Robert Friese, O.D.
Ophthalmology (Eye Diseases)
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Individuals often take eye health for granted. However, for many people, dry eye disease is a very real condition that affects their daily lives. People with dry eye disease often produce poor quality tears, poor quantity of tears or both, which leads to chronic inflammation of the eye surface.
I have dry eyes, but my eyes are watery all the time. How can that be?
There are three kinds of tearing: basal (basic), emotional and reflex tears. In dry eye disease, it’s the basal tears that are of poor quality and quantity. Emotional tearing occurs when individuals are upset or moved by a sensitive situation. In this instance, there are plenty of tears; however, they’re typically poor quality. Reflex tearing occurs when something gets in your eye and the eye tries to flush it out. Again, this is a situation where there are excessive tears of poor quality. When your eyes get dry enough, they act as if there is something in them and try to flush it out, which leads to watery eyes. In fact, watery eyes are the No. 1 complaint of dry eye sufferers.
What factors contribute to dry eye?
- Normal aging changes your eyes, and they don’t function as well as when you’re younger.
- Changes in hormone levels associated with age, menopause, pregnancy or birth control pills affect the eyes.
- People who have acne rosacea (50 percent have dry eyes), diabetes, thyroid disease, autoimmune diseases and inflammatory diseases that include rheumatoid arthritis (often dry eye disease is a presenting symptom), lupus and Sjogren’s syndrome are more likely to develop dry eyes.
- Oral medications, including antihistamines, antidepressants and birth control pills, can increase the likelihood of dry eyes. Preservatives found in medicated eye drops that are used chronically, including glaucoma drops and in cheap artificial tears, can also worsen the symptoms of dry eye. Make sure to avoid drops that claim to get the red out. These can lead to rebound red eyes, which cause eyes to be even redder and more irritated than before.
- Irritation from secondary smoke, as well as the internal effects of smoking may lead to dry eyes.
- The standard American diet, which is high in omega-6 fatty acids and low in omega-3 fatty acids, is also a factor. Omega-6 fatty acids cause inflammation, a key component to dry eye disease. A heart-smart diet is an eye-smart diet, such as the Mediterranean diet.
- The health of your eyelid margins and eyelashes is important. Blepharitis (dandruff like debris called scurf) Meibomian, gland dysfunction (poor quality oil, atrophy of glands), ocular rosacea, irregular eye lid margins (scaring, notching), Demodex (mites living in eyelash follicles) can all play a role in dry eye disease.
- Wearing contacts disrupts the tear film, leading to dry eye symptoms and decreased contact comfort and wearing time. Existing dry eye disease can lead to poor successful contact lens wear.
- Dry, windy, dusty and smoky conditions can all be problematic. So is polluted air quality, including second-hand smoke and seasonal air quality.
- A poor blinking rate (normal rate 15 bpm, poor is 4-5 bpm) can affect your eyes. Incomplete blinking (60-70 percent when working on digital devices) can also lead to dry eyes.
- Many people are vitamin D deficient. This contributes to dry eyes, along with many other health issues.
Is there anything I can do to improve my dry eye disease?
Yes, but it takes time. Your dry eye disease didn’t occur overnight. It took many months or years to develop, and it’s not going to go away immediately. Start by seeing your eye doctor and discussing your symptoms. Many people fail to mention these issues to their eye doctor because they don’t see them as important.
How your eye doctor can help
Your doctor will work to evaluate your symptoms and the quality and quantity of your tears.
- First. The doctor will ask questions about your symptoms including when, where, how often and what you’re doing when they occur.
- Second. The doctor will ask questions about your general health and the medications you’re taking.
- Third. A quality evaluation is performed of your eyelashes, eyelid margins, Meibomian glands and the surface of the eyeball (the conjunctiva and cornea).
Once an evaluation is complete, your doctor will design a treatment plan in a stepwise format to improve the environment for your eyes and your dry eye disease. There’s no magic wand to make dry eye disease instantly better. However, if a treatment plan is followed and you learn and use new habits, your dry eye disease can be improved.
Treatment options may include the following:
- Address eyelash and eyelid appearance and inflammation — through hygiene, supplements and prescription drops.
- Monitor quality and quantity of the Meibomain gland oil — using supplements, hot compresses and other treatments.
- Quiet eye surface inflammation — with artificial tears, supplements and prescription drops.
- Increase quantity of tears — using artificial tears, prescription drops and tear duct (punctal) plugs.
- Control your environment — with a humidifier; no forced air across the face.
- Diet — supplements.
- Follow up visits with your eye doctor — to monitor treatment and make adjustments.