I often get the question, “Dr. Hendy, how can my eyes be dry when they are always watering?” Dry eye affects millions of Americans, including myself, and its prevalence is rising due to prolonged digital device use. Some common symptoms of dry eye are burning and stinging, redness, sandy or gritty sensation, and lastly, but most confusing is excessive watering.
You see, we have two different types of tears, basic and reflex. Our basic tears keep our eyes comfortable, help us see, and protect our eyes from dust, dander, pollen, and more. Basic tears are made up of a lower mucin layer which helps the middle watery or aqueous layer adhere to the front of the eye and a top oil layer which aids in keeping the tears from drying up too rapidly.
When our basic everyday tears aren’t plentiful enough to do their job then the body responds by triggering the reflex tears. Your body sends a flood of tears to try to make up for the dryness. Reflex tears are secondary tears that we get when we are hurt or emotional. They are waterier and just run right over the eye and out rather than coating the surface of the eye. Hence the confusion when this happens.
Dry eye can be caused by aging, medications, problems involving the eyelids, or systemic conditions that inhibit the ability to make tears.
So, what do we do to treat dry eye disease?
1) Over the counter artificial tears during the day and possibly an ointment at night to shield the eye while sleeping. Continued use is crucial despite how your eyes feel to avoid issues later. I use a brand called Oasis and have it in office for patients to get started.
2) Temporary or permanent plugs (I like the temporary and have had both). The plug is inserted into the lids in the office and will block drainage of the basic tears. Your tear layer is then more prevalent and reflex tears and watering is lessened.
3) Lipiflow is a device that heats and massages the lids in order to unclog blocked glands which produce oil. An improved oil layer helps to hold tears in the eye longer by preventing evaporation of the water layer.
4). Prescription and nonprescription dry eye medications
Cyclosporine (Cequa, Restasis) help amp up tear production
Lifitegrast (Xidra) used twice a day to improve tear production
Verenicline (Tyrvaya) a nasal spray which aims to increase tear production
Short term doses of steroids
Fish oil or Omega-3 supplements
Your first step is to get a thorough medical eye examination and proper dry eye testing to see what treatment might be best for you. Who better to do that than an eye doctor who also experiences dry eye? Schedule an appointment or contact us today!