There’s more to tears than crying. Sure, we may turn on the waterworks when we’re sad. But there are also “reflex tears” that wash away irritants to the eye.
And there’s a system of lubricating tears that’s there all the time, moisturizing and protecting the surface of the eye.
“Normal tearing is much more complex than most people realize,” says Dr. D.B. Thatcher, an ophthalmologist with Colorado Eye Associates in Colorado Springs, Colo.
Deficiencies in the quantity or quality of lubricating tears cause dry eye syndrome, one of the most common problems that eye doctors see. And with the graying of America, it’s becoming even more of a problem.
That’s because our tear production decreases as we age.
“By age 45, the average person has lost one-third of their tear-production capability,” says Dr. John Christiansen, another Colorado ophthalmologist.
“Chronic dry eye is an often unrecognized, unattended part of the aging process and is quickly becoming an important public-health issue, impacting both the quality of life as well as the physical health of nearly 10 million Americans each year,” warns a report issued this year by the National Eye Institute and other agencies.
Hormonal changes, as in menopause, can lead to chronic dry eye; women are affected by dry eye two to three times more than men. Dry eye also is a common side effect of LASIK eye surgery but usually is temporary.
Environmental conditions, such as wind and low humidity, can exacerbate dry eye.
SERIOUS HEALTH RISK
Mary O’Connor, 61, has been plagued by dry eye for about 40 years, but it has become more of a problem in the last decade.
“Allergies make it worse, certainly,” O’Connor says. “A lot of sun will make it worse.” At times, she says, it’s just a minor annoyance, but when it’s bad “it feels like sand in your eye.”
It’s more than an issue of comfort. Dry eye syndrome can cause blurred vision and leaves the eyes more susceptible to infection.
It also can be a sign of an underlying problem such as lupus, rheumatoid arthritis or Sjogren’s syndrome, a chronic disorder in which the immune system attacks moisture-producing glands.
The first line of treatment for chronic dry eye is the use of over-the-counter drops. Christiansen recommends single-use, preservative-free drops. People can develop an allergy to the preservatives used in larger, multiple-dose bottles, he cautions.
Restasis, a prescription medicine commonly advertised on TV for dry eye, works by stimulating tear production.
“My knock on Restasis is it’s very expensive,” Christiansen says — about $100 a month. Many insurance plans don’t cover it, he says, and not everyone benefits from it.
RELIEF ON ITS WAY
Colorado Eye Associates recently took part in a clinical study examining an alternative medicine to Restasis. Results are still being gathered.
O’Connor, who participated in the study, says she has no way of knowing whether she received the medication or something else, “but whatever I was getting, it was great.”
For now, she’ll continue to use over-thecounter drops when needed. She hasn’t tried Restasis.
“I know that quite a few people don’t get a whole lot of help from that, so I haven’t bothered,” she says.
Another option for people with moderate to severe dry eye is inserting plugs into openings at the inner corners of the eyelids from which tears drain.
“By occluding them, we’re essentially trying to preserve more of the tears that we have,” says Dr. Matthew Chang of Buckley Vision Institute in Colorado Springs. “It’s analogous to stopping up a sink.”
Doctors may start with plugs that are dissolvable and thus temporary. If they prove effective, silicone plugs intended for more extended or permanent use can be inserted.
An alternative, generally reserved for more severe cases, is to permanently seal the openings by cauterizing them.
For many people, some of these simple strategies can help ease or prevent dry-eye symptoms:
Stay hydrated by drinking plenty of water.
Use a whole-house humidifier, which adds moisture to indoor air.
Don’t let air blow in your eyes, as from a car heater or air conditioner. Wearing wraparound glasses can help when outside on windy days.
Remember to blink, which helps spread tears more evenly. That’s particularly important for people working at a computer.
• National Eye Institute, www.nei.nih.gov, (301) 496-5248
• The Office on Women’s Health, www.4woman.gov/OWH, (800) 994-9662