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Dry Eye

The lacrimal glands and glands in the eyelids produce the tear film.This tear film is very essential for lubricating the ocular surface and protecting it by washing away harmful substances. It is produced continuously, without us realizing it!
The tears we shed on being extremely happy or sad are "emotional tears”. These are different in composition from our regular lubricating tears and are of no use as far as properly wetting the ocular surface is concerned!
Hence we may shed copious tears and yet be diagnosed by the eye surgeon as having a ‘dry eye’!

What is dry eye?

Normally, the eye constantly bathes itself in tears. By producing tears at a slow and steady rate, the eye stays moist and comfortable. Sometimes people do not produce enough tears or the appropriate quality of tears to keep their eyes healthy and comfortable. This condition is known as dry eye.

Causes of DRY EYE

• Tear production as well as quality of tears decreases as AGE ADVANCES
• Menopause and pregnancy can cause decrease in tear production.
• Staring continuously at the computer screen results in reduction of normal blinking. This causes dry eye as more tears evaporate from the surface of the eye and the tears are not spread evenly across the ocular surface due to inadequate blinking.
• Sjogrens Syndrome which have dryeyes, dry mouth and arthritis
• Prolonged use of contact lenses can sometimes result in dry eye.
• drugs such as antihistaminics (taken for common colds), antacids, anti-hypertensives, anti-depressants can cause drop in tear production.
• Certain environments contribute greatly to dry eye, such as windy, dusty, dry climates and atmospheric pollution.
Also, overuse of air-conditioners (most likely in most parts of India) causes the room air to become dry, promoting evaporation of our tears.

Symptoms of dry eye

The usual symptoms include:
• Stinging or burning eyes;
• irritation;
• itching
• Stringy mucus in or around the eyes;
• Excessive eye irritation from smoke or wind;
• Excess tearing; - Reflex

What is the tear film?
When you blink, a film of tears spreads over the eye, making the surface of the eye smooth and clear. Without this tear film, good vision would not be possible.

The tear film consists of three layers:

1. An oily layer-produced by the meibomian glands, forms the outermost surface of the tear film. Its main purpose is to reduce evaporation of tears.
2. A watery layer- This layer, produced by the lacrimal gland, cleanses the eye and washes away foreign particles or irritants
3. A layer of mucus- The inner layer consists of mucus produces by the conjunctiva. Mucus allows the tear film to bind to the surface of the eye and helps the eye remain moist.

How is it Diagnosed


Preferably preservative free tear substitutes should be used. Frequency of drops depends on the severity of condition, can be put as frequent as 1 hourly also.

In some cases however, the eye surgeon may advise blockage of the tear drainage ducts so as to preserve the patient’s own tears in the eye for a longer time as well as to lessen the frequency required of instilling tear-substitutes. There are various types of ‘plugs’ available in the market. Chiefly, they are of 2 styles–

a) ‘punctum’ plugs, which are inserted into the tiny openings in the upper and lower lids through which our tears drain and remain visible on the surface of the lid

b) canalicular plugs, which are inserted through the puncti into the drainage pathway and are therefore not visible to the naked eye once inserted. Both these types are inserted in an easy, no injection technique and can even be inserted in the eye surgeon’s office using only eye drop anaesthesia.

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