Dry Eye & Cornea

The most common symptom of dry eye is having to blink to clear things up.

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Dry Eyes

Dry eye is a condition in which a person doesn’t have enough quality tears to lubricate and nourish the eye. Tears are necessary for maintaining the health of the front surface of the eye and for providing clear vision. Dry eye is a common and often chronic problem for people of all ages.

With each blink of the eyelids, tears spread across the front surface of the eye, known as the cornea. Tears provide lubrication, reduce the risk of eye infection, wash away foreign matter in the eye and keep the surface of the eyes smooth and clear. Excess tears in the eyes flow into small drainage ducts (punctum) in the inner corners of the eyelids, which drain into the back of the nose. Dry eyes can occur when tear production and drainage is not in balance.

People with dry eyes either do not produce enough tears or their tears are of a poor quality:

  • Inadequate amount of tears. Tears are produced by several glands in and around the eyelids. Tear production tends to diminish with age, with various medical conditions or as a side effect of certain medicines. Environmental conditions, such as wind and dry climates, can also decrease tear volume due to increased tear evaporation. When the normal amount of tear production decreases or tears evaporate too quickly from the eyes, symptoms of dry eye can develop.
  • Poor quality of tears. Tears are made up of three layers: oil, water and mucus. Each component protects and nourishes the front surface of the eye. A smooth oil layer helps prevent evaporation of the water layer, while the mucin layer spreads the tears evenly over the surface of the eye. If the tears evaporate too quickly or do not spread evenly over the cornea due to deficiencies with any of the three tear layers, dry eye symptoms can develop.  The most common form of dry eyes occurs when the water layer of tears is inadequate. This condition, called keratoconjunctivitis sicca (KCS).
Tear film: aqueous layer, mucous layer, lipid layer

People with dry eyes may experience irritated, gritty, scratchy or burning eyes; a feeling of something in their eyes; excess watering; and blurred vision. Advanced dry eyes may damage the front surface of the eye and impair vision.

Treatments for dry eyes aim to restore or maintain the normal amount of tears in the eye to minimize dryness and related discomfort and to maintain eye health.

What Causes Dry Eyes?

Close up of red, dry eyes

Dry eyes can develop for many reasons, including:

  • Age. Dry eyes are a part of the natural aging process. The majority of people over age 65 experience some symptoms of dry eyes.
  • Gender. Women are more likely to develop dry eyes due to hormonal changes caused by pregnancy, the use of oral contraceptives and menopause.
  • Medications. Certain medicines, including antihistamines, decongestants, blood pressure medications and antidepressants, can reduce tear production.
  • Medical conditions. People with rheumatoid arthritis, diabetes and thyroid problems are more likely to have symptoms of dry eyes. Also, problems with inflammation of the eyelids (blepharitis and meibomian gland dysfunction), inflammation of the surfaces of the eye, or the inward or outward turning of eyelids can cause dry eyes to develop.
  • Environmental conditions. Exposure to smoke, wind and dry climates can increase tear evaporation resulting in dry eye symptoms. Failure to blink regularly, such as when staring at a computer screen for long periods of time, can also contribute to drying of the eyes.
  • Other factors. Long-term use of contact lenses can be a factor in the development of dry eyes. Refractive eye surgeries such as LASIK, can decrease tear production and contribute to dry eyes.

How Are Dry Eyes Diagnosed?

Dry eyes can be diagnosed during a comprehensive eye exam.  Testing, with emphasis on the evaluation of the quantity and quality of tears produced by the eyes, may include:

  • Patient history to determine the patient’s symptoms and to note any general health problems, medications or environmental factors that may be contributing to the dry eye problem.
  • External examination of the eye, including lid structure and blink dynamics.
  • Evaluation of the eyelids and cornea using light and magnification.
  • Measurement of the quantity and quality of tears for any abnormalities. Special dyes may be put in the eyes to better observe tear flow and to highlight any changes to the outer surface of the eye caused by insufficient tears.

With the information obtained from testing, your optometrist can determine if you have dry eyes and advise you on treatment options.

How Are Dry Eyes Treated?

Nurse putting eye drops in eyes of an elderly patient

Dry eyes can be a chronic condition, but your optometrist can prescribe treatment to keep your eyes healthy and comfortable and to prevent your vision from being affected.

Preservative Free Artificial Tears

Mild cases of dry eyes can often be managed using over-the-counter preservative-free artificial tears.  These can be used as often as needed to supplement natural tear production. Artificial tears that have preservatives can actually make dry eye worse.  People with dry eyes that don’t respond to artificial tears alone will need to take additional steps to treat their dry eyes.

Meibomian Gland Dysfunction

Picture of Meibomian Gland Dysfunction (Above)

Eyelid Scrubs, Hot Compress Masks, Omega-3 Vitamins & TearCare

Meibomian glands are on the upper and lower eyelids, when they become clogged, the oils that prevent the tears from evaporating cannot get into the tear film.  This is called meibomian gland dysfunction (or blepharitis).  Eyelid scrubs, a hot compress mask and omega-3 vitamins can help unclog those glands.  Additionally, an in-office device called TearCare® heats the glands for 15 minutes which melts the meibum.  Once melted, your doctor will clear those glands with another instrument.

Prescription Eye Drops

Your optometrist can prescribe eye drops (Xiidra and Restasis) that increase tear production and decrease inflammation in the tear film.

Punctal Plugs

Keeping natural tears in the eyes longer can reduce the symptoms of dry eyes. This can be done by blocking the tear ducts (i.e. punctum) through which the tears normally drain with Punctal Plugs.  Punctal Plugs are tiny silicone or gel-like plugs that block the tear ducts.  The goal is to keep the available tears in the eye longer to reduce problems related to dry eyes.

Punctal Plug Compressor

Amniotic Membrane Tissue

Amniotic membrane tissue comes from the innermost layer of the placenta.  Amniotic membrane tissue contains stem cells that can help decrease inflammation and rehabilitate the ocular surface for select dry eye patients.

Contact Lenses for Dry Eyes

Daily Disposable Soft Contact Lenses

Dry eyes can make wearing contact lenses difficult and cause a number of symptoms, including blurred vision, dryness, grittiness, burning, redness and foreign body sensation.  Think of soft contact lens like a sponge.  They absorb tears from the tear film and therefore dry the eyes out.  Certain soft contact lens materials work better than others for dry eyes.  Often, daily disposables contact lenses are best because replacing your contact lenses more frequently reduces dry eye symptoms.

Scleral Contact Lenses

If you’ve been told in the past that you cannot wear contact lenses because of dryness, ask us about scleral contact lenses. Scleral contacts are large-diameter gas permeable contact lenses specially designed to vault over the entire cornea and rest on the eye called the sclera. The space between the cornea and the back surface of a scleral lens acts as a fluid reservoir to provide comfort for people with dry eyes who otherwise could not tolerate wearing contact lens. Unlike soft contact lenses that contribute to dryness, scleral contact lenses are used to treat dry eye by bathing the cornea with a preservative free solution.

Cornea

The cornea is the clear front surface of the eye and allows light to enter the eye. It’s made up of layers of cells and provides the majority of the focusing power. The cornea is the most sensitive structure in the body because it has hundreds of times more pain receptors than our skin.

Corneal Abrasion

Picture of Corneal Abrasion Above

Corneal Abrasion

A corneal abrasion is a scratch on the superficial layer of the cornea. Most commonly corneal abrasions are caused by fingernails, tree branches, or makeup brushes. Additionally, corneal abrasions can occur from rubbing your eye or by having very dry eyes.

Symptoms include foreign body sensation, red, painful or tearing eyes, blurry vision, or photophobia (light sensitivity). Treatment for a corneal abrasion might include a prescription eye drop and/or a bandage contact lens to improve comfort and alleviate pain.

Corneal Erosion

A corneal erosion is characterized by a sudden onset of pain and blurry vision, often upon waking up in the morning. Erosions occur when the surface layer of the cornea (epithelium) becomes loose from the underlying layers. You are at risk for a corneal erosion if you have very dry eyes, have had a prior corneal abrasion or injury, have a corneal dystrophy or disease, or if you over wear contact lenses. Treatment for corneal erosions include removing the loose epithelium in office, patching, antibiotic eye drops, and/or moisturizing drops.

Corneal Laceration

A corneal laceration is a very serious cut on the cornea, much thicker than a corneal abrasion, and can be caused by an object flying into the eye at a high speed. A corneal laceration requires urgent medical attention in order to avoid vision loss.

Symptoms include severe pain, tearing, light sensitivity, decreased vision, bleeding and foreign body sensation. It is important to wear eye protection when doing activities such as cutting wood, trimming grass, grinding metal, or any other high-risk activities.

Corneal Transplant

Picture of Corneal Transplant Above

Corneal Transplant

A corneal transplant, also known as Penetrating Keratoplasty, is when a diseased cornea is replaced by a healthy cornea from a human donor.   A corneal transplant may be required if the cornea is damaged from disease or scarring beyond repair.  Keratoconus, Fuch’s corneal dystrophy, eye infections and injuries are a few conditions that can lead to a corneal transplant.

Corneal Dystrophies

Corneal dystrophies are a group of inherited and progressive corneal disorders that usually affect both eyes. Corneal dystrophies result from a build-up of foreign material in the layers of the cornea. This build-up causes the cornea to lose its transparency and loss of transparency leads to vision loss or blurry vision. Family history of corneal dystrophies increases your risk. Treatment can range from lubricating drops to corneal transplant, depending on the severity of the disease.

Corneal Foreign Body

Picture of Corneal Foreign Body (Above)

Corneal Foreign Body

A corneal foreign is an object either superficially adherent to or embedded in the cornea of the eye. The removal of a corneal foreign body is a procedure commonly performed at Roswell Eye Clinic.  If corneal foreign bodies are not removed in a timely manner, they can cause prolonged pain and can lead to complications such as infection and ocular necrosis.

When metallic foreign bodies become embedded in the cornea, a corneal rust rings occurs due to the oxidation of iron by the body.  After the foreign body is removed, removal of the rust ring within 24 to 48 hours is imperative to avoid permanent staining of the cornea, persistent inflammation and corneal necrosis.  The AlgerBrush is rotary instrument is used to remove the rust ring.  In addition to removing the rust ring, the AlgerBrush leaves a smooth corneal surface that in turn heals much faster.

Corneal Ulcer

Picture of Corneal Ulcer Above

Corneal Ulcer

A corneal ulcer is an open wound on the cornea. An ulcer usually results from an eye infection after an eye injury or by overuse/misuse of contact lenses (ex: sleeping in contact lenses). The infection from an ulcer can be bacterial, viral, fungal, or parasitic.

Symptoms of a corneal ulcer include redness of the eye, severe pain, foreign body sensation, discharge, blurry vision, light sensitivity, or swelling of eyelids.  It is necessary to be seen by a doctor for treatment of an ulcer.

Our Dry Eye & Cornea Specialists: Dr. Samuel Chado, Dr. Michelle Moscow, Dr. Scott Moscow