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Dry Eye

The eye depends on the flow of tears to provide constant moisture and lubrication to maintain vision and comfort. Tears are a combination of water, for moisture; oils, for lubrication; mucus, for even spreading; and antibodies and special proteins, for resistance to infection. These components are secreted by special glands located around the eye. When there is an imbalance in this tear system, a person may experience dry eye.

What are the symptoms?
When tears do not adequately lubricate the eye, a person may experience pain, a gritty sensation, a feeling of a foreign body or sand in the eye, itching, redness and blurring of vision. Sometimes, a person with dry eye will have excess tears running down the cheeks, which may seem confusing. This happens when the eye isn't getting enough lubrication. The eye sends a distress signal through the nervous system for more lubrication. In response, the eye is flooded with emergency tears. However, these tears are mostly water and do not have the lubricating qualities or the rich composition of normal tears. They will wash debris away, but they will not coat the eye surface properly. In addition, because these emergency tears tend to arrive too late, the eye needs to regenerate and treatment is necessary.

What causes dry eye?
In addition to an imbalance in the tear-flow system of the eye, dry eye can be caused by the drying out of the tear film. This can be due to dry air created by air conditioning, heat, or other environmental conditions. Certain medical conditions such as rheumatoid arthritis can also lead to dry eye.

How is dry eye treated?
There are a number of steps that can be taken to treat dry eye. They include:

Artificial tear drops and ointments. The use of artificial tear drops is the primary treatment for dry eye. Artificial tear drops are available over the counter. No one drop works for everyone, so you might have to experiment to find the drop that works for you. If you have chronic dry eye, it is important to use the drops even when your eyes feel fine, to keep them lubricated. If your eyes dry out while you sleep, you can use a thicker lubricant, such as an ointment, at night.

Temporary punctal occlusion. Sometimes it is necessary to close the ducts that drain tears out of the eye. This is done via a painless procedure where a plug that will dissolve quickly is inserted into the tear drain of the lower eyelid. This is a temporary procedure, done to determine whether permanent plugs can provide an adequate supply of tears.

Permanent punctal occlusion. If temporary plugging of the tear drains works well, then silicone plugs (punctal occlusion) may be used. The plugs will hold tears around the eyes as long as they are in place. They can be removed. Rarely, the plugs may come out spontaneously or migrate down the tear drain. Many patients find that the plugs improve comfort and reduce the need for artificial tears.

Medication: Whereas artificial tear drops and ointments help keep the eyes lubricated, a new drug, RESTASIS Ophthalmic Emulsion, has been found actually to increase tear production. This is only available through a prescription.

Surgery. If needed, the ducts that drain tears into the nose can be permanently closed to allow more tears to remain around the eye. This is done with local anesthetic on an outpatient basis. There are no limitations in activity after having this surgery.

While dry eye cannot be cured, the symptoms can be greatly improved by these treatment options.

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