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Dry Eye Syndrome (DES)
DES is more
accurately described as
ocular surface disease
because its symptom is often
times not just dryness. Many
times it will present as
excessive tearing. DES is
one of the most common
complaints we hear during an
eye exam. In fact, over 10
million Americans suffer
from DES. It is caused by an
insufficiency in either tear
film quantity or quality. |
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Tears are composed of three
layers. The mucus layer is
produced by goblet cells and
is the base layer for the
tears. Its purpose is to
allow the tears to adhere
and coat the eye’s surface.
Without this layer, the tear
film may have enough
moisture, but it “falls” off
the cornea before it is able
moisten the eye. The middle
layer is the aqueous layer.
This the moisture and the
bulk of the tear film. It is
produced by the lacrimal
gland which sits above the
eye. The lacrimal gland is
responsible for both normal
tear secretion and reflex
secretion when the eye is
injured or in emotional
tearing. The outer most
layer is produced by the
meibomian glands and is
called the lipid layer.
Meibomian glands are located
on the edge of the upper and
lower lid margins behind the
eye lashes. This layer acts
as a sealant to slow the
evaporation of the aqueous
layer.
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Dr. Ryan Ames
takes DES
seriously and
will customize a
treatment
regiment
specific to your
individual cause
of DES. |
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A very common
cause of DES is
due to meibomian
gland
dysfunction (MGD).
MGD is when the
glands that
produce the
lipid layer are
blocked.
Hormonal
changes, makeup,
oily skin, or
lotions are just
a few of the
causes of MGD.
This can be
treated through
lid cleansers,
hot compresses,
or in some cases
prescription
medications.
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Tears are
drained from the
eye via the tear
ducts located at
the nasal corner
of each eye.
There is one
duct on the
upper lid and
one on the lower
lid. Often times
we can occluded
the tear duct.
This will allow
the tears the
eye does produce
to stay on the
ocular surface
longer. This is
most often
helpful when
there is a low
quantity of
tears. |
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One of the
main causes of DES is
inflammation. This does not
mean the eye will look
inflamed, but it is actually
a low grade inflammation of
the glands that produce the
layers of the tear film. For
this reason, mild steroids
and/or a drug called
Restasis can be very
helpful. This treatment
option works to stop the
inflammatory process,
thereby eliminating the root
cause of the lack of good
tears. Sometimes this
treatment option will take
months of eye drops before
the individual will even
start to notice the
improvement. But after
sufficient time passes for
the treatment to begin
working, the results are
wonderful. |
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Omega-3 supplementation is an excellent
first step in the treatment of DES. Its
exact method of action is not fully
known, but it may be related to the
inflammatory process mentioned earlier.
There are many brands and types of
Omega-3’s available. Dr. Ames prefers
fish oil over flaxseed oil. There have
been links to elevated chances of
prostate cancer in men who take
flaxseed, but no link with fish oil.
Flaxseed also has to be converted in the
body to the appropriate compounds for
the body to use, but fish oil is already
in the right form. There are not set
guidelines on how much fish oil to take.
We recommend 3000-5000 mg (3-5 capsules)
per day. Because that is a lot of
capsules, we now recommend a supplement
called Coromega. It comes in a yogurt
like consistency, and in three flavors;
orange, orange-chocolate, and
lemon-lime. They come in individually
packaged servings of 2500 mg. It is a
great product and we have had very nice
results with it.
Sometimes it is as simple as using a
good artificial tear (AT). Not all AT
are created equal. Depending upon the root
cause of the DES, a certain AT may work
better. Dr. Ames will recommend the
appropriate AT after he determines the
cause of the DES.
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