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Our tears have both an aqueous (water) and lipid component. If either component is deficient, then rapid tear evaporation and discomfort due to dry eyes may result. Patients with dry eyes typically experience a "gritty" or "sandy" feeling that is worsened by cold and/or windy environments. Many patients with dry eyes will actually experience increased eye watering, referred to as reflex tearing, since feedback from the eye to the brain may result in increased tear secretion from the lacrimal gland (large tear forming gland under the outside aspect of the upper eyelid). In these cases, patients have intermittent, excessive tearing with underlying chronic eye irritation.
The most common causes of dry eyes include:
- aging
- abnormal eyelid position
- post-eyelid surgery
- allergies
- contact lens wear
- blepharitis (eyelid margin inflammation)
- certain systemic medications
There are many other known causes of dry eyes; however, current research has revealed that there is still much to learn about the fundamental cause of dry eyes and the best treatments.
The mainstay of treatment has been tear supplementation. Tear supplements may come in preserved or non-preserved (preservative-free) preparations and are available over-the-counter (OTC) without a doctor's prescription. Drops, gels, and ointments are the most common formulations. Formulations with a preservative are much less expensive than non-preserved supplements, but approximately 10% of patients may be allergic to the preservative. Installation of preservative drops more than 4 times daily or prolonged use may increase the likelihood of an allergic or toxic response. Avoid any drops that are marketed to "get the red out". These drops may cause serious eye problems when used chronically.
Non-preserved drops and ointments may be used as often as needed. These drops are more expensive due to the individual dispensing units and extra packaging. Some examples of non-preserved artificial tears include: Bion Tears and Refresh. Celluvisc is a thicker, non-preserved drop that is good for very dry eyes or when you need extra protection due to poor eyelid closure. Refresh PM is a good lubricating eye ointment and may be recommended for night time use. If you would like to use ointment during the day, you may wish to alternate eyes to decrease the blurring of your vision. If you wish to clear your vision in the morning after night time use, you may use an eye rinse. Eye stream and Dacriose are two options.
Many new eye drops, gels, and ointments become available all the time. Many of these formulations are the same but some of the active ingredients or strengths may vary. We recommend that you try small quantities of the different supplements until you find one that works best for you.
Oral supplements are also available and may, in some patients, diminish dry eye symptoms or lessen the dependence on artificial tears. For severe cases of dry eyes prescription medications, special spectacles, or surgery may be indicated.
Stephen R. Klapper, M.D., F.A.C.S. is a board certified Ophthalmologist and has completed extensive fellowship training in Ophthalmic Plastic and Reconstructive Surgery. In addition to his clinical practice Dr. Klapper has published numerous scientific articles in peer reviewed journals and presented several papers at regional, national, and international meetings on topics related to the field of eyelid and facial plastic surgery. Dr. Klapper's practice is limited to adult and pediatric cosmetic and reconstructive eyelid and facial surgery, tear duct surgery, orbital disease, thyroid eye disease and the anophthalmic patient. Dr. Klapper also has extensive experience performing facial Botox® injections and Restylane® lip and facial fold injections.
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Contact our office to discuss your eyelid problem with Dr. Klapper or a member of his staff. (317) 818-1000
