Dry Eye/Punctal Plugs
Dry eye is a condition that affects a large number of us. Initially,
dry eye may be a relatively minor problem, but it can cause serious
difficulty for some of us. Dry eye may begin at any age, and tends
to get worse as we get older.
(See Photo).
Symptoms caused by dry eye can include burning, irritation, and
itching, as well as tearing or watering eyes. You might not expect
tearing to be a problem in patients with dry eye. This paradoxical
symptom is related to an abnormal tear film or a tear layer
insufficiency. The surface of the eye is dry and sends a signal to
the brain to secrete more tears and moisturize the cornea. However,
the tears that are secreted by the lacrimal (tear) gland may be of
poor quality and not moisten the eye surface in the way that they
should.
Other dry eye symptoms may include eye pain or blurred vision. One
clue that blurred vision is due to dry eye is that it clears
temporarily after blinking. Dry eye symptoms can be especially
troublesome while reading, watching TV, and working on the computer.
Symptoms tend to be worse on windy days and during the winter months
due to dry indoor heat.
In general, artificial tears remain the mainstay of treatment for
dry eye symptoms. There are many brands of artificial tears
available and they vary in their composition, active ingredients,
preservatives, etc. Patients with severe dry eyes are usually
prescribed preservative-free artificial tears to reduce side effects
such as toxicity that can develop when the tears are used more
frequently. Sometimes thicker eye gels are prescribed for severe dry
eye, in order to provide longer lasting lubrication. Dry eye
ointments may be appropriate for people who need additional
lubrication at night.
If the eye is still too dry, then a procedure can be done to block
the system of canals (lacrimal system) that normally drain the tears
away from the surface of the eye. This is the equivalent of putting
a plug in the drain of the sink. Temporary collagen or
longer-lasting plastic punctal plugs are placed in any of the
four punctae (openings that lead into the lacrimal system) to hold
natural or artificial tears on the surface of the eye longer. If
permanent closure of the lacrimal puncate is needed, then a surgical
procedure to cauterize the punctae may be performed.
Severe dry eye can cause damage and scarring of the surface of the
eye. For these patients, eye medications may be necessary to reduce
the surface damage and scarring. Drugs that suppress the body's
natural defenses like steroids or immunosuppressants such as
cyclosporine can be applied in drop form to reduce surface
inflammation.
Dry eye may develop on its own, or it may result from other
problems. Such problems include abnormalities of the eyelids or poor
eyelid closure, general health problems or medications used to treat
these problems, or environmental factors such as air conditioning,
humidity and smoke.
The management of dry eye can vary significantly from patient to
patient and we have more treatment choices than ever before. Consult
your eye doctor to determine what treatment program will be the most
appropriate for you.
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