Eye Conditions We Treat at Our Center

There are many causes. The tear surface on the front of the eye naturally becomes thinner with age. Hormonal changes can cause the tears to become thinner. Other causes include systemic diseases like rosacea and rheumatological diseases such as rheumatoid arthritis, Sjogren’s syndrome, superficial eye infections, and meibomian gland dysfunction. Medications can cause the tears to be thin, including antihistamines, hormone replacements, SSI inhibitors, drug reactions, such as Stevens-Johnson syndrome, and diuretics.

People with dry eyes or tear deficiency will typically complain that their eyes feel tired, especially towards the end of the day. In addition, vision will commonly become blurry when reading. As the symptoms get worse, the eyes begin to feed scratchy as if there is “trash” or “sand” in the eyes. Itching or feeling the need to rub the eyes may become a factor.

Commonly, thin watery tears will roll out of the corner of the eyes and down the cheek. The eye surface remains dry even though tears are pouring out. Patients will also protest, “How can my eyes be dry? I have tears flowing down my cheek.” Dry eye, wet cheek.

Since there is no cure for tear deficiency, we manage the symptoms. The symptoms may sometimes be absent, and others may be quite severe. The object of treatment is to keep the front surface of the eye moist so that the eye can heal. Healing is not immediate and usually takes several days or weeks after adequate moisture has been consistently achieved.

The mainstay of treating tear deficiency is the use of artificial tears. Most people find using an artificial tear 4 -6 times per day is all that is necessary. For more severe cases, tears can be used more frequently.

When you look at the vast array of tears in the drugstore, the question immediately arises as to which tear is best. Not an easy answer since each patient’s needs are different. Artificial tears are not just salty water but are complex chemical formulations. Many of the actual chemical ingredients are completely different in the different brands, though several brands may use the same ingredients. 

As guidance:

• Some drops are thinner (less viscous), and some are thicker (more viscous). Thinner drops may feel better when they first go in and may not blur your vision, but they do not last as long between drops. Thicker (more viscous) drops may feel gel like  when they go in and blur your vision for several minutes, but last longer. People with milder tear deficiency generally prefer the thinner drops, and those with a more severe deficiency prefer the thicker drops.
• If eye discomfort wakes you up at night, use a tear gel or an eye ointment before bed. 

Most eye drops in a bottle have a preservative since germs will grow in a bottle if no preservative is present. These preservatives are mildly irritating to the eye, but if you use the drops 4 -6 times a day, it doesn’t seem to make much difference. However, if you were using the drops more than that, the teardrop may be helping, but the preservative may irritate your eye. If that is the case, either use a product that is preservative free  or a drop with no preservatives. Non-preserved tears come in single-use vials where you pop open the top, put the drop in, and throw away the rest of the tiny vial. 

• Taking fish oil tablets by mouth or eating a diet with lots of fish can be helpful.
• The use of prescription drops for dry eyes can help reduce the inflammation associated with dry eyes. 
• There are also some medications that increase the number of tears. In some cases of dry eyes, they can be useful. 

• Airflow across the eyes causes tears to evaporate, quickly leaving the eye dry. For this reason, patients with difficulty with tear deficiency should avoid being under a fan. Likewise, driving with the air conditioner blowing in your face or the windows down can also be uncomfortable. 
• Using a C-pap for sleep apnea is a frequent problem for people with dry eyes. Since the masks rarely fit tightly, there is a constant flow around the mask and into the eye while the patient is asleep. The eyes remain chronically dry as a result. Using lubricating eye ointment before bedtime and wearing an eye patch or a sleep mask that keeps the air away from the eyes is helpful. 
• Smoke and fumes are very irritating to people with tear deficiencies. It is helpful not to allow people to smoke in your house and to avoid industrial or cleaning solutions. 
• Cosmetics, eyeliner, and mascara release particles that end up in tears. These gritty particles can make the eye more uncomfortable. 

• Normally, your tears flow from your eyes through a small passageway into the nasal cavity. It is relatively easy for your eye doctor to put a small plug into the entrance to this passageway to keep the tears you are making on the eye's surface. This is helpful to many people.