Dry Eye Disease
None of us are getting any younger. Sobering as that may be, dry eye disease is rising across all age groups. It is one of the most common conditions eye doctors see in their chair every day.
There are many contributing factors to this condition, including age, gender, medications, and the visual demands of the patient. It is important to understand that the tear film should always be present and stable on the front of the eye. It is, in fact, a refracting surface in the optical system that enables you to see clearly. Without it, your vision will be compromised.
The skin and hair of the body dry out as we get older – the eyes are no different. The lacrimal gland that produces the moment-by-moment lubrication of the eye is aging right along with the rest of you. It just can’t produce the tears that it did. Women also tend to dry out much faster than men due to hormonal differences.
Medications are another contributing factor to this condition. Blood pressure medication, hormone replacement, thyroid medication, anti-anxiety or anti-depressants, as well as over the counter cold and allergy medication can all have drying effects on your eyes. Clearly, we don’t recommend stopping these medications because of dry eye, but you have to realize that if you have to be on any of these medications, you will have to be more aware of the effects on your ocular comfort and vision.
Activities such as staring at a phone, laptop, or computer, reading a book, sewing, watching TV, or driving, all contribute to dry eye syndrome. When you are visually focused on these activities, you’re not blinking at a normal rate – you’re staring for long periods of time without realizing it. The longer you stare, the faster the tear film evaporates off of the surface of the eye. Suddenly, your vision has “gotten blurry” or “run together”. Again, without the tear film on the front of the eye, you’re missing a “lens” in the optical system that is necessary to maintain clear vision.
Device usage has certainly increased the incidence of dry eye in younger and younger age groups. From the time a toddler can hold their parent’s phone, they are staring at it every chance they get. Twenty years ago, dry eye in children was not very common. Not so, today.
The second role of the tear film is to protect the eye from infection, clear debris that gets into the eye, and aid in healing of the ocular surface. So often, patients blame all their symptoms on allergies. While they may, indeed, be allergic to dust or pollen, a healthy tear film protects the eye from allergens floating in the air. Without the tear film, the barn door is wide open to these irritants landing on the surface of the eye and causing inflammation and irritation for the patient.
Allergy drops are what these patients reach for first, but without realizing that allergy medications, topical or oral, dry out the mucous membranes of the skin. Guess what this does to the eye? Increases the dryness. A recommended artificial tear used consistently four times a day should be the initial treatment.
Another role of the tear film is to keep the eye comfortable. Just below the tear film, lies the skin of the eye known as the cornea. It is composed of five layers. Patients often tell me “I don’t feel dry so I don’t need to use tear drops”. What they don’t realize is that in order to “feel” dry, the dryness has to work it’s way down to the third layer of the cornea in order to affect the corneal nerve endings that tell the brain that the eye doesn’t feel good. At that point, the eye has been dry for hours.
To better understand why consistent use of ocular lubricants is important, think of your skin. When your skin initially dries out, you usually don’t feel it, you see it flaking and peeling. At this point, most of us go get a moisturizer to correct the way it looks, but we feel nothing. No pain, no irritation. Why don’t you wait to “feel it”? Obviously, if that was the criteria for reaching for body lotion or moisturizer, most of us would be walking around with cracked, bleeding skin. That’s when we would feel it!
We don’t moisturize the skin of the body in reaction to pain, but to prevent ever feeling the pain of dry skin. It should be the same for the eyes.
There are many good lubricating products on the market, but there are several not so good lubricating products out there and it’s important to know which ones to reach for. I never recommend generics as they tend to contain cheaper preservatives that may cause a sensitivity and are generally not as potent as some of the name brands. Blink, Refresh, Retaine and Soothe are great lubricating brands, to name a few.
Each brand contains several different products – tears, gel tears, and ointments. As we dry out with age, we may have to upgrade our lubrication. Think of body lotion, body cream, and body butter. Same thing. Your eye doctor will know best how to determine the lubrication, medication, or treatment that you may need. The important thing to know is that there are many options available.