Dry Eyes are a common disorder affecting anywhere between six to ten million people in the United States. Put another way this problem affects as many as eleven percent of adult males and seventeen percent of females. Since dry eyes are primarily a disease of middle age and older, these rates will certainly increase over the next ten to twenty years as the population ages. Symptoms of dry eyes are vary. They may consist of irritation, red eyes, itching, pain, and the need to blink frequently in order to relieve discomfort and improve vision. These symptoms often seem worse in the early morning hours upon awakening and later in the evening after a day’s work. Activities such as reading and computer use which involve concentration can lead to a decreased blink rate and also result in symptoms of dry eye.
There are many causes for dry eyes starting with inflammation of the lid margins that affects the outer, oily layer of your tears which is responsible for preventing premature evaporation of the tear layer.
The aqueous layer, which is formed by the lacrimal glands and other accessory glands constitutes the middle layer of your tears. When this layer is effected other medical conditions may be present. These conditions are often associated with Sjogren’s syndrome, a common cause of dry eyes. In fact as many as 4 million people in the USA may suffer from Sjogren’s syndrome and up to 3 million of these people go undiagnosed. Sjogren’s syndrome is one of the most commonly found autoimmune diseases along with rheumatoid arthritis and lupus Erythematosus. It may occur alone or in association with these diseases. 90% of affected individuals are women.
Sjogren’s affects the lubricating glands of the body and should be suspected either by family history or when other parts of the body are affected such as a dry mouth. Since it is an autoimmune disease the joints can be affected resulting in arthritis. Less commonly it can affect other areas of the eye resulting in corneal infections and melts as well as inflammations of all other areas of the eye including the retina and optic nerve. It can also result in depression, muscle pain, fatigue, lung problems, skin rashes, neurologic problems such as numbness and even affect your gums. Even more seriously Sjogren’s, up to 5% of people with Sjogren’s may have lymphoma.
For these reasons early diagnosis of Sjogren’s is important. At North Shore Eye Care we can now offer early diagnostic testing of this disease with a newly developed blood test. Early detection can prevent future serious medical problems. The eye problems associated with this disease can be treated by your Ophthalmologist. Other associated medical problems are treated with immunosuppressive drugs, usually prescribed by a Rheumatologist.
The third, inner layer of the tears is the mucin layer which enables the tears to adhere to the cornea, the clear window of your eye. This is produced by the goblet cells of your cornea which can often be depleted by inflammation and aging.
One of the primary ways of treating dry eyes is with artificial tear formulations which have been in existence in one form or another for at least 3500 years dating back to Egyptian times. Over the last few years these formulations have significantly improved. Also we now have two topical formulations that are FDA approved that can now actually help stimulate your own natural tears. Fish oil preparations and doxycycline antibiotics are also beneficial.
Another common method employed by Ophthalmologists to decrease dry eye symptoms is to insert punctum plugs in your lids. These plugs can be removed at any time if symptoms improve and work by preventing tears from evacuating your eyes.