Dry Eye

Dr. Talamo and his staff have expertise in the treatment of dry eye syndrome. If you are a patient suffering from dry eye, new treatments are available.

Dry Eye Syndrome or dry eye is a common complaint. About 20 million Americans experience some degree of difficulty from dry eye. Patients who suffer from this condition have often tried many approaches to combat this problem, but for many, problems persist.

Dry eyes are caused by both decreased tear production and quality. The most common symptoms include pain from irritation, a sandy feeling, and lack of tolerance when wearing contact lenses.

THE IMPORTANCE OF TEARS

Your tears are very important to your vision! They have many functions. Not only do they protect your eyes but also they are the only way to deliver nutrients to the eye's surface. Your tears also wash the eye clean, and lubricate the eyelid. Contact lenses sit among the top of your tear film, not on your eyeball.

CAUSES FOR DRY EYE

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. This is more pronounced in women. 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. Various systemic diseases such as lupus, rheumatoid arthritis, or Sjogren’s Syndrome can also cause dry eyes. Environmental conditions, some prescription and over the counter medications, and wearing contact lenses also contribute to dryness.

ARTIFICIAL TEARS

For many patients with mild dry eye, the use of artificial tears is sufficient to relieve symptoms. If artificial tears are used more than four times a day they should be preservative-free.

RESTASIS

Research has shown that chronic dry eye can be the result of inflammation in the tear-producing glands of the eyes. This causes a decline in the quantity of tears the eyes make naturally. This decline can have an impact on one’s day-to-day routine.

RESTASIS has been clinically shown to increase tear production that may be suppressed by ocular inflammation. The approved treatment is one drop in the morning and one drop at night. Indeed, many patients using RESTASIS Ophthalmic Emulsion report noticeable improvement in tear production with continued use. Individual results may vary.

PUNCTAL PLUGS OR PUNCTAL CAUTERIZATION

Punctal plugs are used to treat eye dryness that does not adequately respond to topical lubricants.

In order to understand how punctual plugs work, a review of how tears are produced by the eye and how they drain away from the eye is needed. Tears are produced by the lacrimal gland, located at the outer aspect of the eye, under the brow bone. Tears produced by the lacrimal gland enter the eye via an INFLOW duct and across the surface of the eye, keeping the surface of the eye lubricated.

Tears drain AWAY from the eye through two openings (called “puncta”) in the inner corner of the eye, near the nose. For each eye there are two punctal openings, one in the lower lid and one in the upper lid. Two thirds of the tears drain through the lower lid punctum and one third through the upper.

Via the punctal openings, tears then drain into the nose and from there into the throat. This is why one’s noise gets “stuffy” when one is crying. It is also the reason one can taste eye medication.

Plugs can be placed in these punctal openings. This serves to cause the tears to back-up and therefore to stay on the surface of the eye longer, keeping the eye lubricated. This is akin to putting a stopper in a bathtub drain, therby not allowing the water to drain out of the bathtub.

Plugs are placed in the exam room at the slit lamp. The procedure takes approximately 30 seconds to one minute per punctal opening. The procedure is not painful; however, patients may experience a mild “pricking” sensation during placement. No anesthesia is required.

Punctal plugs are less than one millimeter in width. Once placed, they are generally not visible to the naked eye. Upon very close examination, the silicone plugs may be visible as white or clear “dots” in the corner of the eye.

There are two main types of plugs:

Dissolvable: These are often used only to asses whether or not a patient is a candidate for longer-term punctual occlusion. If these are placed, it is important for the patient to assess whether or not they are working before they have completely dissolved. Quick-dissolving (also known as “collagen plugs”). These dissolve after 4 to 7 days. Long-lasting dissolvable. These last 1 to 2 months.

Non-Dissolvable: Removable (often known as ‘silicone plugs”). Non-removable (one type in the “Smart plug”).

The punctual openings can also be permanently closed by process of cauterization.

Side-effects: Rarely, excessive tearing. This is alleviated by dissolution of the plugs or by removal of the plugs. However, dry eye patients are often grateful for the increase in tears! The silicone plugs may fall out and require replacement. The silicone plugs may cause a slightly foreign body sensation. If this is the case, they are removed and replaced with another type of plug.

OTHER TREATMENTS

Omega-3 fatty acids, fish, flax seed oil and other related oral prescriptions are often helpful in treatment of dry eye. Please consult your doctor to see of these supplements would be right for you.

Many patients also have a condition called blepharitis that contributes to dry eye symptoms. Please see our section on BLEPHARITIS to learn more.