09/14/2009 - Questions and Answers

Dry eye problems

By: Mark Castleden

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Question

Recently I've noticed that my eyes have become really dry and itchy. I am a 63-year-old woman. Do the eyes lose the fluid that you normally have when you are young? I also have diabetes. Can that have anything to do with it? What can cause Dry Eyes?

 

Answer

Dry eyes are a very common problem, thought to affect approximately 60 million Americans. The cause is usually unclear, but there appears to be an imbalance between tear production and tear volume drainage through the nasolacrimal ducts. The tear film is made up of a mucous layer against the eye, a middle aqueous (watery) layer, and an outer lipid (oily) layer. All three components are critical to a normal tear film. If any of the three layers of the tear film are deficient, the eye may suffer symptoms of dry eye.

People with dry eye syndrome have the following symptoms: burning; stinging; redness of the eyes; and tearing. The excessive tearing is felt to be a reflex attempt by the lacrimal (tear) gland to overcome the poor quality of the tears that are produced. Tearing that produces these symptoms usually occurs in conditions that more rapidly evaporate tears from the eye, such as being outdoors in a high wind. Heat, low humidity, and the presence of smoke may compound the problem. Unfortunately, in most cases the cause of dry eye syndrome is unknown. However, there are numerous diseases and medications that may be associated with dry eye.

Patients with rheumatoid arthritis and those individuals who take antihistamines (for allergic symptoms) probably represent the largest groups of patients who present with a known cause for dry eye syndrome. Sjogren's syndrome is a condition where patients suffer from both dry eyes and a dry mouth.

Your ophthalmologist can usually diagnose dry eye syndrome simply by your description of symptoms, but an exam and testing is confirmatory. On exam, the there is reduced tear volume and a rapid tear break-up time (the time for dry spots to occur on the cornea (the clear covering cap of eye). Fluorescein dye dropped into the tear film allows it to be better visualized. The severity of dry eye syndrome determines the course of treatment.

Most patients benefit by using artificial tears up to 6 times a day. These usually contain a preservative. Some patients require non-preserved artificial tears that are more costly but safer. A humidifier in the home, especially next to the bed at night, has been found to be particularly helpful. Use of artificial tear ointments will also help the eyes feel better but they can cause blurring.

Patients who fail to improve with the above treatment, or have a severe dry eye problem, may need blockage of the puncta (tear drainage openings) located in each of the eyelids. It is typically painless to have the plugs placed and they are usually unnoticed by patients once they are in position. It is also possible to close the duct openings by cautery, which is usually permanent.

There can be many causes for your eyes to itch. Dryness can be one of those causes, but some others include allergies and blepharitis. Blepharitis is a condition of eyelid inflammation that can be associated with dry eyes in about 50% of patients. The most common cause is a build up of material on the eyelashes and eyelid margin that becomes a collection for bacteria to grow, which then release material that causes redness, itching, and even corneal scarring. This condition can often be improved with warm compresses once to twice daily (hot and wet washcloth for about 5-10 minutes) and eyelid hygiene.

Diabetic patients can suffer with dry eyes, but this is not usually a major concern. Diabetes can cause far more serious eye damage - blindness and visual deterioration due to damage of the retina.

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Eye Pain What can cause a pain behind one eye?

Created on: 10/23/2001
Reviewed on: 09/14/2009

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