The incidence of dry eyes in America has grown dramatically over the past decade as the environment has changed, and the average age of Americans has increased. As such, new and better therapeutic alternatives are required to treat this chronic and potentially damaging condition. While most individuals simply chose to live with the discomfort of dry eyes, the physiological changes that can, and do occur as a result of decreased tear flow are worth noting.
Dry eyes can occur either as a result of decreased tear volume, or an alteration in the tear quality. There are several components to tears including water, mucin and enzymes; each with a special responsibility. If any one of these components are missing, decreased or altered the result will be dry eyes. For example, if there is an inadequate amount of mucin in the tears, the tear/cornea interface will be changed and the tears will not maintain a constant and even coverage. Tear break up time will be short, usually less the 10-15 seconds, and the eyes will become uncomfortable. Like wise if the enzyme component is altered, there is an increase in the likelihood of bacterial build up on the eyelid margins resulting in Blepharitis; which is a lid inflammation. This in turn will reduce tear production into the eye. Obviously, a simple decrease in the tear volume will result in dry eyes since there will not be enough tears to cover the cornea for the required time period.
Dry eyes result in symptoms such as sandy, burning, red eyes which if untreated will get worse over time. This will cause individuals to rub their eyes often abrading the cornea. In addition, a dry eye results in the corneal epithelium to lose its transparency giving it a milky haze. Naturally, this can and often does makes the vision worse. Continued dry eye conditions can permanently alter the corneal tissue, and scarring may result. As the eyes dry out, the lids become more involved and the Blepharitis worsens resulting in the eyes to be even dryer. It is a vicious cycle that must be broken as soon as possible.
Treatments have evolved, and patient comfort has dramatically improved along with these changes. Artificial tears are the starting point, but most often do not solve the problem. Next up is treatment with steroid eye drops along with lubricating drops. This therapy frequently does show noticeable improvement in the condition. When additional help is required, Restasis eye drops are employed to stimulate tear production. This medication is a good alternative, but does require its’ use for many months, twice per day at substantial cost to the patient. Unfortunately there are still many patients that are still uncomfortable.
The inner corners of the eye lids have small openings called Puncta. These openings drain the tears into the nose via ducts, allowing tear flow out of the eyes. On occasion, they get clogged causing tear overflow, and must be surgically opened. This concept is employed to balance tears in the eye when the eyes are dry. Small cylindrical materials can be painlessly inserted into the duct, and effectively blocks the out flow of the tears. This would be similar to covering the drain in the tub. In this case, by preventing tears from leaving the eye we can increase the tear volume, and improve comfort and function. There are two basic types of Punctal Plugs. The first is a temporary one that is made of collagen. These are great because they dissolve in 2-3 months, and result in immediate relief to the patient; but do not have long lasting potential for infection or tissue alteration. If during that 2-3 month period there is an increase in tear production then there would be no need to reinsert another plug. If additional treatments are required, it can be easily done as long as is necessary. There is also a permanent type made of silicone. These are inserted the same way, and have the exact same affect, but do not dissolve. If a problem arises they must be physically removed. In short, punctal plugs are a great way to reduce the deleterious effects of dry eyes, and significantly improve patient comfort.
Dr. Jay B Stockman is a contributing editor for VisionUpdate.net , and a practicing doctor for New York Vision Associates, http://newyorkvisionassociates.com