Surface Disease



What is Dry Eye Syndrome? Back to Top
The eye needs tears to maintain a normal surface. Tears not only keep the surface from getting dry, but they also nourish the cells in the very surface of the eye and keep them healthy and clear so that rays of light can pass through easily. When the eye surface dries out, it becomes irregular and the rays of light become distorted as they pass through, causing blurry vision in addition to the discomfort of the dry eyes.
 
 
The tear film is made of an aqueous component (water), which is secreted by the lacrimal glands in the upper eyelids, a lipid component, secreted by the glands located in the eyelid margins, and a mucous component, secreted by the cells in the conjunctiva (the surface of the eyeball). The lipid and mucous components prevent the evaporation of the aqueous component.
 
 
What are the symptoms of Dry Eye
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The usual symptoms include:
-     Stinging or burning of the eyes
-     Scratchiness
-     Stringy mucus in or around the eyes
-     Irritation of the eyes with minimal smoke or wind
-     Excessive Tearing, which is just the reflex production of more tears that will also evaporate faster than normal, perpetuating the cycle.
-     Difficulty wearing contact lenses
 

Why do Eyes become dry
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There are two main reasons why eyes become dry:
- Aqueous deficiency
- Lipid / Mucous Deficiency
 
AQUEOUS DEFICIENCY occurs when there is insufficient production of the aqueous component of the tears by the lacrimal glands. This can be associated with aging, affecting some individuals more than others. Also, environmental factors, such as temperature and humidity, most commonly associated with Air Conditioning or Heaters, can also affect the rate of evaporation of the tears and induce dry eyes.  Insufficient blinking can also leave tears exposed longer and increasing the rate of evaporation. This can happen when we are staring at the computer or reading for long periods of time, which decreases the amount of times that we blink.
Some medications can also induce or worsen dry eye symptoms, such as antihistamines, diuretics, beta-blockers (usually taken for Blood Pressure), sleeping pills, and other medications including nerve and pain pills.
There are also some medical conditions that affect the lacrimal gland and decrease the production of aqueous tears, such as Sjogren’s syndrome or rheumatoid arthritis.
 
LIPID / MUCOUS DEFICIENCY results when one of the mechanisms of production of mucous or lipid is affected.  The most common cause of this type of dry eye is Blepharitis.

 
What should I do if I have Dry Eye symptoms
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The first step is to identify the cause of your dry eye. Most of the time it is a combined mechanism, and different causes need to be treated simultaneously. Our doctor will be able to tell you the main cause of your dry eyes.
Usually the treatment of dry eyes is a stepwise approach, starting with the simplest treatments and advancing to more specific treatments if the previous steps fail. Drinking more water and taking Omega 3 may help.
 
Artificial Tears are the mainstay treatment of tear deficiency. They are drops formulated to resemble the natural tears. The duration of the effect is short; therefore they need to be applied frequently. Gel drops last longer but may cause some initial blur. If the drops must be used frequently the preservative in artificial tears may irritate the eye. Preservative free drops avoid this problem.
 
Punctal Occlusion
Since tears are normally drained away from the eye surface through the lacrimal drainage system, our doctors can apply a very small “Plug” to plug one of the sites of tear drainage (the punctum). This makes the tears remain on the eye surface for longer periods of time. Ask our doctors for further details about this option and whether it is right for you.
Medical Treatment
There are also options to treat dry eye syndrome with specific medications. Our doctors will be able to tell you if this is needed and if you are a good candidate.
 

What is Blepharitis
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Blepharitis is a condition in which the eyelid margins are inflamed because the small glands in the eyelid margin are plugged and do not secret enough lipid for the tear film. This leads to irritation and causes symptoms of itching and burning of the eyelids and eventually makes the tear film evaporate faster, causing Dry Eye syndrome. The irritated eyelid glands then secrete mucus and protein and these products also build up on the eyelid margin making the irritation worse.

 
What should I do if I have Blepharitis
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One of the easiest ways to break the cycle of blepharitis is to keep the eyelids clean. This will reduce the overgrowth of the normal skin bacteria and will decrease the inflammation of the lid margins.
 
The best way to maintain Eyelid Hygiene is to scrub them twice a day with a clean cotton-tipped applicator soaked in a cleaning solution. Rinse thoroughly after scrubbing.  There are several products available for this. You can also mix 1 drop of baby shampoo in 1 cup of warm water.
 
It is also useful to apply heat in the eyelid margins In order to melt the accumulated lipids that are built up inside the glands. Be very careful to apply the right temperature and avoid injury from heat. Use a clean washcloth soaked in hot clean tap water, up to a temperature that you can tolerate without discomfort. Apply this heated washcloth on the eyelid margins with gentle massage for 2 minutes, soak them again in the hot water and apply for 2 more minutes with gentle massage. You can perform your routine eyelid hygiene after this to remove the secreted lipids from the eyelid margins.
 
Omega-3 Essential Fatty Acids have also been proven to be effective as an adjuvant in the treatment of Blepharitis. It helps make the secretion inside the glands more liquid and easier to express, and it also helps decrease the inflammatory response in around the glands. Omega-3 Essential Fatty Acids are present in oily, cold-water fish and in flax seed; but they are also available as nutritional supplements over the counter.