As winter approaches more and more people suffer with dry eyes

While those of us on Long Island don't live in an arid climate, as winter approaches and we rely more and more on dry heat, many people suffer with dry eyes.  Dry eyes can effect people at different times of the day or night.  For instance, people that get up in the middle of the night for whatever reason may notice trouble blinking at first because their eyes feel so dry.  These same symptoms often occur first thing in the morning upon awakening.  While symptoms often abate during the day they often recur in the late afternoon and evening hours.  Patients with this problem often complain of tired eyes.  Vision can often be blurred and improves with frequent blinking.  A sandy feeling is another manifestation of this problem.  

There are many ways to help diagnose this problem other than simply relying on the symptoms that patients have.  Schirmer testing using paper strips placed between the lid and the eye over a five minute period was one of the first ways of testing for this problem.  This test is performed over a five minute period and is considered normal if the test strip is wet  beyond ten millimeters.  There is now a quick-zone test that gives approximately the same information over a ten second period using a thread that changes color when moistened by your tears.  While such testing is helpful it's not foolproof as there are many false positives and negatives with this method.  More recently vital stains and dyes have been used.  For instance fluorescein dye is commonly used to detect abnormal staining seen with dry eyes.  Healthy tissues won't pick up stain while damaged tissues will.  Additionally with normal tear secretion and even film of fluorescein can be detected on the surface of the for at least eight seconds.  If the film disperses in less time dry eyes can be suspected.  Two other dyes commonly used are Rose Bengal staining and Lissamine green staining.  Both of these are quite useful in detecting damage to the conjunctival surface cells of the eye.  One of the newest ways of detecting dry eyes which is considered the most reliable methods for detecting this condition is with the tear lab. North Shore is one of the very few places on Long Island that has this lab.  This lab relies on the principle that if insufficient tears are produced they will be more concentrated. A very small aliquot of tears is collected and the osmolarity of this sample is then determined. If the osmolarity is high, i.e. greater than 308 most people will be found to have the symptoms and signs mentioned above of dry eyes.

The tears are made of three principal layers.  The innermost layer is known as the mucinous layer and is produced by goblet cells found on the surface of the eye.  This has been found to be an essential component of the tears as it is responsible for keeping the tears adherent to the surface of your eye by reducing the surface tension of the tears.  Age and trauma as with contact lenses or surgery can damage goblet cells.  Cyclosporine, known as Restasis has been shown to effectively increase the goblet cell population.  The middle layer of the eyes is the watery or aqueous layer produced by the lacrimal gland which can be affected by autoimmune diseases such Lupus, rheumatoid arthritis, and Sjogren's disease.  Immune modulators including steroid drops and cyclosporine drops can help with this problem.  Punctum plugs that reduce the outflow of tears from the lids and eye as well as ocular lubricants are also helpful.  Lastly the outer layer or oily layer is responsible for keeping the tears from evaporating too quickly from your eyes.  This layer is produced be the meibomian glands found behind your lashes.  When these glands become dysfunctional they can be restored to normalcy using warm compresses and sometimes steroid drops or antibiotics taken orally or topically.

As you can see the diagnosis and treatment for this problem can be quite involved.  If you think you may be suffering from this problem we invite you to visit one of our offices either in Smithtown or are soon to be opened office in Riverhead for a personal consultation and exam.