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Dry Eyes or Sjögren’s Syndrome

Dry Eyes 0 Sjogren's Syndrome

What is Dry Eye?
Dry eye or more commonly Dry Eye Syndrome, is a collection of symptoms that results from insufficient quantity or quality of tears. Symptoms may include dry, red, irritated eyes or difficulty wearing contact lenses. Often people suffering from dry eyes will feel a “gritty, sandy” sensation in their eyes. They may even have seemingly paradoxical watering eyes. The eyes may water or tear excessively as a reflex response to the dryness and irritation. The cause is usually due to either a decreased production of “normal” tears or increased evaporation of tears related to poor quality of the tear film. Dry Eye Syndrome has also been called kerato-conjunctivitis sicca or sicca syndrome. 

 

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What causes Dry Eye Syndrome?
Several factors commonly contribute to Dry Eye Syndrome, including:

  • Meibomian gland inflammation and Blepharitis

    Eye DiagramOften dry eye symptoms can result from inflammation of the eyelid glands (meibomian glands). This is frequently associated with red eyelid margins and scaly eyelashes. These conditions compromise the quality of the tear film causing tears to evaporate more quickly.

    Over-growth of bacteria (usually Staphylococci) normally found on the eyelids also contribute to the inflammation of the meibomian glands and eyelash follicles. These problems can be improved with warm compresses, eyelid hygiene and sometimes special antibiotics.

  • Medications
    Several medications can increase dry eye symptoms:
    decongestants, antihistamines, blood pressure medications, oral contraceptives, antidepressants, drops for “red eyes” (e.g. Visine, Naphcon, Clear Eyes).

  • Diseases
    Diseases that may be associated with dry eyes include rheumatoid arthritis, diabetes, asthma, thyroid disease, lupus. Sjögren’s Syndrome is the name given to the combination of dry eyes, dry mouth and arthritis.

  • Age and Gender
    Tear production steadily decreases with age. Dry Eye Syndrome affects 75% of people over age 65. Women suffer from dry eye syndrome far more than men. Hormonal changes causing decreased tear production are associated with pregnancy, lactation, menstruation and menopause.

  • Computer users
    Computer users tend to blink much less frequently (about seven times per minute versus a normal rate of around 22 per minute). This leads to increased evaporation along with the fatigue and eye strain associated with staring at a computer monitor. Evaporation of tears can be reduced by adjusting the monitor so that it is below eye level thus allowing the upper lid to be positioned lower and cover more of the eye’s surface. Trying to be more conscious of blink rate, air circulation and glare can also help to reduce dry eye symptoms. 

  • Contact lenses
    Dry eye is the leading cause of contact lens discomfort or intolerance. It more commonly affects soft contact lens wearers causing irritation, protein deposits and red eyes.

How is Dry Eye Syndrome Diagnosed?
Eye Diagram - Lacrimal SystemIn-office diagnostic tests can be used to evaluate both the quality and the quantity of your tears. General health, medications, environmental factors and examination findings are all important in determining the factors contributing to your Dry Eye Syndrome. 

How is Dry Eye Syndrome Treated? 

It is important to have the particular factors contributing to your Dry Eye Syndrome properly identifi ed. Following this assessment, you will have the greatest chance of symptom relief with a personalised treatment programme. As there are frequently several factors contributing to Dry Eye Syndrome, it is not uncommon for treatment to be a staged process in order to properly address the various causes and to maximise long-term comfort. With respect to the tear film, tears need to be replaced or conserved in order to provide relief.

  • Replacing Tears
    Artificial tears are usually the first line of treatment for Dry Eye Syndrome. They give temporary relief, and can be purchased without a prescription. There are many brands of preserved multi-dose artificial tears. While these drops suit a few people, if you need to use these drops any more than three times daily, the preservatives that they contain will lead to toxicity and increasing irritation. For frequent use, preservative-free artificial tears are essential (Bion tears, Cellufresh, Polytears-free or Refresh).

    Eye Diagram - Schirmer's test for dry eyesThese preservative-free drops are also safe to use with contact lenses. A clever eye drop has recently been developed. These multi-dose artificial tears (Genteal or Refresh Plus) contain a special type of preservative that gets neutralised and disappears upon contact with your own tears. Occasionally thicker drops (Celluvisc, PolyVisc) or ointments are required for longer lasting comfort. In special situations, tear replacements need to be manufactured from the serum component of the patient ’s own blood.

  • Conserving Tears
    Punctal OcclusionIn cases of persistent dry eye symptoms despite the use of frequent preservative-free artificial teardrops, reduction of tear drainage may be the best solution. This temporary or permanent closure of a tear drainage channel is termed punctal occlusion. You have four tear drainage channels, one in each eyelid. For permanent but reversible punctal occlusion, silicone plugs can be placed into one or more of the tear drainage channels. Punctal occlusion allows you to retain your own, natural tears without the bother of constantly replacing the tear film with artificial tears.

What has Eye Institute done to help patients with Dry Eye Syndrome?
Eye Institute has and continues to be involved in dry eye research in New Zealand. We have purchased an important research tool called a Tearscope that provides unique information about a patient’s tear film. This Tearscope continues to be used for the analysis of current dry eye treatments and the development of new treatments. Eye Institute introduced the use of autologous human serum eye drops in New Zealand. This has been a sight-saving treatment for some patients with severe dry eyes. Eye Institute specialists are invited to lecture to other eye care professionals as well as annual lectures to members of the NZ Sjögren’s Society.