Due to the dry, windy conditions and particulate-type pollution in Colorado, most patients have “dry eye syndrome”.  Excessive reading and long-term computer use tend to aggravate this condition, as does indoor pollution common to high-rise office buildings.

 

The tear film is composed of three layers.  First, there is a mucous base that allows the water of the tear to adhere to the hydrophobic cornea.  The next and thickest layer is the watery aqueous. The outer layer is an oil film that prevents evaporation and stops the tears from spilling over the lid.  In addition to proper balance of the three layers and sufficient tear volume, proper lid closure both during sleep and during routine blinking is necessary to spread the tear film over the entire eye.

 

For patients with red eyes, drops that “get the red out” may be needed for those suffering from allergies.  But the same neurotransmitters that blanch the blood vessels also decrease tear production, thus aggravating dry eyes.  These drops should never be used while wearing contact lenses.  

 

For redness caused by dry eyes, artificial tears should be used.  One very effective product is Refresh Celluvisc by Allergen.  Since its thickness blurs the vision, it is best used only at night, just before going to bed.  The thickness helps the drops work longer than regular artificial tears.

 

In cases of severe dryness it may be necessary to plug the drainage holes causing a greater volume of tear in the eye. This procedure, called lacrimal occlusion, keeps vision from blurring or contacts from drying.  It can be performed in the office. Another treatment is Restasis eye drops. It is an anti-rejection, prescription drug. It is the only drug known to increase tear production.

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Two things that patients can do to treat dry eyes without drops or lacrimal occlusion are forced blinking and lid massages. Especially effective for dryness caused by extended computer use, forced blinking aids eyeball lubrication by holding the head straight but shifting the gaze of the eyes to one side and forcefully squeezing the lids shut. This forces extra fluid into the eye, and spreads the tear film completely across the entire surface of the eye. 

 

Lid massages and lid scrubs are daily hygiene habits that could eliminate dry eye symptoms for most patients.  The miebomium glands run deep within the lids and open where the skin of the outer lid meets the mucus of the inner lid.  Although special “lid scrub kits” are available in the drug store, lid hygiene can be easily performed in the shower. 

 

Start by closing the eyes and moving the face into the shower stream.  The warm moisture will soften the plugs at the opening of the glands.  Remember to keep the eyes closed, because tap water will irritate the eyes, and is not sterile.  Draw the head back out of the water. With the eyes open, look up and press the lower lid against the eyeball.  Press firmly across the width of the lid.  If the pressure is too great, the vision will temporarily black out. But do squeeze almost that hard.  This forces the plugs out of the gland opening and restores the free-flowing clear tear fluid.  Now the plugs and ‘fermented’ fluid is coating the base of the eyelashes.  So close the eyes and move the face back into the shower stream. Wrap a washcloth around a finger and scrub the lashes while the water washes over the face. This will rinse away the residue.  Doing this procedure on a routine basis will make the eyes feel better, improve contact lens wearability, and decrease redness without drops.

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