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Dry Eyes

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Dry Eyes


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Dry eyes
Dry eyes, also known as keratoconjunctivitis sicca, is a condition that occurs when too few tears are produced to lubricate the eyes. The eyes become irritated, creating a feeling that there is something in the eye, particularly when blinking. Dry eye syndrome tends to develop in people over the age of 60, women being affected more often than men.
Each time someone blinks, the eye is coated with a film of tears that helps keep the surface of the eye smooth and ensure good, clear vision. This film of tears is made up of three layers. One is an oily outer layer produced by glands in the eyelids. This layer helps to stop fluid evaporating from the eye. Another is a watery middle layer produced by the tear (lacrimal) gland. This layer of tears cleans the eye and washes out any foreign particles. The third is an inner layer of mucus produced by the conjunctiva, the thin lining inside the eyelid. This layer helps tears to spread evenly across the eye. As a person get older, the glands producing the tear film layers start to deteriorate and the eyes gradually lose their natural lubrication. Women especially suffer from dry eyes as a result of ageing and it can also be one of the symptoms of the menopause.

There are also a number of conditions that cause dry eyes. People with Sjogren’s syndrome, an inflammatory disorder affecting certain glands in the body, may suffer from dry eyes, as well as a drying out of other normal secretions such as saliva in the mouth. People with rheumatoid arthritis may suffer from this syndrome in particular and dry eyes in general. The environment can also cause short-term dry eye conditions. Particular culprits are windy days or air conditioning in offices and aeroplanes and central heating in the home. These lower the moisture levels in the air leading to evaporation of tears and causing dry eyes. Staring at a computer for long periods at a time can also dry out the eyes because when looking at a screen there is a tendency to blink less frequently. Some tablets such as antihistamines and travel sickness tablets can inhibit tear secretion and lead to dry eyes.
People with a long-term dry eye condition rarely feel that their eyes are actually 'dry'. Instead they will feel irritation, burning, scratchiness and a sensation that there is something in their eye. Their vision may also be blurred and they may get mucus discharge from their eyes. In severe cases, blinking may even be painful. If left untreated, there is an increased risk of eye infections and of developing ulcers on the cornea.
The aim of treatment is to relieve discomfort and prevent damage to the front of the eye (the cornea). Artificial tear eye drops containing hypromellose, carbomer, polyvinyl alcohol and other lubricating agents can be bought from the pharmacy or prescribed by a doctor. These have preservatives to help stop germs (bacteria and viruses) growing in them and it means they are safe to use for a month after opening. However, some people can not tolerate the preservative so they will need single-dose vials which do not need a preservative. Lubricant ointments are best used at bed time as the ointment can blur vision. Women who experience dry eyes during the menopause may benefit from hormone replacement therapy prescribed by a doctor. If the condition is severe and is not helped by treatments, surgery may be an option. This is a minor operation and involves permanently shutting off the tear drainage holes in the eyelids so that the tears stay in the eyes longer.
When to see your pharmacist
Artificial tear eye drops containing hypromellose, carbomer, polyvinyl alcohol and other lubricating agents can be bought from the pharmacy without a prescription. If you find that your eyes become irritated by any of these products, talk to your pharmacist. You may be experiencing a reaction to a preservative and the pharmacist will be able to recommend another product that contains a different preservative or will suggest that you use single-use drops which are preservative free. Preservative-free eye drops are particularly recommended if you wear contact lenses.

Let your pharmacist know what medicines you are taking as these may be the cause of your dry eyes.
When to see your doctor
If over-the-counter eye drops have not helped and the problem has been ongoing, see your doctor. The doctor can do a series of tests to find out the cause and type of dry eye condition you have and recommend a suitable treatment. If you are suffering from dry eyes and have rheumatoid arthritis, or are going through the menopause, see your doctor.
Living with dry eyes
Try not to let your dry eyes restrict the things that you do. It is a matter of achieving a balance between coping with the pain of dry eyes and continuing everyday activities. Carry your artificial eye drops with you or keep another bottle at your place of work. If you forget your drops, buy more from your pharmacy, do not wait until you return home. Tell your pharmacist, doctor or optician if the drops are no longer effective.

Wear wrap-around glasses or sun glasses when outside to reduce glare and to reduce evaporation of the tear film.

Explain to friends and relatives that you have dry eyes. That way they will not find it strange if you want to close your eyes to rest them and they will understand when you say that you prefer to avoid dry or smoky environments.

In the workplace, talk to your employer or health and safety officer about the lighting and ventilation in the area you work. If you use a computer regularly, ask for a filter that helps cut down reflection, and get someone to check that your computer screen is set up in the right position and is not too bright. Periodically, look away from your computer screen and focus on a distant object. Take regular breaks away from your computer.
Advice for carers
If you care for someone with dry eyes who needs help putting drops or ointment in the eye, learn to apply the preparations properly. Your pharmacist is always available to provide advice if you need it.

When putting drops in someone else’s eye, it is easier if the person lies on their back or, if capable, tilts the head back. Pull the lower eye lid down with the index finger of one hand to create a pocket below the eye. With the other hand, bring the eye dropper close to the eye over the eye pocket. Place the other fingers of this hand on the nose, for balance and to avoid touching the eye with the dropper. Squeeze the eye dropper gently allowing a drop to fall into the eye pocket. Count out the required number of drops. Release the lower eye lid and ask the person to close their eye gently. If necessary, gentle pressure can be placed in the corner of the eye near the nose to prevent the drops from running out of the eye. Repeat the procedure for the other eye, if both eyes are affected. If you need to administer more than 1 type of eye drop, wait 10 minutes between giving each type.

When putting ointment in someone else’s eye, it is usually best to do it at bed time to avoid disturbing the person’s vision. Pull the lower eye lid down with the index finger of one hand to create a pocket below the eye. With the other hand, bring the tube of eye ointment close to the eye over the eye pocket. Point the tube towards the corner of the eye near the nose. While gently squeezing the tube move it to allow about a centimetre of ointment to emerge as a thin line along the inside of the lower eye lid. Release the lower eye lid and ask the person to close their eye gently. Repeat the procedure for the other eye, if both eyes are affected. ¬†Avoid touching the eyes or eye lids with the tip of the tube.
Useful Tips
  • Blink consciously when doing close or continuous work (e.g. at computer) - blink fully with the whole lid shut
  • Close eyes for a few seconds from time to time to give them a rest
  • Use a humidifier to reduce the dry atmosphere in the office and home
  • Avoid car heaters, particularly at face level
  • Sit away from direct heat such as gas or electric fires
  • Use lubricating eye drops when doing activities that can dry the eyes, e.g. watching television, reading, sewing and writing
  • Avoid smoky atmospheres

Based on information supplied by: Royal National Institute for the Blind (RNIB)
Helpline: 0303 123 9999