A special “thank you” to Dr. Brisco and the staff who helped me in transitioning through a medical challenge. Knowing you are there for me gave me extra strength to continue my fight. God bless!
– Patricia A.
Dry, Cracked Eye by Yashna M on Flickr
This is a question that I am often asked, “Why can I cry when my eyes are dry?”
The answer is that a dry eye doesn’t make enough quality tears or blink sufficiently to keep the eyes moisturized, nourished, clean and protected from environmental debris. When this happens, the brain sends a message to release more tears which causes excessive tearing. The problem is this type of tear dries out on the surface of the eye quickly and are not being efficiently used. These aqueous tears are also not sufficiently oily or mucousy to adhere to the eyes long enough to prevent the tears from evaporating so quickly.
Dry Eye Syndrome (DES) and Ocular Surface Disease (OSD) is the number one eye problem that we face. The causes include:
- Prolonged computer use
- Flying in an airplane
- Not enough sleep
- Certain medications such as: allergy, birth control, anti-depressants, hormone replacement, high blood pressure such as diuretics and beta-blockers, thyroid, and glaucoma (since drops are used chronically). Over-the-counter medications such as eye drops that get the red out with tetrahydrozoline, and allergy drops that contain naphazoline or phenairamine
- Dry environments such as Los Angeles & Las Vegas (desert conditions), high altitude ski resorts such as Aspen or Vail)
- Sjögren’s syndrome
- Air conditioners and heaters dry out the air and your eyes
- Environmental or pet allergies
- Sports where wind or cold air is blown in your eyes such as skiing, ice hockey, cycling
- Thyroid disease
- Chemotherapy or radiation treatments
- LASIK or other eye surgery
- Autoimmune diseases such as lupus, sarcoidosis or rosacea
- Age (we lose approximately 30% of our tear making glands with age) especially in women over 40 years old due to menopausal hormonal changes
Symptoms of DES and OSD include:
- Burning – usually worse at end of day
- Excessive tearing or watery eyes
- Gritty feeling like sand in your eyes
- Vision clears up with blinking, but is blurry between blinks
- Vision is blurry towards end of day
- Symptoms are worse around fans or wind
- Red eyes
- Discomfort wearing contact lenses
- This can be accompanied by dry mouth or dry skin
- Frequent eye infections
What do we do in a dry eye workup?
The history is where we determine if there is a good chance that you have dry eyes even though you can cry, or your eyes seem to water all the time. Then we measure the different layers of your tears to determine which layers are deficient. We examine your eyes using a biomicroscope to check the lid and lash health, look for unhealthy dilation or growth of tiny blood vessels both on the sclera (white part of the eyes) and the eye lids, examine the different tear glands such as the meibomian glands to see if they are clogged or atrophied, eye lids that are turned in or out, eye lashes that are turned in or out, the quality and completeness of your blink, and whether or not the caruncles are inflamed. Our doctors will also press on the tear glands to evaluate the quality of your tears. Then we will measure your tear production quality and and quantity and place a dye in your eyes to detect pathological drying of the cornea or front surface of your eyes. Finally, we will evaluate your cornea for dystrophies or degenerations that can cause or aggravate OSD.
Treatment is based on the underlying cause of your discomfort. Treatment could include dietary changes, homeopathic tear stimulation drops, nutritional supplements to encourage better quality and quantity of tear production, anti-inflammatory medications such as steroids or Restasis), environmental management, change of contact lens type, or plugging tear ducts to maintain your own tears longer on your eyes.
Sometimes management of OSD requires surgery such as removal of a pterygium, glaucoma surgery to eliminate or decrease use of glaucoma drops, superficial keratectomy for severe epithelial basement membrane dystrophy , surgical correction for eyelids that turn in or outwards (entropian or ectropian), or dacryocystorhinostomy for tear duct obstruction.
So as you can see, there are many reasons why you can still cry even though your eyes are dry, and there is much more than meets the eye when it comes to Dry Eye Syndrome or Ocular Surface Disease. Please call our office if your eyes are uncomfortable because there are many ways that we can help.