So many things change as we take each trip around the sun. From infancy to adolescence to middle age to the last hurrah, our bodies are in a constant state of flux. Sometimes good. Sometimes bad. Always different.
Complaints that we hear often – mostly as our patients move farther along in their lives – is that their eyes are either a) feeling dry or b) constantly tearing. Believe it or not, both issues are caused by the same condition – Chronic Dry Eye Syndrome. If you want to get fancy and impress all your friends, you can call it “keratoconjunctivitis sicca” – “keratitis sicca” for short. Or, just “dry eye”. Whatever you call it, we can all agree that it is not the funnest thing that you will ever experience.
As benign as “dry eye” may sound, it is actually an irritating – and sometimes painful – condition. Symptoms can range from itching to feeling like there is sand in your eyes. They can include tearing and blurred vision, as well. Often, it is a combination of symptoms.
So, what can be…. WAIT!….. WHAT??!! I have “dry eye” and that’s why my eyes are constantly watering? What’s that all about??
Well. Okay. I guess we’ll address that first:
The eye, as we already know, is a very complex system. Answering a question like “Why are my dry eyes so wet?” is like asking “Why does rain fall out of a sunny, blue sky?” There is a logical, scientific answer but, jeepers! Do we really want to get into all that? Let’s try to make it simple enough to make sense. Here goes:
We’ll keep it to two of the primary functions of the tear – or lacrimal – system — the glands that produce the salty liquid that we know as tears and the glands that produce the lubricating substances that help make your tears behave.
Think of your eyes like puddles of water in a parking lot. We’ve all seen one where rain has mixed with motor oil and left a rainbow-like sheen across it. Let’s say that the puddle next to it doesn’t have any oil mixed in. The oil acts as a barrier against evaporation on the one puddle, while the other doesn’t have that barrier and dries up more quickly.
Go find a couple of puddles and watch what happens. I’ll wait…
So, you get the idea. When the glands along our lash lines that produce the oils don’t work right, the process of blinking doesn’t spread the secretions over the tear layer the way it should. Because the lubricating mixture isn’t where it’s supposed to be – or isn’t healthy – the tears dry faster and make your eyes feel like the Sahara Desert.
Okay… Sooooo… why do my dry eyes water so much?
I’m getting to that.
You said it was going to be simple…
Yes. I did.
If these glands go on the fritz the brain receives a signal and says, “Oops! The eyes are hurting! I’d better send more tears!” So, now you’re getting twice the tears – which are cascading over your lashes – and no one is playing by the rules.
If you want to impress your friends even more, tell them that the tiny glands along the lash line are called “meibomian glands”. When they don’t work right, it’s called “meibomian gland dysfunction”. Or MGD. If caught early on, MGD can be easy to treat. Most doctors will prescribe warm compresses, eye lid scrubs and lubricating eye drops (artificial tears). Sometimes, oral and/or topical antibiotics are used to control bacteria in the glands (think Clearasil on a pimple). Topical steroids can also be used to control inflammation. MGD can be caused by a condition known as blepharitis. Blepharitis is an inflammatory – and sometimes infectious – eyelid problem. Symptoms can include redness and crusting on the lids and lashes. An eye doctor’s first line of defense is generally going to be prescribing warm compresses and lid scrubs.
Dry Eye Syndrome can have many causes other than blepharitis. Environmental factors such as wind, low humidity and allergies can affect tear quality. Some medications from antihistamines and decongestants to prescriptions for Parkinson’s disease and high blood pressure are known culprits as are autoimmune conditions such as Sjogren’s syndrome and rheumatoid arthritis.
Surgeries that compromise the eye’s surface – like LASIK – can also cause dry eye though, in most cases, this is temporary.
Age is a contributor, naturally.
Prolonged screen time can also cause dryness! We tend not to blink as often when we are concentrating on computer monitors, tablets and cell phones. Even with healthy, perfectly functioning meibomian glands, if we don’t blink, the secretions don’t get distributed and our eyes dry out.
And, of course, smoking can be a big factor. Smoke is a major irritant whether you are the smoker or you are experiencing it second hand.
So, how do we fix it?
Sometimes, it’s as simple as lubricating eye drops. Plain saline or contact lens solution won’t do it. They will get your eyes wet, but the effect is temporary. Drops like Visine can cause your eyes to feel drier. The main ingredient in the majority of drops that “get the red out” is tetrahydrozaline. A decongestant. Overuse of this ingredient can be more irritating than helpful.
Artificial tears, like Refresh Optive, Systane or Retaine, are lubricating. Some work to prevent tear evaporation as well as provide moisture. For more severe cases, there are ointments and gels that remain in your eyes longer but can cause temporary blurring. For this reason, most people use these at bedtime.
Some artificial tears will contain preservatives. Because these are multiuse bottles, the preservatives are included to inhibit bacteria growth once the bottle has been opened. The preservatives can cause irritation if used too frequently. Your best option, should you require drops more than four times a day – is a preservative free drop. These come in little vials and contain fewer additives, so they are less likely to bother your eyes.
Sometimes your doctor will insert tiny silicone or collagen plugs into the tiny holes at the inside corners of your eyes that allow tears to drain through the nasolacrimal system. By the way, these canals are what causes your nose to run when you cry!
Anyway, the plugs allow more of the tears to stay in your eyes, thereby relieving some of the dryness.
Some of the things that you can do to help yourself include:
Protecting your eyes from the wind with sunglasses that have a bit of a wrap.
Remembering to blink! Especially when you are using electronic devices like computers and tablets.
Directing your car AC vents away from your eyes. (Ceiling fans above the bed can also contribute to nighttime dryness).
And avoiding smoking and smoky areas.
Increasing your intake of “good” fatty acids may help, too. Oily fish like salmon, mackerel and sardines, along with canola, flax and olive oils are examples of Omega 3 and 6 fatty acids. Seeds and nuts like pumpkin seed, flax seed and walnuts are also beneficial suppliers of the Omegas.
If you’re experiencing dry, gritty eyes or if your eyes are overflowing (and you aren’t watching “Beaches”), don’t suffer in silence thinking that this is how it’s supposed to be! Dr Kay and Dr Deweese are awesome when it comes to treating dry eyes.
Your eyes will fill with tears of joy when you finally find relief from your dry eye symptoms.