Each year, dry eye sends countless patients to the ophthalmologist seeking relief from burning sensations, discomfort, blurred or unstable vision — even stabbing eye pain.
“At a basic level, you can think of dry eye as a plumbing problem,” says Kavitha Sivaraman, M.D., a cornea specialist at Cincinnati Eye Institute (CEI). “It’s an imbalance between the rate at which tears are produced and how rapidly they are eliminated from the surface of the eye.”
The lacrimal glands that produces our tears are located in the upper outer corner of the orbit (the boney socket that holds the eye). They flow onto the eye and then out through a tear drainage system, the openings of which are in the inner corner of the upper and lower eyelids.
“In some folks, there can be an imbalance of those factors,” explains Sivaraman, noting that how quickly the tears are evaporated from the surface of the eye can also influence the tear film. This can be affected both by environmental/situational or biological factors. For instance, artificial heat in the winter creates dry air as does artificial air conditioning, which also sucks the moisture out of the eye. In addition, working outside in the cold or wind can make tears evaporate faster. In these cases, a patient may or may not have an actual deficiency of tear production, but the environment is wreaking havoc on the eyes nonetheless.
“Unstable vision can affect one’s ability to do things that require fine vision, like driving at night,” says Sivaraman.
Screen time is a likely culprit.
“Our lives revolve around screens these days and that can certainly exacerbate things because we are staring and not blinking,” says Sivaraman, who cites this as the most common complaint she hears. “People say, ‘I’m working at the computer and it starts out OK, but as my day goes on, my vision gets really blurry.’”
According to Sivaraman, when we look at a screen or focus on any near task, we naturally tend to blink less. That’s problematic.
“Blinking is nature’s windshield wipers, which distributes your tears over the surface of your cornea and helps maintain a normal tear film and normal focusing of the eye,” she explains.
Though dry eye can plague anyone, it can be associated with certain medications such as blood pressure meds, antidepressants or antihistamines. In addition, autoimmune diseases such as Sjögren syndrome commonly cause dry eye, and other conditions such as sleep apnea and thyroid eye disease can also be associated. Both sleep apnea and thyroid eye disease can be associated with eyelid malposition — if eyelids are not closing all the way during sleep, the eyes get dried out, leading to chronic burning and redness. On top of that, aging and hormonal changes cause tear production to decrease.
“In short, there can be wide variety of reasons you might find yourself with dry eyes,” says Sivaraman. “Each eye patient is a bit of a puzzle, so we’ve got to find out if their issue is due to age, tear production decline, lid malfunction or an issue with tears evaporating too quickly.”
There is also an oil component to the tear film that is secreted from tiny glands in the margins of the eyelid. When one of them gets clogged, t
his can result in what’s commonly known as a stye. Normally, those oils are secreted, creating a type of “oil slick” that prevents excessive evaporation or too rapid evaporation.
“We have to look at each patient to determine which component of each of these things is contributing to the dry eye, then ask how we can direct our treatment to address the biggest contributor,” says Sivaraman.
When it comes to treating dry eyes, the basic conventional treatment ophthalmologists typically start with are over-the-counter artificial tear replacements that are commercially and synthetically produced. Though they tend to work really well, sometimes they alone won’t fix the underlying issue that’s causing dry eye. If, for example, a patient is suffering from an eyelid malposition, they’ll be sent for an evaluation on how to correct it. If it’s a matter of clogged oil glands, ophthalmologists will prescribe treatment to unclog the glands and keep them flowing by following an eyelid hygiene regimen. If an ophthalmologist feels that tears simply need to stay in the eyes longer, they can put tiny silicone plugs into the tear drainage system. Finally, if a patient is not producing enough tears, they can be prescribed eye drops that help boost tear production and cut down on the inflammation to the ocular surface. Some doctors may prescribe Omega 3 fatty acid supplements to help with the oil layer of the tear film.
“Those are the gamut of the conventional treatments,” says Sivaraman. “Once we’ve exhausted those options, we have to start thinking outside the box.”
Often that involves autologous serum eye drops, tear replacement drops made out of a patient’s own blood.
CEI’s certified nurse practitioners (CNPs) draw blood from the patient and send it to CVP’s Northmark Pharmacy where it’s put into a centrifuge that separates the components of the blood. Pharmacists then make the drops from the blood’s serum component, dilute it with a sterile solution, and then patients apply it as eye drops several times a day in place of synthetic tears. Because it’s unique to the patient and is more similar in composition to the patient’s actual tears, it often produces great results.
“It doesn’t work for everybody, but there are people for whom they make a huge difference,” says Sivaraman. “This is because over-the- counter artificial tears are not going to have antibodies, growth factors, or the same enzymes your natural tears have and that serum tears also contain.”
These special treatments that can work when conventional treatments no longer do is one reason CEI is an excellent choice for patient care.
“We pride ourselves on doing the best for our patients,” says Sivaraman, noting that dry eye is a treatable, though typically not a curable, condition. “It’s something we do our best to control so that our patients can have far more good days than bad days, but it’s a journey and you want someone who is going to walk that journey with you.”
Cincinnati Eye Institute is a partner practice of CVP Physicians. There are 16 clinic locations in Greater Cincinnati. To make an appointment, visit cincinnatieye.com.