There are three layers to the tear film – the water layer (keeps everything wet), the mucous layer (holds the water on the eye) and the oil layer (keeps the water from evaporating). A problem with any of these layers can cause dry eye, or, ironically, can cause the eyes to water. Treatment for dry eye depends on which layer(s) is causing the problem.
Take this Dry Eye Questionnaire to help us evaluate the severity of your dry eye! (This form can also be used for tracking, to make sure any treatment we design for you is working.)
If you suspect you have dry (or excessively wet) eyes, and would like to develop a treatment plan, contact us for a Dry Eye Workup.
Meibomian Gland Dysfunction (oil-layer deficiency)
responsible for 85% of all dry eye cases
The meibomian (my-BOH-mee-an) glands line the upper and lower eyelids. They are responsible for producing the oil layer of the tear film, to prevent it from evaporating too quickly. There are approximately 25 oil glands on the lower lid and 30 glands on the upper lid of each eye. Ideally when we blink, a small amount of olive-oil consistency oil is excreted into our tear film. When these glands become inflamed or clogged, the oil congeals in the glands, becoming more butter-consistency.
Symptoms of MGD include the persistent need to rub the eyes to see better. If the water portion of the tear film evaporates too quickly, it can also stimulate the lacrimal gland to produce more of the water portion of the tears, leading to eyes that water excessively.
MGD has been found to be more prevalent in those who spend lots of time looking at devices (computers, phones, tablets, etc.) due to the decreased blink rate that these devices cause.
Aqueous deficiency (water-layer deficiency)
responsible for approximately 15% of all dry eye cases
When the lacrimal gland fails to produce enough tears to thoroughly coat the surface of the eye, aqueous deficient dry eye occurs. Several problems happen when we do not have enough water in the tear film – the front of the eye gets dry and “chapped” (just like our lips get chapped when they are dry), which can cause excess watering, itching, burning or redness. If there is not enough water in the tears, the tears can become hyperosomotic, or salty, and can cause irritation, watering and redness.
Aqueous deficiency is more common in the older population, women, and people with certain autoimmune conditions such as Sjogren’s.
Some medications can also cause dry eye, such as antihistamines, acne medications, blood pressure pills, or hormone replacements.
There are several over-the-counter artificial tears designed to address various types of dry eye. Doctor Darnell recommends patients avoid any drops that “get the red out” for multiple reasons. First off, those drops constrict the blood vessels that provide nutrients to the front of the eyes, thus starving the eyes for oxygen, promoting inflammation and dryness, and ultimately making the problem worse. Secondly, if your eye doctor is trying to assess the severity of your dry eye, drops that mask the redness can make an accurate assessment challenging.
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Wednesday 9:00 A.M. – 6:00 P.M.
Friday 9:00 A.M. – 6:00 P.M.