Dry, Wet, Sticky Eyes
By Dr. Latif Hamed, MD, FAAO, MBA
Former Tenured Professor of Ophthalmology, UF College of Medicine
What if I told you that dry eyes, wet eyes, and sticky eyes are different facets of the same disorder? Wait! How can dry be the same as wet eyes? As Ricky would say to Lucy in "I Love Lucy," let me esplain."
The eyes are coated with a very complex film of tears that contains numerous ingredients in precise proportions including water, oils proteins, antibodies, enzymes, and other molecules and substances at a precise pH. So at the outset, we have to surrender the concept that tears are a simple water solution.
Why do we need tears?
The tears coat and protect the surface of very precious cargo. The outer most layer of the eye, the conjunctiva and the surface of the cornea are in direct contact with the environment. The cornea is not just a clear barrier between the contents of the eye and the outside world, it is actually the stronger of the two natural lenses that bend incoming light to torm a crisp image on the retina. The crystalline lens (the one replaced in cataract surgery) is hidden inside the eye and is not exposed to the elements, but the more vulnerable cornea is in direct contact with the elements. It can easily become dry, scratched, infected, or injured. The complex tear film is needed to keep the cornea smooth and free of scratches, as well as to fight potential germs. In addition, the upper and lower lids, just like windshield wipers, rewet the cornea with every blink to keep it moist and dear.
Where do tears come from?
There are basically three different types of glands on and around the eye. The lacrimal gland in the eye socket secretes water, the meibo-mian glands at the eyelid margin secrete oils, and the goblet cells on the eye surface supply proteins. Different conditions can affect one type of gland but not the other, leading to a disturbance in the proper mix of tears. Some patients with very watery eyes may be surprised to learn from their eye doctors that they have dry eye. This is actually very common. If the oil and protein glands dry up, the water gland tries to compensate by pumping more water onto the surface of the eye, making the eyes more teary. The solution to this problem is not to add more water to the eye but rather to replenish the missing oil and proteins. By contrast, patients with Sjogren syndrome, wherein the water gland is not working properly, have eyes that are bone dry.
Patients with oil gland or protein gland dysfunction have impaired immune defenses against invading germs and may develop puralent conjunctival infections. Wet, dry, or sticky, all these eyes have "dry eye syndrome" and may be very irritating to the owner.
In medicine, making a precise diagnosis is vital to intelligent treatment. This is the reason we obtain a medical history, perform a physical examination, order laboratory tests and imaging studies and obtain biopsies. Once a precise cause is identified, a specific treatment can be tailored to the patient, instead of using a "shotgun" approach wherein you throw a bunch of things at the problem in the hope that it may go away. This approach has governed the way we deal with dry eyes for a long time: it is crude, imprecise, and often ineffective. "You have dry eyes so take these wetting drops and call me in the morning." Not anymore, or as the old cigarette commercial used to say, "You've come a long way, baby?"
The future of dry eye is in tailoring the treatment to the underlying cause. Ideally, we will be able to revive the various malfunctioning glands so that they can supply their specific ingredients without the need for lubricating eye drops. Science is making some headway in this arena with various eye drops like Restasis, Xiidra, and Cequa, with others in the pipeline. In the meantime, we can attempt to replenish the missing tears by supplementing with eye drops that restore the quantity and quality of the tear film. Knowing the underlying pathology helps in selecting a proper tear supplement that suits a
Now we know that the tear film lubricates and protects the surface of the eye. What about the condition of the surface of the eye itself? To use a skin analogy, you can rub the best moisturizers on your skin, but if the skin is damaged due to excessive exposure to sun and chemicals and the elements, then that limits the skin's performance. In a similar manner, the health of the actual sur face of the eye is vital for how our eyes feel and perform. Similar to the skin, excessive exposure to the sun, chemicals, dust, germs and other factors damages the surface of the eye over time, which is a separate and distinct reason for the emergence of the symptoms of dry eye, independent of whether the eyes are well lubricated or not.
In other words, no amount of lubrication is going to make a scarred eye surface feel and perform well. What does this translate to from a practical standpoint? I recommend protecting the eyes from noxious factors by wearing sunglasses and avoiding chemical fumes and other harmful exposures in order to maintain a healthy eye surface.
Do it as early in life as you can, and do it consistently. Start now.
Homeopathically, there are sorne recipes that may help dry eyes that are sale and practically tree. Keeping the eyelashes clean and free of bacteria and accumulated mascara by washing with baby shampoo can help keep the pores of the oil glands open. Redirect the air flow from car air conditioners away from the eyes and avoid sleeping under. Some people, unbeknown to them, sleep with their eyes lightly open and for those, wearing sleeping masks or applying lubricating ointment at bedtime can help. If you are finding yourself taking lubricating drops numerous times a day without reliet, remember that less is sometimes better than more. You may consider backing off the eye drops some or taking a drop-free vacation for a couple of days to see how you feel, and substitute your eye drops with preservative free ones because the preservatives in the bottled eye drops can make the symptoms of dry eye worse rather than improve them, Why should ayone use preserved eye drops with their potential side effects instead of preservative-free, you may ask. Answer: cost.
Using warm compresses can help; the heat liquifies the solidified oil that may be plugging the ducts of the oil glands, allowing oil to flow.
Some uncooked rice placed in a thick (clean) athletic sock and heated in a microwave for 30 seconds is a good home-nade warm compress device. This is the principle behind the use of a laser device to heat the oil glands, a procedure that can run in the thousands of dollars.
I am not a big fan of using artificial lubricants liberally whether you need them or not for three reasons:
Most of the lubricants that come in a bottle contain chemical preservatives that may actually irritate the eyes and cause a problem in and of themselves. Using preservative-free lubricants in some patients is preferred.
Adding too much lubricant from a bottle may render your own glands lazy through a negative feedback loop, making you increasingly dependent on using eye drops.
Adding artificial tears washes away or dilutes the natural tears your glands make, which contain useful substances not present in artificial tears.
The syndrome of dry eyes can be likened to chronic pain. People with chronic pain may seek pain management and may become dependent on narcotics which exact a health cost in the long run. Depending entirely on external medication and removing the personal internal effort to heal may provide blunting of pain, but I hope we can agree it is less than ideal. Your homework, fellow readers, is to apply what I just said about pain management to dry eye syndrome.
Give it a try. I respect your intelligence.
Dr. Latif Hamed is located at 3230 SW 33rd Rd. Ocala, FL. 34474. For more information, call his office at 352-237-0090.
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