Dry Eye Syndrome

What is dry eye syndrome?

Dry eye syndrome is a condition in which your eyes do not produce enough tears or the tears do not have the normal chemical makeup. Another name for dry eye syndrome is keratoconjunctivitis sicca.

How does it occur?

Normally, your body produces 2 types of tears:

• Lubricating tears: which are produced all the time. They help keep your eyes moist and clean and help fight infection. The tear film that forms contains layers of water, mucus, and oil. Dry eye can occur when any one of these layers is not normal. Most often, the watery layer is too thin.
• Reflex tears: which are produced in response to injury, irritation (such as smoke or toxic chemicals), or emotion. They may even be produced in response to dry eye, when your eyes lack lubricating tears, so your eyes may be more watery than normal.

Dry eye may be caused by:

• Aging: You may not produce enough tears or your tears may be of poor quality.
• Your environment: Dry air may cause your eyes to dry out.
• Medicine: Some medicines may decrease your body's ability to produce lubricating tears. Examples of such medicines are antihistamines, birth control pills, diuretics, and beta blockers.
• Lack of vitamin A: This reduces tear production.
• Disease: Some diseases reduce tear production, such as some types of arthritis, Sjogren's syndrome, systemic lupus erythematosus (SLE), leukemia, and Stevens-Johnson syndrome.
• Eyelid problem: A change in the eyelid may not allow your eye to close properly.
• Burns: Chemical or thermal (heat) burns can change the composition of your lubricating tears.

Sometimes dry eye occurs for no apparent reason.

What are the symptoms?

Symptoms may include:

• A scratchy, gritty, burning feeling in your eyes (like when you have something in your eye). This feeling may be made worse by reading, driving, or looking at a computer screen because you blink less during activities that involve concentration.
• Excessive watering.
• Stringy mucus in your eyes.
• Blurred vision that goes away when you blink or close your eyes or put tear drops in your eyes.

How is it diagnosed?

Your healthcare provider will examine your eyes and ask about:

• your symptoms
• your environment
• your overall health
• medicines you are taking

The answers to these questions will help your provider determine if you need other tests, such as:

• Schirmer test (a strip of filtered paper placed in your eye at the edge of your eyelid to test the amount of tears you make)
• fluorescein or rose bengal staining (special eyedrops that help your provider see problems with the surface of your eyes)

How is it treated?

There is no cure for dry eye. However, several treatment options are available that can reduce your discomfort and protect your eyes. Usually, your healthcare provider will recommend that you use eyedrops called artificial tears during the day and sometimes similar ointments at night.

If these products do not help, your provider may recommend other treatments, such as:

• temporary or permanent plugs that block the punctum (tear drain) so the eye can make full use of the lubricating tears it does produce
• laser treatment or minor surgery to close off the punctum permanently
• eyedrops such as steroids or cyclosporine to reduce inflammation so your eyes can produce more and better tears
• warm compresses (warm, moist cloths put on your eyes) and eyelid hygiene to reduce irritation of the eyelids and help you make better tears

How can I take care of myself?

• See your healthcare provider if you have any symptoms of dry eye.
• Follow your healthcare provider's instructions for controlling your dry eyes.
• Have your eyes checked regularly (at least every 2 or 3 years).

Reviewed for medical accuracy by faculty at the Wilmer Eye Institute at Johns Hopkins. Web site: http://www.hopkinsmedicine.org/wilmer/

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