Dry and Tearing Eyes
Table of Contents
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 the situation 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.
Tearing is a very common, but confusing, symptom of dry eye. Eyes that have deficient or poor quality baseline tears tend to produce excess reflex tears and patients complain of wet eyes and tearing. This is a reflex which attempts to keep the eye well lubricated.
In some cases, symptoms occur only in certain situations. Pay attention to situations that cause your symptoms – then find ways to avoid them.
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. Full home humidifiers may be helpful but are often disappointing because the average humidifier is not strong enough to adequately increase the humidity.
- 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 (e.g. Visine). 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:
- Drops with preservative. Preservatives are added to some eye drops to prolong shelf life. You can use eye drops with preservatives up to four times a day. Using the preservative drops more often than 4 times daily can cause eye irritation.
- Drops without preservative. They come in packages of single-use vials and can be used as often as needed. After you use a vial, you must throw it away. If you need drops more than four times a day, non-preservative drops are safe.
- Consider over-the-counter lubricating liquid gels, gels and ointments (marketed by Refresh Liqui-gel, Celluvisc, Refresh P.M. Systane Gel Drops, Systane Gel, Genteal gel, 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” under Frequently Asked Questions.
- 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.
- Apply hot compresses (see “How To” under Frequently Asked Questions)
- Use a mild soap such as baby shampoo on your eyelids. Put the soap on your clean fingertip and gently massage closed eyes near the base of eyelashes. Rinse the soap completely away. Do this daily, even when you don’t have dry eyes symptoms. Stopping this daily routine may cause your dry eyes to return.Commercial lid scrubs and foams are available over-the-counter (Ocusoft lid scrubs, etc)
- 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, patients with congestive heart failure and patients on blood thinners:
- Flaxseed oil seems to have an effect on estrogen and hormones and might interfere with your body during pregnancy. Ask your doctor.
- If you have congestive heart failure you should consult with your cardiologist about taking supplemental omega-3 oils.
- Some omega 3 supplements have a thinning effect on the blood. Please consult your doctor about taking supplemental omega-oils if you are on blood thinners or have thin blood for other reasons.
What can we do to help you?
Prescriptions:
- Antibiotic drops
- Drops to increase tear production: Xiidra, Restasis, Cequa
- Steroid drops
- Non-steroidal anti-inflammatories
- Lacriserts (inserts that provide continuous moisture)
- Prescription strength nutritional supplements (Omega 3/6 etc)
Procedures:
- Punctal Plugs- 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.
- Bandage Contact Lens: 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.
- Lid surgery when eyelids are in abnormal position.
