Friday, June 28, 2013

[Optometry Student Share] DRY EYE SYNDROME

Dry eye syndrome is a chronic lack of sufficient lubrication and moisture on the surface of the eye. Symptoms of dry eye are persistent dryness, scratchiness and a burning sensation. Paradoxically, watery eyes can also be a symptom of dry eye due to overstimulation of the watery component of the tears as a protective mechanism.


Insufficient Tear Production

In this case, the lacrimal gland doesn’t produce enough tears. This can be caused by aging, menopause, medications and auto-immune diseases such as lupus or rheumatoid arthritis.

Meibomian Gland Dysfunction (MGD)

Your doctor may diagnose meibomian gland dysfunction (MGD), which is commonly associated with dry eyes. The meibomian glands are tiny, oil-secreting glands along the margins of the upper and lower eyelids. These glands play a very key role in producing the lubricating, oily part of your tear film that prevents your tears from evaporating. Over time, blocked or poorly producing glands often result in inflammation, red eyes, and significant changes to lid structure.


Symptoms include generalized discomfort, burning, scratchy, gritty, or sandy eyes. Unstable vision and excessive tearing are also associated with this condition.

Who is Affected?

68% of people over the age of 60 years will suffer from some form of meibomian gland dysfunction although younger people can be affected. Acne Rosacea can be a contributing factor for some patients.


Chronic MGD can lead to permanent structural changes within the eyelids, leading to a lifetime of discomfort and secondary corneal disease issues. Your tears contain important enzymes that assist in combating a variety of bacteria and other organisms. A decreased production of these important tear elements leaves you at greater risk of related eye infections.

Dry eye syndrome cannot be cured, but the aggravating symptoms can be successfully managed.

Insufficient Lacrimal Gland Function

If your dry eyes are caused primarily from a lack of tear production, your doctor will normally prescribe an artificial tear to help add moisture to the eyes. It is important to use the drop your doctor has prescribed at the recommended frequency as some lubricating drops contain harsh preservatives and should be avoided.

If the lubricating drops alone do not alleviate your symptoms, your doctor may prescribe a steroid drop to reduce inflammation in the eye, followed by Restasis. The steroid drop is normally prescribed 4 times per day for two weeks. Then Restasis is introduced twice a day, while the steroid drop is reduced to twice per day for an additional 6 weeks. Once the steroid drop is discontinued, patients continue on Restasis twice per day plus artificial tears 4 times per day. Restasis is a special medication that can help your lacrimal glands to produce more tears. This medication can be quite successful in the treatment of dry eye; however, it can take 3 to 6 months to take full effect. If these measures are still not sufficient, your doctor may insert tiny plugs into the drainage holes in the lid to prevent the tears from draining fully away, allowing more tears to bathe the eye.

Meibomian Gland Dysfunction

While there is no complete cure for MGD/posterior blepharitis, there are 3 important steps you can take to ensure continued function.
1.    Heat: Apply warm compresses to your eyelids nightly for at least 5 minutes.  Repetitively apply a clean wet facecloth and apply until it cools and repeat. Or you may wish to purchase a Fire and Ice Mask which only requires heating in the microwave to produce a very effective hot compress. This will soften the contents of the meibomian glands to allow easier expression in the steps below. Note the location of this gland at the back of the eyelid, (diagram above) requiring heat for 5-10 minutes for optimal effect.

2.    Theralid application: Wash hands and then apply a thin layer of foam to the lid margins. Wait for 1 minute and then rinse off with warm water and pat dry with a clean towel.

3.    Finally: Take your finger and gently apply constant pressure for 15 seconds to the edge of your lower lid margin at the base of your lashes, working your way from the lid area closest to your nose and moving outward, top and bottom. The portion of the lid from the middle and towards your nose is the most important area to apply this pressure.

A special type of artificial tear is also prescribed for patients with MGD that helps re-establish the missing oil layer in the tears.

In addition to home therapy, your doctor may book in-office lid expression visits to more effectively unplug the blocked meibomian glands and allow you to produce more of the oil layer in your tears. If excessive inflammation is present, your doctor may also prescribe a steroid drop &/or Restasis as indicated above.


1.    A diet rich in Omega 3 fatty acids has been proven to be helpful for long term lid care. These can be found in foods such as salmon, sardines and other oily fish, flax seed, flax oil, and walnuts.  Note that Omega 6’s are not recommended.

2.    Supplements of Omega 3’s are helpful for many patients as dietary amounts are often not sufficient or practical. 2000 mg/day of a good quality Omega 3 supplement (triglyceride form) is the recommended dosage. Our office recommends Nutrasea.

3.Avoid heavily circulated air, fans, dry environments, cigarette smoke.

4.Avoid excessive staring at computer screens.

5.Some patients may benefit from oral prescription Minocycline for 8-10 weeks.

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