If you have chronically irritated and watery eyes, you’re not alone. Dry eye syndrome is one of the most common problems treated by ophthalmologists. It is usually caused by a problem with the quality of the tear film that lubricates the eyes. Fortunately, there are various methods of controlling dry eye syndrome. A number of treatment options are available to patients with dry eyes.

The Tear System

Tears are comprised of three layers. The mucus layer coats the cornea, the eye’s clear outer window, forming a foundation so the tear film can adhere to the eye. The middle aqueous layer provides moisture and supplies oxygen and other important nutrients to the cornea. This layer is made of 98 percent water along with small amounts of salt, proteins and other compounds. The outer lipid layer is an oily film that seals the tear film on the eye and helps to prevent evaporation.

In addition to lubricating the eye, tears are also produced as a reflex response to outside stimulus such as an injury or emotion. However, reflex tears do little to soothe a dry eye, which is why someone with watery eyes may still complain of irritation.

The commonest reason for dryness is simply the normal aging process. As we grow older, our bodies produce less oil – 60% less at age 65 then at age 18. This is more pronounced in women, who tend to have drier skin then men. The oil deficiency also affects the tear film. Without as much oil to seal the watery layer, the tear film evaporates much faster, leaving dry areas on the cornea. Many other factors, such as hot, dry or windy climates, high altitudes, air-conditioning and cigarette smoke also cause dry eyes. Many people also find their eyes become irritated when reading or working on a computer. Stopping periodically to rest and blink keeps the eyes more comfortable. Contact lens wearers may also suffer from dryness because the contacts absorb the tear film, causing proteins to form on the surface of the lens. Certain medications, thyroid conditions, vitamin A deficiency, and diseases such as Parkinson’s and Sjogren’s can also cause dryness.

Common symptoms are:

Itching

Burning

Irritation

Foriegn body sensation - 'feeling of something in the eye'

Redness

Blurred vision that improves with blinking

Excessive tearing

Increased discomfort after periods of reading, watching TV, or working on a computer.

Treatment

Most people who suffer from dry eyes find relief from using artificial tears on a regular basis. Some of these products are watery and alleviate the symptoms temporarily; others are thicker and adhere to the eye longer. Preservative-free tears are sometimes recommended because they have fewer additives that could potentially irritate. When choosing an artificial tear preparation it is often useful to try a few different brands. Patients often find that they are more comfortable with a particular brand of artificial tear preparation. Also, patients often find that a watery preparation is more useful during the daytime (eg Hypromellose or Sno-tears) as they do not cause blurring, but a thicker solution (eg Viscotears or Lacrilube) is useful before going to sleep as it provides a longer period of relief. All of these are available from a chemist without the need for a prescription, and are usually cheaper than the price of a NHS prescription. Commonly used preparations are -

Hypromellose

Sno-tears

Viscotears

Refresh*

Celluvisc*

Lacrilube*

Systane

Oxyal

(* these are preservative free)

If artificial tear preparations do not provide adequate relief it is useful to close the opening of the tear drain in the eyelid with special inserts called punctal plugs. This works like closing a sink drain with a stopper. These plugs trap the tears on the eye, keeping it moist. This can be done semi-permanently with a silicone plug which can be removed if required. By reducing drainage, more of your natural tears will remain in your eye to protect your vision and provide necessary nutrients to protect your eye.