It’s better to shed tears than having a ‘Dry Eye’. Literally, because, it’s actually a medical condition that occurs when eyes do not produce tears properly. It also makes working on a computer, reading for a longer stretch of time difficult. It is therefore advisable to protest ourselves from this condition that causes burning sensation in the eye, watering, blurring of vision, white discharge from the eyes, sticky eyes, red puffy eyes and sometimes agonizing pain in the eyes.
Dr Suvarna Koppikar (MS Ophthalmology), a renowned eye-surgeon from Mumbai, Maharashtra, take us through the mysterious world of ‘tears’ and all about the Dry-Eye syndrome.
Tears are equated with grief, and sometimes with joy. Do tears play any other role?
A big role, they are the pillars of our eye-health. Tears are essential for clear and comfortable vision. Any disturbance in the quality of tears or consistency of tears is termed as ‘dry-eyes’.
Tears are just salt water, aren’t they?
Far from it. Those tiny droplets are actually made of three layers – an oily layer, a watery layer and a mucus layer. The fabric of tears is vital. Each of these layers has their own purpose and when there is disturbance in formation of any one of these layers it is called as dry eyes.
Tell us more about these ‘layers of tears’
The oily or lipid-layer (outermost) is produced by glands which are present in the eyelids. Its purpose is to keep the tear surface smooth and reduce or prevent evaporation of tears. The middle watery-layer makes up most of what we ordinarily think as tears. This layer is produced by the lacrimal glands in the eyelids to cleanse the eye and wash away foreign particles or irritants that try to enter our eyes as the surface of our eye remains exposed to the outer environment. The inner layer is made up of mucus which is produced by the white surface of the eye called conjunctiva. Mucus allows the watery layer to spread across evenly over the surface of the eye and helps the eye remain moist. Mucus layer is very important as without mucus tears would not stick to the eye.
When we shed tears of grief or while cutting the onions, we are actually protecting our eyes, right?
Not really. We produce basic tear at a slow and steady rate, these tears do not well up in our eyes or flow out like when we cry. Basic tears constantly bathe our eyes. The eyes stay moist and comfortable because of basic tears. When we cry due to emotions or while cutting the onions, we shed what is called the reflex tears.
Do you mean that we suffer from ‘dry eyes’ when we stop producing the basic tears?
Dry eyes do not mean no tears or less tears but it is the disturbance of quantity or quality tears. People with dry eyes complain of “WATERING ‘of eyes which disturbs them.
What are the causes of ‘dry-eyes’?
Dry-eyes can be due to local, internal, environmental or life-style related factors. Local causes pertaining to the eye are long term use of contact lenses and eye-drops that contain preservatives. Internal problems especially auto immune diseases (when our immune cells attack our own body) like rheumatoid arthritis or diseases like diabetes and Herpes Zoster (RASH touching the eyes) lead to reduced tear secretion and thereby cause dry-eyes. Many common medications like painkillers, anti-anxiety medications, sleeping pills, anti-allergic, and certain blood pressure medicines can lead to dry-eyes as side effects. Environmental factors like allergies related to seasonal changes and air pollution are common in children and give rise to short term dry-eye symptoms.
How about artificial tears? Do they also have preservatives? Any other reasons for ‘dry-eyes’?
Preservative free artificial tear eye drops are now available in the market as daily disposable units. Other common causes of dry eyes are the surrounding environment. Excessive dry or windy climate as well as air conditioning which evaporate tears gives rise to “evaporative dry eyes”. Avoiding these irritants and using protective glasses can give relief to dry eye symptoms.
Are ‘dry-eyes’ more common in men or women?
Anyone can experience dry-eyes symptoms though it is more common in women especially after menopause and other hormone related conditions like pregnancy and menstruation.
What are the lifestyle factors that lead to ‘red-eyes’?
That’s a good question. Normally we blink 18-20 times a minute but studies show that blink rate goes down by half or more while using computers and other digital screen devices either for work or for play. These days children are exposed to computer screens and other devices such as mobile phones etc and they use these devices to play for long hours. They develop eye strain and other dry eye symptoms of watering, gritty sensation, itching and photophobia (sensitivity to light).
Extended reading, writing or other intensive “near-work” can temporarily cause eye strain and watering of eyes or blurring of vision. Computer related symptoms become worse by sleep deprivation. During sleep our eyes are replenished by nutrients and regain the focusing power for close distance activity. Contact lens induced dry-eyes are due to infrequent blinking, improper cleaning of lenses, sleeping with lenses on.
Excessive smoking can also lead to dry eyes. What kind of treatment do you recommend?
Though many a times dry-eyes cannot be cured completely there are a number of steps that can be taken to treat them.
Use of artificial tear drops and ointments is the primary treatment for dry eyes. Preservative free eye drops are better for people with chronic dry eye and it is important to use the drops even when eyes feel fine to keep them lubricated. Lubricant eye ointments are also available for people with chronic dry eye symptoms.
Disposable eye drops containing cyclosporine that helps eyes increase their own tear production with continued use are available and are a boon for chronic dry eye patients.
There is growing evidence that increasing the oral intake of fish oil and omega 3 via diet or supplement is very helpful to those suffering with dry eye.
Self-medication is strongly discouraged as the chemists may dispense eye drops containing variable amount of steroids which have side effects. A formal consultation with an ophthalmologist is recommended to get the diagnosis established.
What about crocodile tears Doc?
Oh they are most dangerous. I recommend no one must shed them!
If you are using contact lenses
* Limiting use of contact lenses and wearing glasses periodically.
* Practice correct method of cleaning your lenses.
* Wash your hands before handling lenses.
* Avoid touching lenses with water.
* Use fresh solution every time for storing and cleaning.
* Rub your contact lenses when you clean them.
* Clean your storage case daily and replace it every 2-3 months.
* Stop wearing lenses if you develop redness, irritation, watering, sensitivity to light, burning, eye swelling or discharge. Do not take these symptoms lightly. One must visit an eye doctor if you develop these symptoms.
To reduce computer related eye strain and dry eyes:
* Sit about 25 inches from the computer screen and position the screen so that your eye gaze is slightly downward.
* Practice the rule of 20. Every 20 minutes shift your eyes to look at an object 20 feet away for at least 20 seconds.
* Use artificial tear eye drops to refresh your eyes when they feel dry.
* Blink often and practice conscious blinking i.e. remind yourselves to blink.
* Take regular breaks from computer work and try to get enough sleep at night.
The author is a microbiologist and has worked for food and pharmaceutical companies in marketing as well as business development in countries like Germany, India and the United Arab Emirates. She has written articles on ‘health & medicine’ in a leading Marathi newspaper and was also a freelance health columnist for a leading English newspaper in the Gulf for several years.