Dry Eye Syndrome, or Dysfunctional Tear Syndrome (DTS) as it is now called, is a tremendous problem for patients in the Western United States.  Symptoms include redness, blurring, gravelly, scratchy eyes, contact lens intolerance, pain and may include vision loss in some individuals.  This is worse in computer users who tend to blink less than they should, and much worse in smokers.

DTS is more prevalent in women than men, particularly those over 40 years of age or perimenopausal women.  It is also more common in those with autoimmune disease including Rheumatoid Arthritis, Sjogren's Syndrome, Psoriatic Arthritis, Lupus, Scleroderma, Rosacea, Polymyalgia Rheumatica and Fibromyalgia.  Thyroid disease patients are also at risk. 

Numerous medications increase dry eye symptoms, including diuretics used in treating lymphedema and hypertension.

Treatment strategies vary by individuals, but true dry-eye patients typically need artificial tears more than 6 times/day.  Treatment options beyond palliative relief (artificial tears) include the following:

1)  Omega-3 fatty acid therapy, eg. Flax-seed or Fish-oil, 2,000 - 2,500 mg/daily

2)  Restasis - Twice daily dosing x 6 months restores tear production in about 80% of users.

3)  Doxycycline - useful in cases of dryness due to Ocular Rosacea/Facial Rosacea.

4)  Punctal occlusion by temporary or semi-permanent plugs.  Cautery is rarely utilized any longer.  This requires failure of one of the above treatments before insurance will cover.

5)  Bandage contact lens usage.

6)  Evoxac - an oral medication that may stimulate tear production - has side effect profile that must be discussed with patients.

7)  Testosterone cream - this is a non-FDA approved treatment for severe dryness useful in some women.

8)  Autologous serum tears - patients can undergo a blood draw, and utilize their own serum as an artificial tear source.  Contraindicated in patients with corneal transplants who have active autoimmune disease.

9)  Lacrisert - these are essentially dried artificial tear pellets - placed under running water to activate, they are then placed inside the lower eye lid.  They "leak" artificial tears into the eyes for about 12 hours.  Most patients remove at night before bed.  Available by prescription only through your local pharmacy.

Your work up with Dr. McNeel will utilize vital staining of the ocular surface with Rose-Bengal, Lissamine Green Stain and Flourescein to differentiate which type of dry eye disease you have.  Schirmer testing or Phenol Red Thread testing can quantify tear production and is useful to determine effectiveness of treatment.  Dry eye disease is a permanent (usually) progressive condition that is responsive to early treatment. 

Dr. McNeel is a member of the Allergan Speaker's Panel and lectures to other doctors about dry eye disease and treatment strategies.