Dry eye

Dry eye is a term used to describe a condition in which the eyes either produce too few tears or they tear without the proper chemical composition. There may be as many as 34 million Americans who experience some of the symptoms of dry eye. The condition is most often the result of the natural aging process. However, it may also be caused by:

  • Problems with the blinking reflex
  • The use of certain types of medications
  • Environmental factors such as a dry climate or exposure to wind
  • Chemical or thermal burns to the eye
  • Some health problems, such as arthritis or Sjogren's syndrome.

One of the symptoms of dry eye is excessive watering of the affected eye. The watering is a natural reflex, caused by irritation of the surface of the eye because the tears are of abnormal chemical composition. This symptom is one of the primary reasons why so many people with the disorder do not consider the possibility that the term "dry eye" might apply to them. Other symptoms are an eye that is scratchy, dry, irritated or generally uncomfortable. Sometimes redness, a burning sensation, or the feeling of having something in your eye may also occur.

Because these symptoms can occur in conjunction with many disorders, the only way to be sure about a condition with such symptoms is to visit an eye doctor. The condition of dry eye can normally be diagnosed and treated by any general eye care practitioner, either an optometrist or an ophthalmologist.

Preparation for the Examination

If this is an initial visit to a new eye doctor, it will start with the completion of several forms, which provide the information necessary for the patient record. This will include the mailing address and telephone numbers, insurance information, names of other doctors, list of medications being taken, and past medical records if available.

The Examination

If it's been more than a year since the patient's last eye exam, the doctor will probably perform several tests to define the patient's visual abilities and ocular health. This will include an overall look at the appearance of the eye and surrounding area and checking for signs such as squinting, drooping of eyelids, facial muscles that do not appear to be working properly, and irritation such as redness or swelling. A check of pupil function will also be done at this point using a pen light to see if the pupil responds normally. In addition, the eye care professional will perform the following checks:

  • Eye alignment
  • Near convergence - point at which both eyes together can see a single image
  • Near point of accommodation - closest point at which an image is seen clearly
  • Stereopsis - ability to see three dimensionally
  • Color vision
  • Confrontation fields - a test of peripheral (side) vision

If any of these initial tests indicate a potential problem, more extensive testing may be done later in the exam.

If, however, an eye exam has been conducted recently, the doctor may concentrate on the specific symptoms of the problem. First, the doctor examines the outside structure of the eye, including the eyelids for any signs of irritation or other problems.

A slit lamp or biomicroscopic examination of the lid margins including the meibomian glands will also be performed. The meibomian glands are located within the eyelids and supply the outer layer of the tear film that protects your eyes. The doctor will also use the slit lamp to look for any debris in the tear film that may indicate that the eye is not being adequately "flushed" by tear flow.

A wide variety of procedures are available to the doctor for checking the quantity and composition of tears, and several may be used to ensure that a proper diagnosis is made. Some of these tests will include the instillation of fluorescein dye, while others might use filter paper to indicate the quantity of tears being produced. A procedure used to evaluate the quality of the tears being produced is called a tear osmolarity test.

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