July is Dry Eye Awareness Month

History of Cataract Surgery

July is Dry Eye Awareness Month

In recognition of Dry Eye Awareness month, we are publishing a few articles on dry eye.

Dry is very common and affects over 25 million in the United States alone.  Dry eye can occur in anyone and the chances of suffering from the symptoms of dry eye increase with age.

Dry eye syndrome is a condition in which your own tears evaporate too quickly or you don’t produce enough tears to keep your eyes sufficiently moist.  Many contact lens wearers experience dye eyes and it is a common condition in people over the age of 50. LASIK surgery can also cause dry eye syndrome. Dry eye syndrome can range from moderate to severe.

Having dry eyes affects your ability to focus and makes reading, driving, computer work, and watching TV uncomfortable and difficult.  When your eyes are dry they may feel itchy or burn, they may also look red.

Self-care Therapy

For most people with dry eyes, over-the-counter artificial tears will alleviate their symptoms and maintain the necessary moisture for healthy eyes. 

Warm compresses placed on your eyes can help to warm up the oil in the oil glands of your eyelids and make the oil flow to provide better eye lubrication.  Make sure the compresses are comfortably warm and not too hot.

If you experience dry eyes mainly when reading, using a computer, or watching TV, take eye breaks and close your eyes and blink several times.

If your dry eye symptoms persist despite using artificial tears and other self-care therapy, visit your eye doctor for a complete evaluation of your condition.

Comprehensive dry eye exam and diagnosis

Your doctor will exam you to determine the quantity and quality of your tears and how quickly your tears evaporate.

Your doctor can measure your tear production by using special paper strips inserted into the corners of your eyes.

Another test is the fluorescein eye stain test in which a few drops of a yellow-orange temporary dye are placed into your eyes and then you are asked to blink several times to distribute the eye drops.  After the dye is distributed over your eyes, your doctor will use a blue light to examine your eyes for any abrasions that may have been caused by your dry eye syndrome and to determine how long it takes for your tears to evaporate.

Clinical Treatments

Sometimes dry eyes are caused by medications.  The treatment may be as simple as having your doctor change your medication.  Dry eyes can also be caused by eyelid inflammation where your doctor might prescribe anti-inflammatory medications, either in pill form, or as eye drops.  

Another dry eye treatment is an eye insert that you place in your eye each day that dissolves and releases lubrication, but without the nuisance of drops.  

Dry eye syndrome can also be caused by blocked oil glands in the eyelids and procedures to unblock the glands can bring relief.   “Meibomian gland dysfunction” is very common cause of dry eye.  Essentially, the normal oily layer is of poor quality and causes rapid evaporation of the tears.

If too much tear drainage is causing your dry eyes, then tiny plugs made of silicone or collagen can be inserted to block your tear drainage.  Partially blocking the nasolacrimal duct (tear ducts) will slow the drainage of your tears and keep your eyes moist.  The “punctal plugs” are reversible. 

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Dry Eye

Do You Have Dry Eye?


Dry EyeIt sounds counter-intuitive, but tearing is one of the more common symptoms of dry eye.

The tearing is “reflex” tearing and occurs in response to your eye being irritated due to dryness, or getting poked in the eye.

Dry eye syndrome, also known as keratoconjunctivitis sicca, is very common and affects over 300 million people around the world.  Dry eye is probably the most common reason for a visit to the eye doctor.

Symptoms of Dry Eye

With every blink, tears are evenly spread across the surface of your eye.  Tears help fight infection and also keep your cornea hydrated, smooth and clear.

The cornea is exquisitely sensitive.  If you have ever scratched your cornea, you know how sensitive and painful your eye can become.

The cornea is also responsible for about 2/3 of the overall focusing power of your eye.  Any change to the cornea can translate into blurry vision.

Common Symptoms of Dry Eye;

  • Tearing and redness
  • Burning
  • A dry sensation
  • Blurry vision
  • Heaviness
  • Itchiness

Normal Tear Film

Your tears are actually a 3 layered film.  On the surface of your tear film is an oily layer which prevents evaporation.

The middle layer is the watery part and the bottom layer, called the mucin layer, ensures that the tears are spread evenly across the eye.

The oily layer is produced by Meibomian glands located on the edges of your lids.  The actual tears are produced by the lacrimal gland – there is one lacrimal gland for each eye.

The bottom mucous layer is produced by special cells located in the conjunctiva – the clear tissue on the outside of your eye.

Causes of Dry Eye

If you search “dry eye,” you will find dozens of causes of dry eye, but in reality there are just two basic mechanisms, either of which can be caused by any one of the “causes.”

  1. Insufficient tear production
  2. Rapid evaporation


Macular Degeneration

Never Enough of a Dry Eye

Intermittent blurry vision from dry eye is common, and although ultimately a corneal problem, is a condition often faced by a retina specialist.   Many times, patients with retinal disease, such as diabetic retinopathy or macular degeneration,  are referred to me with unexplained, fluctuating,  decreased vision.  It is always up to me to figure out if the change in vision is due to the dry eye, or the retinal disease.

The cornea is the transparent tissue in the front of the eye.  It is the tissue covered by a contact lens.  The cornea is responsible for about 2/3 of the focusing power of the eye.  Not even our natural lens, which rests inside the eye, has this much focusing power.

Tear Film – When we blink, the eyelids spread tears across the surface of the eye.  The tears keep the cornea hydrated.   A well-hydrated cornea has a very uniform and smooth surface.  The air-water interface, where the air hits the watery tears on the cornea, gives the cornea so much focusing power.

(Actually, it is the radius of curvature of the cornea and the index of refraction of the  air-water interface that yields the final focusing power of the eye.  This is also why laser vision correction works; it changes the radius of curvature, or roundness, of the cornea.)

In dry eye conditions, the surface of the cornea becomes, uh…dry.  On a microscopic level, it is no longer smooth.  A “dry” cornea is irregular and rough.  It does not focus light accurately or consistently as the tear film is some what patchy.  The result is a very blurry image that reaches the retina.  We complain of blurry vision.

Treatment for dry eye usually consists of artificial tears and lubricants.  Other treatments are available, but are beyond my scope of practice.  It is important to remember, yet hard to implement, that the use of artificial tears should be regular and not used only when symptoms develop.  The idea is to prevent dry eye from developing.

Symptoms of dry eye include blurry vision, burning, sensitivity to light and tearing.  The blurry vision may only be at certain times of the day, during certain activities, such as reading, or may be more prevalent at certain seasons (winter is generally drier along the East coast).  The cornea is a highly sensitive tissue, the dryness causes the burning and sensitivity (try not blinking for 30 seconds).  The tearing develops in response to the burning (as if to wash something away).

What Does This Mean? Due to the enormous focusing power of the cornea, any small perturbation of the corneal surface can translate into rather dramatic change in vision.  To a patient with retinal disease,  these changes in vision are worrisome, scary and can be depressing.  A key difference, however, between loss of vision from dry eye versus progressing retinal disease is that the symptoms from retinal disease should not fluctuate, especially on a daily basis.

I am always happy to “blame” the dry cornea for changes in vision and we all breathe a sigh of relief when I find the retinal  disease is stable and unchanged.

It really should be called “dry cornea.”


Randall V. Wong, M.D.

Ophthalmologist, Retina Specialist
Fairfax Virginia

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