Many people living in Colorado suffer from dry, scratchy eyes. Dry eye, an actual medical diagnosis, is more common here because the ambient air has less moisture. In winter months, the cold air is even less humid so patients with dry eye have even more trouble. Windy conditions also worsen dry eye. Symptoms can include redness, itchiness, and even too much tearing.
An ophthalmologist has many tools to help determine the cause and severity of dry eyes. I have been in private practice for 25 years and have also been a principal investigator in seven national dry eye research studies which have evaluated new drugs and devices for the treatment of dry eye. While dry eye is actually quite complex, a good understanding of the basics can be helpful.
Tear composition. Tears are made primarily of water which is produced in a gland under the outer part of the eyebrow (the lacrimal gland). This water flows across the eye and mixes with some oil and some protein. The proper mix of these complex chemicals forms a thick, smooth layer that coats the surface of the eye (the cornea), provides nourishment to the surface cells, and allows for comfort and excellent vision. Any change in the mix can cause problems.
While there are multiple causes of dry eye (medication-induced, dryness associated with certain systemic diseases, etc.), the most common type is from decreased tear production. Usually this is from decreased function of the lacrimal gland. If you don’t produce enough of the water part of tears, the tears can become filmier, the vision can become more blurry and your eyes are less comfortable. Damage to surface cells can occur also.
Artificial tears: I approach dry eye treatment in a step-wise fashion. First, I recommend artificial tears. These are over-the-counter products that mimic the correct mix of water, protein, and oil in natural tears. Good quality artificial tears like Refresh Optive, Systane Ultra, or TheraTears offer more benefit than less expensive options. Avoid those drops that “get the red out” as these can cause serious side effects if used daily. Artificial tears that come in a bottle can be used up to six times a day. Because they contain preservatives, they can actually cause irritation if they are used more than this. Preservative-free tears are available in small vials, but each of these should be thrown out within 24 hours after opening. Night time gels can help at bedtime.
Environmental changes: Portable humidifiers in bedrooms or work spaces can help improve the local environment. Sunglasses worn outside to protect from the wind can also help. Especially while reading or working on the computer, it’s helpful to blink frequently to spread the natural tears across the cornea.
Punctal Plugs: After tears flow across the eye, they drain through small, circular openings (tear ducts) in the lower and upper eyelids near the nose. Specially designed “plugs” can be inserted into one or more of these to help the tears drain out more slowly. This quick and painless procedure can be done in the exam room. The plugs I most commonly insert dissolve over a four- to six-month period and can be replaced. If plugging the lower openings doesn’t offer enough relief, the upper openings can be plugged too. For most patients plugs are extremely effective at relieving dry eye symptoms.
Medicated drops: Some patients require short- or long-term treatment with anti-inflammatory medications. I prescribe these on an individual basis depending on findings at the microscope.
For most patients with dry eyes, treatments in various combinations can offer a return to complete comfort and eye health.
-Donald McCormack, MD
If you would like to schedule an appointment with Dr. McCormack, please call (303) 440-3049.