Dry eye syndrome is without a doubt one of the most frequent reasons to visit an eye care professional. The manifestations of this problem are multiple and very common, and are usually a cause of frustration for those who suffer from them.

Let’s start from the beginning.

The eye is on the surface of the body, and to function properly, it must always be lubricated. This humidity comes in the form of a very thin liquid film on its surface, that is spread by the eyelids every time they close and open, like a windshield wiper on a car.

This thin film is at the same time composed of 3 parts, like a sandwich (see image 1). The innermost part, which sits on the actual eye, is mostly mucous material secreted by the conjunctiva, or “the skin” of the eye. The central part of the tear film is water, made by the lacrimal gland, and the most external part of this sandwich is a small quantity of oil produced by the eyelids, which helps by protecting the water from evaporating too quickly.

The 3 parts of the tear film, and the wiper, should function adequately in order to maintain proper levels of humidity.

Unfortunately, all too commonly, this is not the case.

Due to many causes, which will be presented gradually in future entries, the tear film or its spreading mechanisms can malfunction, and as a result, the surface of the eye begins to dry, and to become inflamed (irritated).

On this surface there are many nerves, and are very sensitive to irritation. Consequently, there is pain, redness, and in many occasions, exaggerated secretion of water by the lacrimal gland, trying to compensate for this dryness. When this compensating mechanism exceeds a certain threshold, the water “overflows” towards the cheeks and the person feels the famous “tearing”.

However, if the initial cause of this lack of humidity was a problem in any of the other components of the tear film, the exaggerated secretion of water tends not to solve the problem.

The single most important factor in the treatment of dry eye syndrome is the correct identification of the cause, so that we can solve it.

Generally, however, having dry eyes is like having dry skin, and analogous to applying moisturizing cream on your hands, is lubricating the eyes with artificial tears. Almost every patient with dry eyes should have a bottle of lubricating drops and use them several times a day.

On the other hand, an eye examination in the office will put us in the right direction regarding which layer of the tear film is deficient, and in this way decide on the specific therapy, both in direction and intensity.

Although it is true that most patients with dry eye have very mild visual complaints (that is, they do not have blurry vision), the compromise in quality of life due to pain, redness, irritation, or tearing, is enough to take each case very seriously and come up with strategies oriented to reducing the nuisances from the first day.

We will soon be analyzing the specific causes of tear film malfunction, and contributing with tips and advice to reduce them from home.

Thanks for your attention, 

Dr. Victor Flores.

Image 1 (Courtesy of the National Institute of Health)