Dry Eye

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This is a common chronic (longer-term) problem, which usually occurs as a result of changes in the lacrimal gland, from where the tears are produced. In saying that it is a common problem does not detract from the fact that for some people it does affect quality of life and sufferers should not put up with symptoms unnecessarily.

As we age the lacrimal glands produce less tears. Hormonal factors are an issue and women tend to have more dry eyes than men, particularly with advancing age. There is a less common condition called Sjøgren’s where there is a reduction of tears as well as saliva. Sometimes this is associated with other conditions such as systemic sclerosis, SLE (Lupus), and various forms of arthritis.

Symptoms

Burning, irritation, mucus stringy discharge, all of which may feel worse in a dry air-conditioned environment, on an aircraft or towards the end of the day.

Management/treatment

If you have an arthritic complaint such as above, you would be advised to have your eyes assessed. The volume of tear film production can be measured (Schirmer’s test).

Sometimes symptoms of dry eye may be confused with other common conditions of the eye, such as blepharitis or allergic problems. If you have these problems they will need treating as they make dry eye symptoms worse.
Omega 3 supplements (fish oil) are helpful taken by mouth.

    • Avoid air conditioning where possible
    • Wear protective glasses
    • Remove contact lenses in aircraft
    • Use tear film supplements – there are many different types, all of which help in differing degrees. Do make sure that they do not have an astringent in them. Astringents whiten the eyes by constricting the blood vessels, however, a few hours later the eyes will be redder than ever as the vessels rebound dilate Ask your pharmacist

If you have problems with allergy to preservatives choose a preservative-free drop. These come in small vials that can be discarded each day.
Some supplements are liquid and some are gels. Liquids cause less blurring. Gels last longer and are more suitable for night-time use.

If lubricating drops or gels fail to settle the problem you may need to have the eyes reassessed.

Sometimes the tear ducts can be temporarily closed with a silicone plug. If this works well and does not cause watering, permanent closure can be achieved by cauterizing the opening to the duct.

A relatively new drug, currently not available on the PBS, is Restasis or Cyclosporine A. This is a medicine, not a lubricant. It suppresses inflammation. It sometimes stings. Generally it takes a month to start to have a beneficial effect and things continue to improve up to six months. It has a beneficial effect in about 75% of people.


Useful link:

http://www.rcophth.ac.uk/page.asp?section=365&sectionTitle=Information+Booklets