Monday, October 13, 2008

Tears Part II

In an earlier post, Tears 101, I briefly outlined what a normal tear is made of, and what glands create tears. In Sjogren's Syndrome and some other autoimmune diseases, lymphocytes with faulty information impair those glands that secrete all the components of normal tears, and dry eyes are the result. 

In my case, my eye doctor told me that the lipid component of my tears is affected, so I have a normal level of water in my tears, but without the lipids, the tears evaporate much more quickly than they would otherwise. 

 So how is autoimmune dry eye treated? 

 The Sjogren's Syndrome Foundation website has an excellent article which details treatment options. Here are the major points:

·     For moderate dry eye, use of over the counter drops offers temporary relief. They suggest using drops which do not contain preservatives.

·     Punctal occlusion by use of small silicone plugs, prevents tears from draining away from the eye. 

·     Hydroxypropyl cellular inserts, placed once daily in the pocket of the lower lid, dissolve slowly over the day providing lubrication for the eye. These are available only by prescription and the brand name is Larisert.

·     Cyclosporine opthalmic emulsion, sold under the Restasis brand name, and available by prescription, suppresses inflammation that causes tear disruption. 

·     Use of essential fatty acid supplements high in omega 3 oils has proven promising in some studies in reducing dry eye symptoms. 

·     Two prescription oral medications, Evoxac and Salagen, used to stimulate saliva production, may also decrease some of the discomfort from dry eye. 

Their list of practical suggestions for coping with dry eyes is too good to paraphrase, so I will copy this list as a quote: 

"Making changes in your environment, habits, and medications can help minimize dry eye symptoms. Here are some suggestions:

· Avoid environmental stresses that worsen dry eye, such as low humidity, drafts from air conditioners or fans, smoke, dust, or excessive makeup.

· When possible, avoid taking drugs that cause dryness as a side effect, such as certain drugs for blood pressure regulation, antidepressants, and antihistamines (e.g. Benadryl®). These drugs and others may decrease tear secretion and worsen dry eye. Your ophthalmologist can help determine whether any drugs you take may be contributing to your condition.

· Try blinking on purpose or taking a short break with your eyes closed when reading or working at a computer. We tend to blink less often during these activities, potentially aggravating dry eye.

· Wear special glasses or goggles to lessen dry eye. These items decrease tear evaporation by blocking air drafts and increasing humidity around the eyes. Increased humidity has proven to prevent the evaporation of natural and artificial tears.

· Use specially-formulated ophthalmic gels or ointments. Although these may blur vision, they can be used overnight to keep eyes moist. Alternatively, use artificial tears before bedtime and in the morning.

· Apply warm compresses on the eyes. Compresses can soothe dry, irritated tissues and improve secretion of oil from meibomian glands in the eyelids. Try applying them after waking in the morning and periodically during the day.

· Keep your eyes lubricated throughout the day, even if you don’t have dryness symptoms. Don’t wait until your eyes hurt to seek treatment for dry eye because this could lead to damage to the eye. Patients should use one or more of the treatments listed above and ask their healthcare professional about any FDA-approved medications."

Just how much damage could be done to eyes affected by defective or decreased tears? Aside from the inconvenience of frequently using eye drops and dealing with pain sometimes described as blinking shards of glass, damaged cornea and decreased vision could result. Serious stuff. You can read more about it here on the Research to Prevent Blindness publication. 


Anonymous said...

Thanks for a very good article Julia. I would also point out to people that when your eyes actually tear up it could be a sign of dry eyes as the glands are producing more tears to compensate. Also I recommend this article

Mary said...

Great posting. And, thanks for the link to the NYT article a couple of posts back; I had not seen it and it was interesting. It is always nice to see Sjogrens info out there in the "big" media!

As a Sjogren's person myself (diagnosed for five or six years now) the absolutely most helpful thing I do regularly is take fish oil for the omega 3 (in addition to the Restasis, which I also love). I was on Vioxx until it was pulled, but even that did not control all my pain. I started chugging down two pills in the morning and two at night, and I'm up to three at each time - but it has been like giving me an entirely different life! I can get out of bed in the morning without waiting 30 minutes or so for the pain to pass. I can move my hands without feeling that ground-glass pain in my joints. I still have trouble with bright lights, but my energy levels are way up, and I rarely have the flares that confined me to bed for days at a time feeling like I had a terrible case of the flu.

In fact, I'm now biking long distances regularly! When peddling, I wear a pair of my regular prescription sun glasses and a pair of those little old lady glasses that fit over and around your regular glasses, to keep the brightness down and the wind out. It usually helps; plus, I'm already a plump middle aged chick wearing spandex and looking like a dork, so a little extra dorkiness with the glasses does not bother me! :)

I know everyone's autoimmune experience is individual (part of the fun!) but always like to share my fish oil experience in case it helps anyone else.

Thanks for your blog!

Brussels Chronicles said...

Just wanted to add... A good long yawn helps me as well... this brings a little extra moisture to the eyes!