Ocular surface disease is the preferred name because many people with “dry eyes” have symptoms of tearing. Other symptoms include: burning, stinging, redness, irritation, blurred vision, inability to wear contacts comfortably, foreign body sensation, and in severe cases, corneal breakdown, with scaring.
This condition is more common with advancing age but can occur in youth and in both sexes. The tear film actually consists of:
- a mucous coat on the eye secreted by cells in the conjunctiva
- lacrimal fluid excreted by the lacrimal gland
- an oil layer excreted by oil glands on the lid margins.
A defect in any or all of the above, results in ocular surface disease, and that is why some therapies may vary.
Causes can be aging, hormonal changes, auto-immune disease, lack of sensation, medications, chemical or thermal ocular injuries, poor blinking, and other rare conditions or past infections.
Therapy usually starts with artificial tears used 4-6 times daily or as needed. Some people can develop or have sensitivity to the preservatives used to prevent contamination and that is why preservative free artificial tears are also available. There are many over the counter artificial tears, gels, and ointments which can be tried. If replacement tears are not effective, closing the outflow of tears in the nasal corner of the lids either by plugs or surgical closure can be very effective. Some people who have an auto-immune cause are better after using Restasis, (which works by immuno-suppression) but it must be taken for two months before the result is appreciated.
A condition known as BLEPHARITIS which is an inflammation or infection of the oil glands of the lid can exacerbate symptoms and may need to be treated also. Usually that consists of lid hygiene, sometimes antibiotics, and hot and cold compresses.
If a local area of oil glands are occluded, and CHALAZION results which is a large swollen area on the eyelid margin that may form a white or yellow “head” on the outside or inside of the lid. This can swell up quite quickly and turn red. In its early development and chalazion responds well to hot and cold compresses, if it is chronic a steroid injection or surgical removal may by indicated. In the chronic phase it feels like a round ball in the lid when felt by fingertip.