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My eyes can't be dry, they are always tearing!

Dry eye (or ocular surface disease) is an exceedingly common eye problem that often times goes underappreciated by patients and providers.


Keep reading below to find common symptoms, misconceptions, and initial treatments for ocular surface disease. .




Ocular surface disease affects between 5-15% [1] of the US population and is especially common in women and the elderly. Ocular surface disease costs the United States economy over $55 Billion dollars annually[2]!


Why do my eyes tear constantly if they are dry?


This is a major point of contention for some patients when it comes to dry eye disease. Tearing is a common symptom with dry eye because the eyes reflexively send signals to your brain to increase the tear production due to being dry. However, these tears may not by the the correct tears or may lack the proper composition, which can worsen the cycle of dryness and cause more tear production.


I prefer to term ocular surface disease because this removes any connotation of liquid from the discussion and also includes other contributing factors to dry eye, such as the meibomian glands and environmental factors.


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What are tears?


Tears are a complex microenvironment of three layers made by the meibomian glands in the eyelids, the lacrimal glands and a group of specialized cells called goblet cells found in the conjunctiva.


  1. Oily layer - made by the meibomian glands in the eyelids. This layer helps prevent evaporation of the tears.

  2. Watery layer - made by the lacrimal glands. This layer the majority of our tears.

  3. Mucus layer - made by conjunctival goblet cells. This layer helps the tears adhere to the surface of the eye.

A problem with any one of these layers can lead to ocular surface disease and discomfort.


Risk factors:


Non-modifiable risk factors include:

  1. Increased age

  2. Female race

  3. Meibomian gland disfunction

  4. Systemic medical problems such as Rosacea, Connective Tissue Diseases and Sjogren's Disease

Modifiable risk factors include:

  1. Hormone deficiencies and hormonal replacement therapy

  2. Contact lens use

  3. Electronic overuse

  4. Environmental factors (low humidity, dirty environment, fans, car vents, forced air)

  5. Medications (antihistamines, antidepressants, antianxiety medications and isotretinoin to name a few)


Treatment


Treating ocular surface disease can be sneakily challenging because every patient has different symptoms and a different underlying cause for their dry eye. Treatment requires dedication on the patient's part and a little trial and error.


Treatment starts with trying to improve the composition of the natural tears. I refer to this as the basics of treating dry eye. Most patients should be using artificial tears (we'll discuss more in a second) and using warm compresses, every day. These measures help to improve the composition of our tears which leads to improved symptoms.


If you've ever seen the eye care aisle at the pharmacy you understand that choosing an artificial tear can be overwhelming. In my opinion you can't go wrong with one brand of artificial tears versus another and if you try enough of them, eventually most people find one they like the most. The only word of caution is to avoid using eye drops that say "get the red out" frequently as these can make the eyes more red and irritated over time. We'll have another blog post specifically on the different types of artificial tears, so keep posted!


After doing the basics, if the eyes are still uncomfortable there are a lot of different options for improvement including tear duct plugs, anti-inflammatory prescription medications and specialized contact lenses.


Please don't suffer with Ocular Surface Disease!


We are fortunate to live in the time we do, as we are gaining an understanding of the ocular surface disease process annually and new therapies are constantly coming into the market. If your eyes are uncomfortable or you are unhappy with your vision please make an appointment to come and see us, because I am confident we'll be able to help!


References


[1] USA General Population 2018 Cross Sectional Study and Census.gov Population Clock – accessed March 2023

[2] https://pubmed.ncbi.nlm.nih.gov/21045640/

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