Dry and Tearing Eyes
What is "Dry eye"?
There are two types of tears, baseline tears (responsible for comfort and clear vision) and reflex tears (watery tears that respond to eye irritation, trauma and emotion.) Dry eye refers to when your eyes either do not produce enough baseline tears or the baseline tears are of poor quality.
What are the symptoms of dry eye?
The most common symptoms are burning, stinging, blurry/fluctuating vision,
tearing and gritty sensation.
What can you do to prevent or minimize symptoms?
Avoid air blowing in your eyes. Don't direct hair dryers, car heaters, air conditioners or fans toward your eyes. If you can't avoid blowing air, protect your eyes with eyeglasses. Best protection is afforded by wraparound eyeglasses, eyeglasses with shields or goggles. Shields can be added to the tops and sides of eyeglasses to block wind and dry air from getting to your eyes. Ask about shields where you buy your eyeglasses. Swim goggles may create the same effect.
Wear wraparound glasses on windy days.
Wear goggles while swimming.
Add moisture to the air. In winter, consider using a room humidifier. Humidifiers may be helpful but are often disappointing because the average humidifier is not strong enough to adequately increase the humidity of an average size room.
Take eye breaks during long, concentrated visual tasks. When you read, watch TV, do computer work, etc., you blink less often and you need to take periodic eye breaks. Close your eyes for a few minutes or blink repeatedly for a few seconds to help spread your tears evenly over your eye. Blink frequently while driving.
Position your computer screen below eye level. If your computer screen is above eye level, you'll open your eyes wider to view the screen. Position your computer screen below eye level so that you won't open your eyes as wide. This may help slow the evaporation of tears between eye blinks.
Stop smoking and avoid smoke. If you smoke, stop. If you don't, stay away from people who do.
Limit antihistamines and decongestants use. They may worsen dry eye symptoms. Avoid excessive use.
Pain relievers. Some pain relievers, such as ibuprofen (Advil, Motrin, etc.) and naproxen (Aleve) may contribute to dry eyes. Avoid excessive use. Consider alternatives (aspirin, Tylenol, etc).
Birth control pills. May contribute to dry eyes. Consider other methods of contraception.
Miscellaneous drugs. Some drugs used to treat high blood pressure, (central-acting agents), diuretics, some antidepressants and isotretinoin-type drugs (Retin-A) for treatment of acne may worsen symptoms. Discuss with the doctor prescribing the drugs.
Use over-the-counter artificial tears. Look for lubricating eye drops; avoid those that claim to reduce red eye (they can cause additional eye irritation). Artificial tears are wetting agents that afford short term relief; they do not increase tear production. How often you need to put them in will depend on your symptoms. Some people need to use them every hour; other people use them only when symptoms are present. They can be used at any time and won't interfere with your vision. Some points in selecting eye drops:
Consider over-the-counter lubricating liquid gels, gels and ointments (marketed by Duratears, Hypotears, Thera Tears, Lacrilube, etc). Lubricating eye gels and ointments coat your eyes and provide longer lasting relief than drops. They are thicker than drops and can cloud your vision so they may best be used just before bedtime (especially ointments). Choose whichever product feels best. To apply ointment see "How To"
Control lid inflammation (Blepharitis). Inflammation along the edge of your eyelids (blepharitis, rosacea, etc) causes poor quality tears. Controlling blepharitis may improve tear quality and symptoms.
Dietary support for dry eye. Increasing oral intake of Omega-3 fatty acids may relieve dry eye symptoms. They are also good for your arteries (heart, brain, etc). It may be advantageous to use both, flaxseed and fish oil. Omega-3 fatty acids are available as capsule supplements (Omega-3, Flaxseed Oil, Flax/Fish Oil, TheraTears Nutrition for Dry Eyes, etc). Omega-3 fatty acid supplements can cause a fishy aftertaste and upset stomach. If capsules bother you, try adding foods that contain omega-3 fatty acids to your diet (walnuts, salmon, tuna, mackerel, sardines).
Notes to pregnant women and patients with congestive heart failure and those on blood thinners:
What can we do to help you?
Prescribe antibiotics drops, ointment or pills to reduce eyelid inflammation. Prescribe Restasis, steroidal and non-steroidal anti-inflammatory eye drops. Prescribe eye inserts that work like artificial tears (Lacrisert type). Prescribe prescription strength nutritional supplement (Omega3/6, etc.). Insert silicone plugs into tear ducts to reduce draining away your own tears and added artificial tears. This in-office procedure is painless. The tiny silicone plugs can be removed or left in. Cover your cornea with a special "bandage" contact lens to shield the eye surface and trap the moisture close to your eye and so relieve your dry eye symptoms. Perform lid surgery when eyelids are in abnormal position.