focused light beam the doctor uses to see changes in the ocular surface. Many times this is used in conjunction with staining.

Frequently Asked Questions of Chronic Dry Eye

What is Chronic Dry Eye?

Chronic Dry Eye is known by the scientific name, keratoconjunctivitis sicca. It is a condition that, overtime, decreases the eye’s ability to produce tears. Tears help protect the surface of the eye and keep it moist and lubricated. Reduced tear production can lead to damage to the eye’s surface. If left untreated, severe forms of Chronic Dry Eye can lead to more serious problems, including increased risk of infection and possibly vision impairment.

What are the causes of Dry Eye?

Chronic Dry Eye is caused by a functional problem in the tear-making glands of the eye. This results in a declining quantity and quality of tears. High risk factors for this condition include those individuals with health issues such as hormonal changes associated with aging and menopause, autoimmune diseases such as arthritis, lupus and Sjögren’s syndrome. Medical conditions such as diabetes or blocked tear ducts also can contribute to it.

Are allergies and weather conditions a cause of dry eye?

Environmental, occupational and lifestyle factors, such as allergies, smoke, dry air, dust, the wearing of contact lenses for extended periods of time or prolonged computer use can aggravate Chronic Dry Eye, but they are not the cause. The cause of Dry Eye is a dysfunction of the tear producing glands which results in reduced production of tears.

How do I know if I have Chronic Dry Eye?

Your eye doctor can check your eyes for clinical signs of Chronic Dry Eye. He or she also may use several quick and painless tests to measure visual clarity, tear production, eye surface dryness and damage to the cornea or conjunctiva (the membrane that covers the white part of the eye and the inside of the eyelids). The doctor will find it helpful if you describe your condition in detail.

Be sure to tell your doctor if you experience dryness, itchiness, the persistent feeling you have “something in your eye,” have difficulty reading, watching TV, or other activities associated with eye sight.

What treatments are available for Chronic Dry Eye?

It’s important to ask your eye doctor what Dry eye treatments are available in addition to over-the-counter artificial tears.

What do artificial tears do?

Over-the-counter artificial tears can provide quick but temporary symptom relief and help lubricate eyes. Some over-the-counter artificial tears, designed for cosmetic improvement of the eye’s appearance, may actually worsen the condition and also may create potential eye health problems if used too frequently. It’s always wise to ask your doctor before using any dry eye treatment on your eye.

Questions to Ask Your Doctor About Dry Eye Treatment

It’s important to talk to an eye doctor and determine the best course of treatment for your specific dry eye problem. You may want to prepare a list of questions that will help you better understand the possible cause and the most effective therapy for you. Here are some of the subjects other dry eye patients have raised.

What kind of dry eye condition do I have?

I’m very aware of the dryness of my eyes. But I don’t know whether it’s because of an allergy, the weather, or staring at the computer screen all day. Do I have Chronic Dry Eye, or some other condition?

Do my contact lens cause dry eye?

If contact lenses don’t cause dry eye, do they make it worse? Can I keep wearing them?

Is it long-term?

This came upon me gradually and now it’s an everyday thing that I just can’t get used to. Is this a permanent condition? Will it go away all by itself?

How often can I use artificial tears?

Artificial tears seem to help. Is it OK to use them regularly? How many times a day?

Is there a difference among the many artificial tears and products that claim to get the red out?

Is there anything I should know about certain kinds of artificial tears, or may I use just any over-the-counter product?

What are my dry eye treatment options?

Are there options other than artificial tears?

All Information from http://www.focusondryeye.com


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