Dry Eye Syndrome

As seen in the Consultant Connection November 2013 Issue
By; Irene Sours, RN, Nurse Consultant, ICP, Inc

Dry eye syndrome is a decreased tears production or increased tear film evaporation over the eye that keeps the eyes lubricated and moist.  Nearly five million Americans 50 years of age and older are estimated to have dry eye.  Tens of million more have less severe symptoms of dry eye syndrome.  Dry eye is more common after menopause however women who experience menopause prematurely are more likely to have eye surface damage from dry eye.
Types of dry dye are aqueous tear-deficient and evaporative dry eye.  Aqueous tear-deficient dry eye is a disorder in which the lacrimal glands fail to produce enough of the watery component of tears to maintain a healthy eye surface.  Evaporative dry eye may result from inflammation of the meibomian glands located in the eyelids.  These glands make the lipid or oily part of tears that slows evaporation and keeps the tears stable.
What are causes of dry eye?
  • Dry eye can be a side effect of some medications, including antihistamines, nasal decongestants, tranquilizers, angiotensin converting enzyme or ACE inhibitors for high blood pressure, diuretics, Parkinson’s medications, birth control pills and anti-depressants.
  • Skin disease on or around the eyelids.
  • Diseases of the glands in the eyelids, such as meibomian gland dysfunction.
  • Allergies
  • Immune system disorders such as Sjogren’s syndrome, lupus and rheumatoid arthritis.
  • Chronic inflammation of the conjunctiva, the membrane lining the eyelid and covering the front part of the eye, or the lacrimal gland.
  • Exposure keratitis, in which the eyelids do not close completely during sleep.

Symptoms of dry eyes:
  • Sensitivity to light
  • Tearing
  • Stinging sensations in the eyes
  • Burning feeling in the eyes
  • The urge to scratch eyes often
  • Blurry vision especially after a long day or after focusing for a long time
  • Getting tired quickly after reading for a short while

Treatment options for dry eye depend on the cause. First priority is to determine if a disease is the underlying cause of the dry eye (such as Sjogren’s dyndrome, lacrimal or meibomian gland dysfunction).
  • Over-the-counter options are artificial tears, gels, and ointments for mild cases of dry eyes. To be applied more than four times a day if needed. Avoid artificial tears with preservatives.
  • Fluid hydration is important; educate the resident on the importance of fluids.
  • Cyclosporine or Restasis an anti-inflammatory medication decreases corneal damage, increases basic tear production, and reduces symptoms of dry eye.
  • If dry eye results from taking medication, have physician evaluate changing medication that does not cause the dry eye side effect.
  • More serious dry eyes may require a plug to the drainage holds, small circular openings in the inner corners of the eyelids where tears drain from the eye into the nose.  Lacrimal plugs, also called punctual plugs are inserted painlessly by an eye care professional.
  • Dietary sources of omega-3 fatty acids may decrease symptoms of irritation.
  • Wearing glasses or sunglasses that fit close to the face (wrap around shades) can slow tear evaporation from the eye surfaces.
  • An indoor air cleaner to filter dust and other particles.
  • A humidifier may help by adding moisture to the air.

Sufficient tears are important for maintaining clear vision.  Tears provide lubrication, reduce the risk of eye infection, wash away foreign matter in the eye, and keep the eye smooth and clear.  Eye comfort is a key element of quality of life and safety for our residents within our facilities.
http://phys.org/news163697959.html http://www.nei.nih.gov/health/dryeye/dryeye.asp 

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