“Heaven knows we need never be ashamed of our tears, for they are rain upon the blinding dust of earth, overlying our hard hearts,” said Charles Dickens in his book, ‘Great Expectations’. Indeed, not only that; we also need to be thankful to our tears. For without them...
Tears are a complex mixture of fatty oils, water, proteins and electrolytes. The surface of your eyes are normally nourished, protected and lubricated by tears. In the dry eyes syndrome, your eyes aren’t able to provide adequate moisture either because of poor quality or insufficient tears.
·Poor Quality of tears:
For some people, the cause is an imbalance in the any of the three components of a tear film viz. oil, mucus or water.
Oil: This outermost layer prevents the evaporation of the water layer. This is produced by glands on the edge of your eyelids called Meibomian glands. If you suffer from conditions like Inflammation of the eyelids (Blepharitis) or other skin disorders like rosacea, your glands get clogged up or the oil is broken down by bacteria. This leads to inadequate oil layer production which causes dry eyes.
Water: This middle layer is salty water which is produced by the tear glands called lacrimal glands. This layer washes away any foreign particles and cleanses your eyes. If water is inadequate, the oil and mucus layers touch each other causing a sticky discharge.
Mucus: This innermost layer helps spread the tear film evenly over your eye. A lack of mucus causes dry spots to be formed on your cornea (transparent front surface of your eye).
·Less Quantity of tears:
This is medically known as keratoconjunctivitis sicca. It may be seen in:
Ages above 50 years: Tear production decreases as part of the natural aging process.
Postmenopausal Women: Hormonal changes may be the cause.
Diseases like: Diabetes, Rheumatoid Arthritis, Sjogren’s Syndrome, Lupus, Thyroid Diseases, Scleroderma and Vitamin A Deficiency.
History of having a Laser eye surgery: It is usually temporary.
Damage to your tear glands: Radiation or Inflammation can damage your glands and reduce your tears.
Entropion (In-turning of eyelids) or Ectropion (Out-ward turning of eyelids), Stroke or Bell’s Palsy which causes a difficulty in blinking may affect you. These hamper the adequate distribution of the tear film causing dry eyes.
Certain medications like some blood pressure, anti-allergy, birth control pills, anti-depressant medicines also lead to dry eyes.
·Apart from the above, wind, dry climate, high altitudes and continuous staring at the computer, TV or books also causes dry eyes.
·Stinging or burning or scratchy sensation in your eyes
·Mucus in or around your eyes
·Increased light sensitivity
·Blurry vision which worsens towards evening or after prolonged periods
·Fatigue in your eyes even after short spells of reading
·Increased sensitivity or irritation due to smoke or wind
·Intermittent reflex excessive tearing
Schirmer Test: Using blotting paper strips, the volume of your tears is measured.
Special dyes in eye drops can be used to determine the quality of your tears
The osmolarity or salt content of your tears may be measured.
Blood tests for auto-immune diseases
·Treating the underlying cause:
This is essential. If a medication is the culprit, it’s substitute is prescribed. If it is an auto-immune condition, you will be referred to the relevant doctor. If it is an anatomic deformity that obscures with your blinking, you may be referred to a plastic surgeon of the eye.
Antibiotics or steroids to decrease the inflammation and eye inserts that release artificial tears may be prescribed.
Over the counter artificial eye drops and ointments can be used in mild cases.
·Plugging tear ducts:
Tear ducts may be plugged to prevent your tears from leaving your eyes too quickly. Silicone plugs or thermal cautery may be used to do this. This may be temporary or permanent.
·Helping you close your eyelids:
This is done by Lateral Tarsorrhaphy in which the outer one third of your eyelids are sewn together.
·Special contact lenses:
Certain contact lenses help form a shield over your eye and trap the moisture in. These are called corneal shields or bandage lenses.
Increased risk of eye infections due to the lost protective cover of the tear film
Inflammation leading to corneal scarring, ulcers and vision problems
·Use eye glass shields at the top and sides of your glasses to block wind and dry air in case of situations like windy days and while swimming (to protect against chemicals).
·Use humidifiers to dampen dry indoor air in winters
·Avoid directing hair dryers, air conditioners, fans or car heaters in your eyes
·Take regular eye breaks during long reading tasks or while using the computers
·Position your computer screen below your eye level so that you avoid opening your eyes too wide. This will help slow your tear evaporation rate
·Use nutritional supplements containing essential fatty acids
·Drink plenty of water
No one could sum it up better than Hans Christian Andersen in his classic, ‘The Little Mermaid’, “But a mermaid has no tears, and therefore she suffers so much more.”