Complaints of dry, burning, gritty eyes are commonly heard in ophthalmologists’ offices. Dry eyes occur more with age, in females and during the winter season (low humidity and the drying effects of forced air heating). For those with certain systemic diseases such as rheumatoid arthritis and lupus erythematosis and those using certain medications such as antihistamines, anti hypertensives and diuretics, the symptoms of dry eyes can be annoying at best and debilitating at worst.
The economic burden of dry eyes is significant. A recent study estimated the annual cost of managing a patient with dry eye disease was $783 resulting in a $3.84 billion annual burden on the U.S. healthcare system. Over a patient’s lifetime, this amounts to $11,302 and a whopping $55.4 billion!
As tears are composed of three elements, oil from the meibomian glands in the eyelid, enzymes from the lacrimal and accessory glands and mucus from the mucin glands in the conjunctiva, a deficiency of any one of the three can lead to symptoms of dryness.
Unfortunately, there is no real cure as symptoms generally wax and wane. The mainstay is over-the-counter artificial tears used frequently, at least 4-6 times a day and maybe more. Bland ointments, also purchased over-the-counter, used at bedtime will help lubricate the eyes during the night. Omega three (and possibly 6) fatty acids in large doses, humidifying the home and work environment, increasing water intake and modifying exacerbating activities, such as avoiding long uninterrupted periods of reading and computer use, are also beneficial
Closing the lacrimal puncta, the two openings into the drainage system that allows tears to drain out of the eye helps by keeping what little tears there are in the eye longer. This minor office procedure can be performed with temporary or permanent plugs or with cautery. Restasis® eye drops used twice daily can actually increase the eye’s production of tears to relieve symptoms. This medication works in about 85% of patients, but it may take up to 3 months to have an effect and must be continued indefinitely. Finally, treating any underlying blepharitis or meibomian gland dysfunction with hygienic measures, antibiotics, etc., may also help relieve symptoms and provide comfort.