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Dry Eyes
An Overview of Dry Eye Syndrome
Our tears have an aqueous (water), mucin, and lipid component. If any component is deficient, then rapid tear evaporation and discomfort due to dry eyes may result. Patients with dry eyes typically experience a “gritty” or “sandy” feeling that is worsened by cold and/or windy environments. Many patients with dry eyes will actually experience increased eye watering, referred to as reflex tearing, since feedback from the eye to the brain may result in increased tear secretion from the lacrimal gland (large tear forming gland under the outside aspect of the upper eyelid). In these cases, patients have intermittent, excessive tearing with underlying chronic eye irritation.
What Causes Dry Eyes?
The most common causes of dry eyes include: aging, abnormal eyelid position, post-eyelid surgery, allergies, contact lens wear, blepharitis (eyelid margin inflammation), and certain systemic medications (some anti-histamines). There are many other known causes of dry eyes; however, current research has revealed that there is still much to learn about the fundamental cause of dry eyes and the best treatments.
How is Dry Eye Syndrome treated?
Treatment of dry includes artificial tear preparations, ophthalmic lubricants, and prescription medications. Tear supplements may come in preserved or non-preserved (preservative-free) preparations and are available over-the-counter (OTC) without a doctor’s prescription. Drops, gels, and ointments are the most common formulations. Formulations with a preservative are much less expensive than non-preserved supplements, but approximately 10% of patients may be allergic to the preservative. Installation of preservative drops more than 4 times daily or prolonged use may increase the likelihood of an allergic or toxic response. Avoid any drops that are marketed to “get the red out”. These drops may cause serious eye problems when used chronically.
Non-preserved drops and ointments may be used as often as needed. These drops are more expensive due to the individual dispensing units and extra packaging. Some examples of non-preserved artificial tears include: Bion Tears and Refresh. Celluvisc is a thicker, non-preserved drop that is good for very dry eyes or when you need extra protection due to poor eyelid closure. Refresh PM is a good lubricating eye ointment and may be recommended for night time use. If you would like to use ointment during the day, you may wish to alternate eyes to decrease the blurring of your vision. If you wish to clear your vision in the morning after night time use, you may use an eye rinse. Eye stream and Dacriose are two options.
Many new eye drops, gels, and ointments become available all the time. Many of these formulations are the same but some of the active ingredients or strengths may vary. We recommend that you try small quantities of the different supplements until you find one that works best for you.
Oral supplements are also available and may, in some patients, diminish dry eye symptoms or lessen the dependence on artificial tears. For severe cases of dry eyes prescription medications, special spectacles, or surgery may be indicated.
Ophthalmic Lubricants (ointments)
| Major Components | Concentration | Trade Name | Preservative |
|---|---|---|---|
| Mineral oil, white petrolatum | 20%, 80% | Advanced Eye Relief Night Time | No preservative |
| 15%, 85% | GenTeal PM | No preservative | |
| 3%,94% | Tears Naturale P.M. | No preservative | |
| Mineral oil, white petrolatum, lanolin | 15%, 83%, 2% | AKWA Tears Ointment | |
| Light mineral oil, white petrolatum | HypoTears Ointment Tears Renewed | ||
| Mineral oil, white petrolatum, | 42.5%, 56.8%, | ||
| chlorobutanol, lanolin | 0.5% | Lacri-Lube S.O.P. | |
| Mineral oil, white petrolatum, lanolin | 42.5%, 57.3% | Refresh P.M. |
Artificial Tear Preparations (with preservatives)
| Major Components | Concentration | Trade Name | Preservative |
|---|---|---|---|
| Carboxymethylcellulose | 0.25% | GenTeal Gel Drops | Sodium perborate |
| 0.25% | TheraTears | Sodium perborate | |
| 0.5% | Refresh Tears | Purite | |
| 1% | Refresh Liquigel | Purite | |
| Carboxymethylcellulose, Glycerin | 0.5% | Optive | Purite |
| Glycerin | 0.3% | Moisture Eyes | Benzalkonium |
| 1% | Advanced Eye Relief | Benzalkonium,EDTA | |
| Hydroxypropyl methylcellulose | 0.2% , 0.3% | GenTeal | Mild/Moderate/Gel Sodium perborate |
| Hydroxypropyl methylcellulose, Glycerin, Dextran70 | 0.3%, 0.2%, 0.1% | TearsNaturale Forte | Polyquaternium-1 |
| Hydroxypropyl methylcellulose, Glycerin, PEG-400 | 0.36%, 0.2%, 0.2%, 0.1% | Visine Tears | Benzalkonium |
| Polyvinyl alcohol, PEG-400, Dextrose | 1% | HypoTears | Benzalkonium,EDTA |
| Polyvinyl alcohol, povidone | 1.4% | Murine Tears | Benzalkonium,EDTA |
| Propylene glycol, PEG-400 | 0.3%,0.4% | Systane | Polyquaternium-1 |
Without Preservative (PRESERVATIVE-FREE,PF)
(**When frequent use required**)
| Major Components | Concentration | Trade Name | No Preservative |
|---|---|---|---|
| Carboxymethylcellulose | 0.5% | Refresh Plus | |
| 1% | Refresh Celluvisc | ||
| Carboxymethylcellulose, Glycerin | 0.5%, 0.9% | Optive Senstive | |
| Hydroxypropyl methylcellulose | 0.3% | GenTeal PF | |
| Hydroxypropyl methylcellulose, Dextran 70 | 0.3% | Bion Tears | |
| Hydroxypropyl methylcellulose, Glycerin, Dextran70 | 0.3%/0.1% | Tears Naturale Free | |
| Hydroxypropyl methylcellulose, Glycerin, PEG-400 | 0.36%, 0.2%, 0.2%, 0.1% | Visine Pure Tears | |
| Propylene glycol, PEG-400 | 0.3%,0.4% | Systane Ultra |
Klapper Eyelid & Facial Plastic Surgery treats disorders, injuries, and other abnormalities of the eyelids, eyebrow, tear duct system, eye socket, and adjacent areas of the mid and upper face.
