Dry Eye Symptoms and Treatment

For us to see clearly, and have a comfortable eye, it is not enough for the eye itself to be healthy. We must also have an excellent tear film. The tear film forms a thin protective layer over the surface of the eye.

If we are not making enough tears, or not holding them in place, this glassy layer begins to break down and evaporate. In early stages this can produce visual blur. It may feel like your eyes are “tired” and need to be closed. The eye does not like to be dry and you may experience burning or stinging.

The tear film is not a single layer, but a mix of secretions from multiple glands. Primarily these are the lacrimal gland, located under the bone in the upper, outer corner of our eyes, and the Meibomian glands or oil glands, located in our eyelids themselves. In figuring out the cause of dry eye it is often helpful to consider which of these glands is not working properly.

The lacrimal gland is under neural control. It creates the watery component of our tear film- the major part and what most of us think of when we describe tears. The function of the lacrimal gland can be reduced by many different medications, infections or autoimmune disease. As part of understanding a patient’s dry eye and the health of their lacrimal gland, a complete drug history and medical history is necessary.

The Meibomian glands make a product that is not unlike olive oil when we are young. The job of this oil is to coat the watery layer of our tear film so that it does not evaporate. When the meibomian glands are healthy, we can tolerate staring, wind rushing onto our eyes or air conditioning without our tears evaporating and our eyes feeling dry.

As we age it is very common for these glands to secrete a thicker product and become blocked or dysfunctional. As this occurs we feel more sensitive to wind and air conditioning.

The brain may respond by triggering more lacrimal gland secretion, leading patients to describe my eye often waters when I am outside. Strategies that improve Meibomian gland secretion often employ a combination of heat to melt the thickened oil and massage to express it onto the ocular surface.

Treating your dry eye may require a review of medication, topping up lacrimal gland secretion with drop, treating systemic medical conditions, helping the Meibomian glands or a combination of all the above.

If you would like more information about laser refractive procedures, please don’t hesitate to reach out to your local optician or ophthalmologist.

Presenter: Dr. Greg Moloney, Ophthalmologist, Vancouver, BC

Local Practitioners: Ophthalmologist