Dry Eye Treatment
Dry Eye Syndrome (DES)
DES is more accurately described as ocular surface disease because its symptom is often times not just dryness. Many times it will present as excessive tearing. DES is one of the most common complaints we hear during an eye exam. In fact, over 10 million Americans suffer from DES. It is caused by an insufficiency in either tear film quantity or quality.
Tears are composed of three layers. The mucus layer is produced by goblet cells and is the base layer for the tears. Its purpose is to allow the tears to adhere and coat the eye’s surface. Without this layer, the tear film may have enough moisture, but it “falls” off the cornea before it is able moisten the eye. The middle layer is the aqueous layer. This the moisture and the bulk of the tear film. It is produced by the lacrimal gland which sits above the eye. The lacrimal gland is responsible for both normal tear secretion and reflex secretion when the eye is injured or in emotional tearing. The outer most layer is produced by the meibomian glands and is called the lipid layer. Meibomian glands are located on the edge of the upper and lower lid margins behind the eye lashes. This layer acts as a sealant to slow the evaporation of the aqueous layer.
A very common cause of DES is due to meibomian gland dysfunction (MGD). MGD is when the glands that produce the lipid layer are blocked. Hormonal changes, makeup, oily skin, or lotions are just a few of the causes of MGD. This can be treated through lid cleansers, hot compresses, or in some cases prescription medications.
Tears are drained from the eye via the tear ducts located at the nasal corner of each eye. There is one duct on the upper lid and one on the lower lid. Often times we can occluded the tear duct. This will allow the tears the eye does produce to stay on the ocular surface longer. This is most often helpful when there is a low quantity of tears.
One of the main causes of DES is inflammation. This does not mean the eye will look inflamed, but it is actually a low grade inflammation of the glands that produce the layers of the tear film. For this reason, mild steroids and/or a drug called Restasis can be very helpful. This treatment option works to stop the inflammatory process, thereby eliminating the root cause of the lack of good tears. Sometimes this treatment option will take months of eye drops before the individual will even start to notice the improvement. But after sufficient time passes for the treatment to begin working, the results are wonderful.
Omega-3 supplementation is an excellent first step in the treatment of DES. Its exact method of action is not fully known, but it may be related to the inflammatory process mentioned earlier. There are many brands and types of Omega-3’s available. Dr. Green prefers fish oil over flaxseed oil. There have been links to elevated chances of prostate cancer in men who take flaxseed, but no link with fish oil. Flaxseed also has to be converted in the body to the appropriate compounds for the body to use, but fish oil is already in the right form. There are not set guidelines on how much fish oil to take. We recommend 2000-4000 mg (2-4 capsules) per day.
Sometimes it is as simple as using a good artificial tear (AT). Not all AT are created equal. Depending upon the root cause of the DES, a certain AT may work better. Dr. Green will recommend the appropriate AT after he determines the cause of the DES.
