Many of our dry eye patients really are fed up with feeling their eyes every time they blink. Some patients have given the analogy of sandpaper rubbing against the front of the eye with every blink.
This often occurs if one of the 3 components of the tear film has stopped production:
1. Oily part (or Lipid part): from the Meibomian Gland; the upper eyelid has about 50 meibomian glands and the bottom about 25-30 (depending on anatomy). If the glands scars down from chronic inflammation, it will no longer work properly. If these glands stops working altogether, it is very difficult and in many cases impossible, to get them working again.
2. Aqueous component: from the Lacrimal Gland.
A decrease in aqueous production occurs in:
– Sjogrens syndrome patients (have symptoms of dry eye, dry mouth, and arthritis).
– androgen deficiency may be a critical etiologic factor in the pathogenesis of
aqueous-deficient and evaporative dry eye syndromes during menopause, aging and certain autoimmune diseases (e.g. Sjögren’ssyndrome, systemic lupus erythematosus [SLE], rheumatoid arthritis [RA]).
-corneal exposure (e.g. seventh nerve palsy),
-occlusion abnormalities such as blepharoptosis,
-ocular surgery (e.g. keratoplasty),
-systemic diseases with effects on the ocular surface (e.g. Sjogren’s syndrome),
-extended use of anticholinergic medications,
Mucin comes from goblet cells which are located on the conjunctiva (the clear covering over the white part of the eye called the sclera).
Things that decrease goblet cells:
-vitamin A deficiencies,
-excessive dosing with drops containing preservatives
-cicatrizing conjunctival disorders can all damage goblet cells and the ocular surface.
-multiple surgical procedures of the conjunctiva or cornea
So when a patient has severe dry eyes, I use a tiered approach to arm them with all the tools they need to aggressively save their meibomian glands and maximize the function of the goblet cells and lacrimal gland.
My early 2014 tiered approach is below:
A new one will include a more elaborate discussion regarding the benefit of personal humidifiers in ones immediate location to help re-create the “warm, hot shower” feeling for ones eyes.
Has anyone had a good effect? If so, please let me know:
Here are some promising-looking ones from Amazon: