Dry Eyes & Dry Eye Syndrome at The Eye Care & Surgery Center in New Jersey

By Joel Confino, M.D.

About Dry Eyes
Dry Eyes or Dry Eye Syndrome (DES) is one of the most frequent conditions that cause people to seek eye care at The Eye Care & Surgery Center. Dry Eyes can have a significant impact on our daily activities including reading, driving, working and even watching television. When most people think about having dry eyes, they mainly think about the common symptoms that cause discomfort such as dryness, grittiness or burning. However, it is important to understand that in order to have normal vision, it is critical to have a sufficient quantity of healthy tears on the surface of the eye at all times. Dry eye is extremely common. It is estimated that in the United States alone, 20-30 million people have mild symptoms of dry eye and another 6 million women and 3 million men have moderate or severe symptoms of dry eye.

Understanding Tears and the Tear Film
The normal tear film is made up of three individual layers. The innermost layer is called the mucin layer, which directly coats the eye and helps the tear film “stick” to the eye. The mucin layer is produced by goblet cells in the conjunctiva or “skin of the eye”. The middle layer, called the aqueous layer, is composed primarily of saline and electrolytes, and brings moisture and oxygen to the cornea.

The Lacrimal Gland, located under the lateral portion of your upper eyelid, and the Accessory Lacrimal Glands, located within the inner surface of the eyelid produce the aqueous layer. The outermost layer of the tear film is called the lipid layer, and it is responsible for preventing the tear film from evaporating too rapidly. Tiny tubular glands in your eyelids produce the lipid layer. All three layers are critical to maintaining a normal tear film. If any of the three layers of the tear film are deficient you may suffer the symptoms of dry eyes.

Dry Eye Syndrome is an eye condition in which there is a deficiency of the tear film due to either an inadequate production of one’s own natural tears or an excessive evaporation of tears. Whether you suffer from inadequate production of tears or excessive evaporation of tears, or both, you may experience a decrease in the quantity and quality of your tear film resulting in the surface of the eye being affected, leading to discomfort.

Inadequate Tear Production
There are many potential reasons that you may not produce an adequate quantity of tears. A number of systemic conditions such as Sjogren’s Syndrome or autoimmune connective tissue diseases such as Rheumatoid Arthritis and Lupus Erythematosis may decrease the quantity and quality of tears that you produce. Patients with Sjogren’s Syndrome may experience dry mouth and arthritis in addition to dry eyes. Inflammation of the Lacrimal Gland may lead to an abnormal and unhealthy tear film. Other factors that can cause the Lacrimal Gland to produce an inadequate amount of your own natural tears include long term contact lens wear, past eye infections, certain allergies and even vitamin deficiencies.

Excessive Evaporation of Tears
There are a number of factors that can cause an excessive evaporation of your tears. These include environmental factors such as exposure to forced hot air heat at home or at work, dry climate in general, air travel, reduced blinking from contact lens wear, reduced blinking from looking at a computer screen or reading for long periods of time, air pollution or even just blowing your hair dry.

Your tears may evaporate too quickly if you suffer from low-grade eyelid inflammation, called Blepharitis. Within your eyelids are tiny tubular glands called Meibomian Glands. Inflammation of the eyelids, from Blepharitis, or a condition called Rosacea can cause the Meibomian Glands to stop functioning properly and decrease the production of the secreting their oily film. This Meibomian Gland Dysfunction is a common cause of dry eye as the oily film is required  to prevent evaporation. Without the oily layer being present, it is very likely that you will have dry eye symptoms.

This is an especially common problem for perimenopausal women, as it is believed that 75% of women in this age group have some presence of facial rosacea. This, along with the general hormonal changes occurring during this time, makes perimenopausal woman particularly susceptible to dry eyes.

Finally, your tear film may evaporate too quickly if the tears are not properly spread and replenished over the surface of the eye because of poor eyelid movement. This may be due to a number of factors including:

  • Improper or incomplete closure of your eyes during sleep
  • Eye “bulging” conditions that may be related to thyroid problems
  • Loss of tone or shape of the eyelids so that they turn in or turn out, called entropion and ectropion.

Diagnosis of Dry Eyes
The proper diagnosis of dry eyes requires a thorough dry eye examination and dry eye consultation. At The Eye Care & Surgery Center, we will take time to carefully review your medical history, eye history and eye conditions including any medications that you are taking. Please be sure to tell us about all of the medications you take or have taken recently, including not only the ones prescribed, but also those that you may have purchased on your own at the pharmacy.

Next, we will evaluate your tear production by using a specialized microscopic technique to observe the height of the tear film and may also use a clinical test called a Schirmer test that allows us to actually measure the rate at which you produce natural tears. We may also use specially formulated dyes such as Fluorescein, Lissamine Green and Rose Bengal to help evaluate the appearance and function of the various layers of the tear film as well as the underlying surface of the eye. This is not uncomfortable and will not interfere with your vision.
From this information, we will be able to make a proper diagnosis as to the particular cause of your dry eye syndrome and prescribe the appropriate treatment. Depending on the cause of your dry eyes, different treatments may be recommended. The usual initial treatment may involve over-the-counter tear substitutes, also known as “artificial tears”.  Prescription eye drops and other treatments are available.

If you or someone you know would like to learn more about dry eye, dry eye symptoms and problems or dry eye syndrome, please call The Eye Care & Surgery Center at 908-789-8999 to schedule an appointment.