Chronic Dry Eye syndrome, or keratoconjunctivitis sicca (KCS), is one of the most common eye conditions affecting 15-20% of American adults. While most cases aren’t severe, even a mild case can cause a significant amount of discomfort and threaten overall ocular health. Though we are developing a greater understanding of tear film production, experts continue to be uncertain as to the underlying cause of KCS. There are, however, various courses of treatment that can be explored to offer relief for the affected patient.
Tears are more than just water. The tear film consists of a unique balance of proteins, waxy and cholesterol esters, and a solution of water, electrolytes, lysozyme, prealbumin, lactoferrin, and immunoglobulin A. These components comprise the mucin, lipid, and aqueous layers respectively. All of these must be in an ideal balance in order for tears to do their job of lubricating and protecting the ocular surface. An imbalance is typically referred to as a “tear film insufficiency” and can actually contribute to excessive tearing. In cases of an insufficient tear film, tears are produced, do not remain on the ocular surface, and run down the cheeks. This leaves the eyes dry and irritated which triggers the body’s natural response to produce more tears. Often times, a wet eye is a dry eye!
Irritation is the most common complaint among dry eye sufferers and usually the first to arise at onset. Typically, patients describe a foreign body sensation that feels as though there is sand, an eyelash, or a dirty contact in the eye. Stinging and burning sensations or increased light sensitivity are not unheard of, either, especially in more severe cases. Symptoms often worsen in aggravating environments such as dry heat, warm or smoky rooms/areas, or with wind exposure.
Diagnosing KCS usually involves simple testing in an ophthalmic setting. Vital dye stains (rose Bengal or lissamine green) are formulated specifically to indicate both dry and devitalized epithelial cells (the topmost layer of the cornea) and mucous by highlighting abnormal changes in the ocular surface. Providers will also often assess tear break-up time (BUT) to determine the stability of the tear film by measuring how long it takes for the uninterrupted tear film to disperse across the ocular surface. In KCS patients, this happens more quickly. Schirmer Tear Tests are also used to determine tear production by measuring tear flow with strips of litmus paper over a period of five minutes.
Though there is no cure, fortunately for KCS sufferers, there are a variety of different treatment options to help ease discomfort. First and foremost are artificial tears (lubricating agents available in drops, liquigels, or ointments), which supplement whatever components the tear film is lacking. These are available over the counter and are likely to be something KCS patients are long-familiar with. Supplements or foods rich in Omega-3s are also highly recommended to fortify tear film from the inside out. By the time most patients reach Cornea Associates, they have already exhausted most over the counter treatments and look to prescriptions. Other topical treatments include Cyclosporin A, an FDA-approved pharmaceutical drop clinically proved to reduce inflammation and improve comfort; and autologous serum drops, which are produced from the patient’s own blood to provide optimum nutrients and natural anti-inflammatory components. Both of these have been clinically proven to better patient comfort. Ocular aids can also be used to treat KCS, the most common of these are punctual plugs and special contacts lenses. The former are made typically made of collagen or silicone and are inserted into the upper and/or lower puncta like a stopper in a drain to keep tears from evacuating the eye so easily. The latter, likely the PROSE (Prosthetic Reconstruction of the Ocular Surface Ecosystem) lens, are scleral contact lenses designed specifically to bathe the cornea constantly by acting as a saline solution-filled reservoir over the majority of the ocular surface.
Consulting with your optometrist or ophthalmologist on a regular basis is always recommended, but is absolutely essential for patients with active ocular conditions, such as KCS. Your provider is the best person to assess your condition and render the best available treatment. They may even be able to offer solutions you’d never known possible (like eye drops rendered from your own blood!) or detect etiologies you may have never thought of (who would’ve guessed long lashes could impact your dry eyes?- click here to see a video about this), so make a point to add a visit to your eye doctor as a part of your regular healthcare routine.