Dry Eye is an Inflammatory Disease That Should Not be Overlooked

If you wake up and your eyes are barely lubricated, find it hard to blink enough tears, have a gritty sensation in your eyes throughout the day, or are feeling that your eyes are simply irritated, you might be suffering from “dry eye”. It occurs when the quantity or quality of tears diminishes and can no longer lubricate the eye adequately. Quigley Eye Center wants to educate the community on the importance of getting a proper diagnosis and understanding the issues that coincide with Dry Eye by sharing the following publication from the AAO (American Academy of Ophthalmology) concerning dry eye.

American Academy of Ophthalmology—Understanding Dry Eye:

Dry Eye Syndrome is one of the most common problems affecting the general population and can cause problems that range in severity from mildly irritating to debilitating. Dry eye syndrome is a general term that describes the state of the front of the eye in response to a breakdown in the natural layer of tears that coats the front of the eye, called the tear film. Normally, this layer of tears is a stable, homogenous layer that not only provides the cornea and conjunctiva a healthy buffer from damage were it constantly exposed to the air, but this interface between the tear film and the air is also responsible for a significant amount of the focusing power of the eye. When the tear film becomes unhealthy, it breaks down in different places on the cornea and conjunctiva, leading not only to symptoms of irritation, but also to unstable and intermittently changing vision.1

While there are numerous different symptoms one can experience, prominent amongst these symptoms is tearing; naturally, a patient may wonder why their eye can be “dry” despite producing plenty of tears. This is because the unhealthy tear film and the irritation that comes from it stimulates the brain to produce a wave or reflex of tears to help counteract the irritation. However, this reflex tearing is simply insufficient to correct the overall problem. For this reason, dry eye syndrome could more appropriately be termed “Tear Film Dysfunction.”1

Other symptoms of dry eye syndrome or tear film dysfunction include:1
• Burning
• Stinging
• Itching
• Tearing
• Sandy or gritty feeling
• Scratchy or foreign-body sensation
• Discharge
• Frequent blinking
• Mattering or caking of the eyelashes (usually worse upon waking)
• Redness
• Blurry or fluctuating vision (made worse when reading, computer, watching television, driving, or
playing video games)
• Light-sensitivity
• Eye pain and/or headache
• Heavey eye lids
• Eye fatigue1

Epidemiology
Dry eye is a common ocular condition and a major reason for visits to ophthalmologists. Its prevalence varies widely among epidemiological studies depending on how the disease is defined and diagnosed, and which population is surveyed. It is estimated to be 7.4%–33.7%.1

Moreover, the definition of dry eye is still under continual revision, and the lack of a single diagnostic tool challenges ophthalmologists worldwide. The 2007 Report of International Dry Eye Workshop recommended to combine subjective symptoms with objective clinical tests to confirm dry eye diagnosis.1

Causes
• Allergies
• Decreased hormones associated with aging
• pregnancy
• Thyroid eye conditions
• Eyelid inflammation (blepharitis)
• Medication/supplement use, including psychiatric medicines, OTC cold medicines, anti-histamines, beta-blockers, pain relievers, sleeping pills, diuretics, Hormones replacement, and oral contraceptives
• Sjogren’s syndrome (dry mucus membranes throughout body)
• Other autoimmune disorders including Lupus and/or Rheumatoid Arthritis
• Chemical splashes / injuries to the eyes
• Eye surgery
• Infrequent blinking, associated with staring at computer or video screens, and Parkinson’s
• Environmental (dusty, windy, hot/dry)
• Contact lens use
• Neurologic conditions, including stroke, Bell’s palsy, Parkinson’s, trigeminal nerve problem,
• Exposure keratitis, in which the eyelids do not close completely during sleep
• Post refractive surgery (LASIK or PRK), it may generally last three to six months,or longer
• Inflammatory eye conditions, including Herpes virus infections and uveitis / iritis
• Diabetes
• Vitamin A deficiency (rare in US)1

Management
Depending on the causes, there are numerous treatments for dry eye syndrome / tear film dysfunction, but the more common treatment modalities include:
• Artificial tears (preferably ones without a redness-reliever component in them)
• Longer acting agents such as artificial tear gel and ointments and lacrisert
• Tear conserving interventions such as punctal plugs
• Warm compresses
• Eyelash scrubs
• Prescription medicines such as Restasis (increase tear-production) or Xiidra (mechanism unclear)
• Topical ophthalmic steroids are helpful in controlling the inflammatory aspect of the disease.
• Oral flaxseed oil or fish oil supplements 2000mg/day has also been found to be useful in alleviating symptoms and decreasing the frequency of topical agents.1

Quigley Eye
675 Piper Blvd., Naples, FL 34110
(239) 466-2020 | www.QuigleyEye.com

Reference:
1. D. Bustos, MD, AAO, EyeWiki, “Dry Eye Syndrome,” November 8, 2018 eyewikiaao.org

Quigley Eye Specialists, founded in 1988, consists of more than 100 medical professionals, including surgeons, optometrists, retina specialists and technicians. Offices are conveniently located throughout Southwest Florida in Sarasota, Venice, North Port, Port Charlotte, Punta Gorda, Cape Coral, Fort Myers, Lehigh Acres, Bonita Springs, Naples and Coral Gables.

For more information, call (239) 466-2020 or visit www.QuigleyEye.com.

About Quigley Eye Specialists
Technology leaders in eye care, Quigley Eye Specialists is one of the nation’s leading multispecialty ophthalmology practices specializing in cataracts, laser cataract surgery, glaucoma, LASIK, dry eye, eyelid surgery, retinal issues, corneal conditions and routine eye care. As the number one choice for cataract treatment in Southwest Florida, Quigley Eye Specialists is committed to providing the highest level of quality eye care and service to the community. The practice has served the region for more than 30 years and offers patients convenient locations throughout Florida including: Sarasota, Venice, North Port, Port Charlotte, Punta Gorda, Cape Coral, Fort Myers, Fort Myers Beach, Lehjgh Acres, Bonita Springs, Naples, and Coral Gables.