BoomerGirl Diary

The winter solstice was approaching but I didn’t need to look at the Earth’s rotational axis relative to the sun to know the date. My work provided this answer instantly. As an ophthalmologist, the winter solstice signals increasing appointments for dry eye patients. The cold, windy weather with its low humidity wreaks havoc on people with dry eye syndrome, also known as "keratitis sicca."

Dry eye syndrome affects up to 60 million people in the United States and is one of the most common eye diseases treated. Women sufferers, particularly postmenopausal, outnumber their male counterparts two to one. Although there is not one specific cause for dry eye syndrome there are many contributing factors, such as hormonal imbalance, coexistent autoimmune disease, environment, medications (such as antihistamines) and age.

Symptoms include itching, burning, tearing (yes, more on this later) and a foreign body sensation. Surprisingly, redness is not usually present.

A normal tear film is made up of three layers. The first is a mucous produced by the conjunctiva (the clear covering over the sclera or white part of our eye). This mucous allows the tears to cover our eyes smoothly and uniformly. The second layer is a water, or aqueous, layer, made by the lacrimal gland, and it is this layer that is most commonly deficient in dry eyes. The final layer is the lipid or oily layer that acts as an “oil slick” and prevents the tears from evaporating too quickly. If production of any of these layers is low, dry eye symptoms occur.

As our eye becomes drier, it sends out a strong message to the lacrimal gland that may result in “reflex” tearing, hence the paradoxical symptom of tearing, or epiphora, with dry eyes. Our tear production naturally decreases as we age and is normally lower at the end of the day and in dark environments. We also blink less frequently when we are concentrating; therefore, it is not uncommon to have the most irritation from dry eye when we are reading at night or attending a movie or play in a dark theater. So what to do?

Mainstay treatment is artificial tears. The most common misconception is that a drop or two a day will solve the problem. If the eye is truly dry, the minimum treatment should include at least four drops per day of an over the counter tear. This is for starters and if it is helpful the dosage can be increased to hourly. If treatment is needed this frequently, non-preserved drops are recommended as the preservative in artificial tears may become irritating to the eye if used more than four times a day.

If artificial tears alone do not provide enough relief, adjunctive treatments such as Restasis or punctual plugs may be prescribed by your ophthalmologist. Restasis, an immunomodulating topical drop, acts as an anti-inflammatory to actually increase tear production. New research includes treatment with androgen, used as an eye drop, to improve tear production, especially in women, as hormone production decreases.

Although we can’t prevent yet another solstice from passing us by, there are effective and helpful treatments for dry eye syndrome.