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Dry eye syndrome is one of the most common problems treated by eye physicians.  In fact, more than ten million Americans suffer from dry eyes.  According to J. James Rowsey, MD, corneal and refractive surgeon at St. Luke's Cataract and Laser Institute, this problem can cause a wide range of symptoms.  "Patients with dry eyes may complain of anything from irritation, itching, and burning to blurred vision and even excessive tearing."  If you suffer from any of these, you know just how uncomfortable and frustrating it can be.  Fortunately, there are many treatment options available and scientists are continually researching this problem. 

Before we talk about the treatment, it's important to understand how the eye's tear film works.  Tears are comprised of three layers.  The bottom mucin layer coats the cornea, the eye's clear outer window, forming a foundation so the tear film can adhere to the eye.  The middle aqueous layer provides moisture and supplies oxygen and other important nutrients to the cornea.  This layer is made of 98 percent water along with small amounts of salt, proteins and other compounds.  The outer lipid layer is an oily film that seals the tear film on the eye and helps to prevent evaporation.  

Tears are formed in several glands around the eye.  The water layer is produced in the lacrimal gland, located under the upper eyelid.  Several smaller glands in the lids make the oil and mucus layers.  With each blink, the eyelids spread the tears spread over your eye.  The excess tears flow into two tiny drainage ducts in the corner of the eye by your nose.  These ducts lead to tiny canals that connect to the nasal passage.  The connection between the tear ducts and the nasal passage is the reason your nose runs when you cry. 

In addition to lubricating the eye, tears are also produced as a response to outside stimulus such as an injury or emotion.  But these reflex tears do little to soothe a dry eye, which is why someone with watery eyes may still complain of irritation.  "Many of my patients with excessive tearing are surprised to learn that they actually have an underlying dry eye problem," says Donald Johnson, MD, corneal and refractive surgeon at St. Luke's.  "But when I explain that reflex tears are mainly water and lack the oil and mucus needed to keep the eye moist, it all makes sense." 

Dry eye syndrome has many causes.  One of the most common reasons for dryness is simply the normal aging process.  As we grow older, our bodies produce less oil - 60 % less at age 65 then at age 18.  This is more pronounced in women, who tend to have drier skin then men.  The oil deficiency also affects the tear film.  Without as much oil to seal the watery layer, the tear film evaporates much faster, leaving dry areas on the cornea.

Dry eyes can result from many other factors.  "This problem has many culprits," explains Dr. Rowsey, "sometimes it stems from an environmental condition.  Living in a hot, dry or windy climate, high altitudes, or even air-conditioning and cigarette smoke can aggravate your eyes."  Many people also find their eyes become irritated and dry when reading or working on a computer.  "You typically blink less when you read, so it's important to stop periodically, rest your eyes, and make a conscious effort to blink," he says.  Contact lens wearers may also suffer from dryness because the contacts absorb the tear film, causing proteins to form on the surface of the lens.  Dr. Rowsey cautions his contact lens patients, "If you wear contacts, it's really important to follow your cleaning and enzyme regimen - not just to avoid dry eye problems, but for the health of your cornea."  Medical problems such as menopause, thyroid conditions, and vitamin A deficiency can lead to dry eye problems.  Some diseases such as Parkinson's and Sjogren's as well as certain medications also cause dryness.

Many find relief simply from using artificial tears on a regular basis.  Some of these products are watery and alleviate the symptoms temporarily; others are thicker and adhere to the eye longer.  Both Drs. Rowsey and Johnson recommend preservative-free tears because they are the most soothing and have fewer additives that could potentially irritate.  Avoid products that whiten the eyes - they don't have adequate lubricating qualities and often make the problem worse. 

If you're using tears 2-3 times each day and are still uncomfortable, you should consult an eye care professional for an evaluation.  The first objective of the exam is to determine the underlying cause of your symptoms by measuring the production, evaporation rate and quality of your tear film.  Three special stains are particularly helpful to diagnose the presence and extent of the dryness.  The first is a light green drop called Fluorescein.  This tints your tears temporarily, allowing your doctor to determine the time it takes for your tears to dissipate after you blink.  The second stain is called Rose Bengal.  It highlights the dry areas on your eye so the extent of the problem can be determined.  The third is called Lissamine Green.  It stains the areas you feel pain.  "These special drops allow me to pick up problems with a microscope that would normally be invisible," explains Dr. Rowsey. 

It may also be necessary to evaluate the amount of tears your eye produces.  This is done with a Schirmer test.  Tiny paper tabs are placed in the lower eyelids.  After a few minutes, the strip is removed from the lid and wet area is measured.  If the wet area is smaller than average, you may not produce enough tears to lubricate your eye adequately.

Finally, your lubricating regimen will be assessed.  In addition to artificial tears, those with extremely dry eyes may also require ointment at bedtime to keep the eye from drying during sleep.  Drs. Johnson and Rowsey both believe that there is no "one-size-fits-all" regimen for treatment.  "I work with my patients to find the game plan for each individual," explains Dr. Johnson.  "What is best for one may not be for another.  It usually just takes a little detective work to customize the ideal treatment." 

Your doctor may also suggest occluding the opening of the tear drain in the eyelid with special inserts called punctal plugs.  This works like closing a sink drain with a stopper.  These special plugs trap the tears on the eye, keeping it moist.  This may be done on a temporary basis with a dissolvable collagen plug, or permanently with a silicone plug.  Dr. Rowsey likes the conservative approach:  "I give my patients with mild to moderate dryness the option to test drive the punctal plugs first.  The collagen plugs dissolve after about a week, which allows my patients to decide if they are beneficial.  If they help, we can insert the permanent ones." 

It is important to evaluate and treat dryness not only for comfort, but also for your eye's health.  "If left untreated, dry eyes can become more than just a nuisance," explains Dr. Johnson.  "The tear film is vital to the health of the cornea.  Severely dry eyes could lead to other problems."  Besides lubricating the eye, the tear film helps fight infection, provides nourishment, and creates a smooth surface on the cornea, keeping your vision clear. 

For the best results, you need to work closely with your doctor.  Your care may include treatments such as artificial tears, punctal plugs, or possibly lifestyle changes.  There are several simple steps you can take.  For example, drinking eight to ten glasses of water each day keeps your body hydrated and flushes impurities.  Make a conscious effort to blink frequently - especially if you're reading a book or watching television.  Avoid rubbing your eyes.  This only worsens the irritation.  Finally, pay close attention to what improves your symptoms and what doesn't.   Your doctor needs your help to treat the problem!  If you suffer from dry eye syndrome, its important to know that relief is available.  All it takes is a little teamwork.