RECOVERY PLAN – Dry Eyes/Blepharitis Myths: Dry Eyes/Blepharitis is just a condition of eyes.

Facts: The eyes often reflect a larger problem that needs to be treated systemically. Overview, Dry Eyes: Dry eyes, often referred to as Dry Eye Syndrome, is the most frequent patient complaint to eye doctors. About 15% of the population in all groups experience varying degrees of dry eye syndromes. Like most eye conditions, Dry Eye Syndrome is often related to health conditions in the rest of the body. It is commonly associated with dryness of other mucous membranes, interior body surfaces such as joints and brittle nails. It can also be a sign of digestive imbalances (see Starch Study) or of more serious systemic autoimmune diseases, such as rheumatoid arthritis, Sjogrens syndrome or lupus erthematosus.

The proper production of tears basically takes place at three layers: * The Mucus Layer – is the closest layer to the corneal epithelium. It is produced by the conjunctival goblet cells, and is absorbed by the corneal surface glycoproteins, creating a hydrophilic corneal surface. * The Aqueous Layer – is between the Mucous and Lipid Layers, and comprises 90% of the tear film’s thickness. It is secreted by the lacrimal gland and incorporates all water-soluble components of the tear film (slightly alkaline at pH of 7.4). * The Lipid Layer – is the most superficial layer. The Meibomiam glands produce it with minor contribution from glands of Zeis and Moll. The secretion is a sebaceous material that is fluid at body temperature, and retards evaporation of the aqueous layer and lowers surface tension thereby allowing tear-film to mould itself to the eye’s surface.

* The Blink renews the tear film by delivering aqueous and lipid to tear film and sweeping away debris. The normal blink interval is every 5 seconds. Tear film is typically stable for about 10 seconds. << back to the start Symptoms: The typical symptoms include dryness, grittiness, irritation, difficulty reading for long periods of time, burning and even the seeming contradiction of excessive tearing or watering. Causes: * Any disruption in the tear production process as described in the Overview.

* Blepharitis can often cause dry eye symptoms due to inflammation of the eyelid margins, which is caused by a bacterial infection (Staphylococci). This condition can compromise the quality of the tear film causing tears to evaporate more quickly. The bacteria produce waste material that can cause a mild toxic reaction leading to chronic red, irritated eyes. Click Blepharitis for treatment.

* Computer Users tend to blink much less frequently (about 7 times per minute vs. a normal rate of around 22 times/minute). This leads to increased evaporation along with the fatigue and eyestrain associated with staring at a computer monitor. Ideally, computer users should take short breaks about every 20 minutes to reduce this factor. Also, adjusting the monitor so that it is below eye level will allow the upper lid to be positioned lower and cover more of the eye’s surface, again to reduce evaporation.

* LASIK surgery temporarily disrupts the ocular surface/lacrimal gland unit. Also, during LASIK, roughly 60-70% of the superficial nerve fibres in the cornea are severed, which impacts sensation and affects aqueous tears. With compromised sensation, the blink rate can slow to the point where the tear film breaks up before the next blink can reconstitute. This may result in mild to severe dry eye syndrome for many months after surgery. This condition usually eventually clears up.

* Diseases that may be associated with dry eyes include Rheumatoid Arthritis, Diabetes (especially when the blood sugar is up), Asthma, Thyroid disease (lower lid does not move when blinking), Lupus, and possibly Glaucoma.

* Age – Tear volume decreases as much as 60% by age 65 from that at age 18. Dry Eye Syndrome affects 75% of people over age 65.

* Hormonal changes for women can cause decreased tear production brought on by pregnancy, lactation, menstruation, and post menopause.

* Other including too much coffee drinking, smoking, wearing contact lenses, air-conditioning or heat. << back to the start Drugs can cause dry eye symptoms:

* Blood pressure medications

* Antibiotics

* Antidepressants

* Diuretics

* Over-the-counter vasoconstrictors (i.e. Visine)

* Antihistamines

* Birth control pills

* Appetite suppressants

* Ulcer medications Conventional Treatment: Artificial Tears: Some form of over-the-counter artificial tears is usually recommended. Although they may provide temporary relief, they merely palliate the symptoms. Worse, the preservatives can aggravate the condition, and can even kill corneal cells. Tears that promise to “get the red out” will reduce circulation in the eye, decrease production of the tear film, and worse, eventually make your eyes even drier.

Punctal Occlusion: Punctal occlusion is a procedure used to help dry eye patients by closing the tear drainage canals with silicone plugs, which keep most of the fluid from the surface of the eye. This may provide long-term relief. Complementary Treatment: Almost certainly, lifestyle changes will be needed to resolve the problem in the long term.

See the action plan for details.