Dry eyes are an extremely common condition, affecting millions of Americans. This ocular condition is more common in older patients and in patients with certain underlying system disease such as Sjogren disease, Arthritis and others. It is estimated that 22% or more of the general population may be affected and remains one of the more difficult ocular condition to treat because of its various etiology and chronic nature. Dry eye is commonly viewed as an imbalance between tear production and the tear drainage system.

The eye has a tear film which coats the outer layer of the eye. This tear film is very important for the lubrication and comfort of the eye as well as for the clarity of vision. The tear film is made up of 3 layers and a disruption in any of these layers can lead to symptoms of dry eyes. As we age, this protective tear film changes and diminishes, leaving the eye more exposed to the drying effects of the air, wind and dust. In many people the dryness is worse in the afternoon and evening.

Dry eye symptoms include burning, stinging or a gritty sensation which may come and go depending on many factors. Itching, tearing and light sensitivity may also occur. Occasionally long strings of mucus can be stretched from a dry eye. Excess tearing is also a symptom of dry eye syndrome. This paradoxical reaction occurs because the tears responsible for maintenance lubrication do not keep the eye wet enough and the eye becomes irritated. When the eye becomes irritated, the lacrimal gland in our eye produces a large volume of tears which overwhelms the tear drainage system. These excess tears then overflow from your eye.

The diagnosis of dry eyes is made by patient's symptoms, measurement of tear production and tear film stability and careful examination with the examination instruments. Diagnostic drops such as fluorescein, Rose Bengal or Lissamine green stain also help in establishing the severity of the disease.

Blinking is very important for the maintenance of the tear film. When performing such activities as reading or working on a computer, we blink less frequently. This aggravates the symptoms of dry eyes. Sometimes environmental factors can also aggravate dry eye symptoms. Dry weather, either in hot or cold temperatures, robs the eye of needed lubricants. Cigarette smoke, fumes, dust and airborne particles are common irritants. In most patients, this condition is not associated with systemic disease.

Treatment with drops and ointment help in most patients, but should be used on a long term basis. The first line of treatment is usually over the counter artificial tear substitute, which works well for the early stage dry eye patients. These artificial tears may require frequent usage throughout the day. Dry eye gel are more viscous than artificial tears, but less viscous than ointments. Gels, such as Refresh Liquigel, Systane Free, Genteal Gel, Celluvisc and others, are often suggested for moderate to severe dry eye. Ointments are sometimes used in severe cases of dry eye or eye surface dryness due to abnormal or incomplete eyelid closure. The ointment's effects may last longer, but they blur vision and are most effective at night. New modalities of treatment, including the use of immunosuppressive medications such as Restasis, steroids and non-steroids eye drops, have brought symptomatic relief for many dry eye patients. Vitamins such as vitamin A, D, Flaxseed and fish oil have all been advocated as helpful supplements in treating dry eyes.

Other techniques to treat dry eye include plugs which block the tear duct openings. These plugs can be placed in the two tear ducts, top and bottom, in both eyes or in only the lower ducts. Sometimes tear ducts are closed permanently to avoid lost plugs or incomplete blockage of the tear duct openings.