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FAST FACTS FOR YOUR HEALTH

Chronic Dry Eye: What Women Should Know
If you've been rubbing your eyes more often, using eye drops more than mascara and giving up contact lenses in favor of more comfortable glasses, take heart: Your symptoms likely are easily diagnosed and treatable.

You may have chronic dry eye, a group of disorders affecting the film of tears over the eye. The condition affects an estimated 3.2 million American women and 1.6 million American men over age 50, but many younger people also are bothered by it. Hispanic and Asian women are more likely to be affected by symptoms of chronic dry eye.

The Basics of Dry Eyes
Tears are more than a sign of emotion. They keep your eyes moist, lubricate the surface of the eye for eyelid closure and guard against infection. They also wash away allergens, protect the eye and keep it healthy. Without tears, good vision is impossible.

When you have chronic dry eye, either you don't produce enough tears, or you have unstable tears and/or excessive tear evaporation. These problems cause your eyes to feel dry and/or irritated, to sting or burn, feel scratchy and sometimes to excessively tear. It most commonly occurs in both eyes, but may affect one eye more than the other.

People with dry eyes have difficulty wearing contact lenses. They also may develop stringy mucus in or around their eyes. They can have pain and redness in the eye, a feeling of heavy eyelids, or blurred, changing or decreased vision. People with more severe cases of dry eye are also sensitive to light.

Although eye infections are more common in people with chronic dry eye, irreversible vision loss from dry eye is rare. Most people with dry eye find the condition to be an uncomfortable nuisance that can interfere with their ability to perform tasks requiring concentrated vision, like reading or driving at nighttime.

What Causes Chronic Dry Eye?
Although we don't know for sure why women are more likely to develop chronic dry eye, we suspect it has to do with hormones. As women age, their production of the male hormone, testosterone, drops (the same is true for men, though levels usually remain higher than in women). Known as "the libido hormone"-the hormone that affects sexual desire-testosterone also plays a critical role in maintaining the tear-making lacrimal gland.

As testosterone levels drop, levels of inflammatory chemicals called cytokines rise. Once the lacrimal gland is inflamed, it slows the release of tears. Other hormonal changes, such as those associated with pregnancy and autoimmune diseases and medical conditions such as arthritis, lupus, Sjögren's syndrome and diabetes can also cause chronic dry eye.

Other things that can cause dry eye or make symptoms worse are:

• dry indoor air
• contact lenses
• car air vents aimed at your face
• medications, including some high blood pressure medications, antidepressants, heart medications, antihistamines, decongestants, muscle relaxants, sleeping pills, pain relievers and drugs for Parkinson's disease and gastric ulcers, and hormone therapy, particularly estrogen therapy
• allergies, which contribute to eye dryness by causing additional eye discomforts such as itchiness, redness, swelling and wateriness
• other environmental triggers, such as high temperature, low humidity, wind, high altitude, air travel and pollutants.

Diagnosing Dry Eye
Early symptoms of chronic dry eye usually include discomfort, dryness, eye redness,1,2 burning, stinging, and/or gritty sensation in the eye, especially in an environment with low humidity, a feeling that something is in the eye and trouble wearing contact lenses.

Your ophthalmologist or optometrist can diagnose chronic dry eye during an eye examination, although you may need a complete physical examination to diagnose any underlying diseases. Make sure you tell your health care professional about any medications you're taking.

Treating Chronic Dry Eye
Until recently, there were just two treatments for dry eyes: over-the-counter artificial tear eye drops, designed to replace your natural tears, or a nonsurgical procedure called punctual plugging in which tiny bits of silicon are inserted into the openings on your lower and/or upper lids where tears drain into your nose. Plugging these openings keeps the tears in the eye and helps prevent your eyes from drying out.

In 2002, the U.S. Food and Drug Administration approved the first prescription treatment for dry eyes. Called Restasis (cyclosporine ophthalmic emulsion 0.05%), this treatment increases the body's ability to produce its own natural, healthy tears by treating one underlying cause of the disease-inflammation.

Restasis is generally recommended to people who use artificial tear eye drops frequently without getting long-term symptom relief.

If you do use over-the-counter artificial tear eye drops, check the labels carefully to make sure you're using the right ones. They differ from redness-relieving eye drops, which only provide the cosmetic benefit of removing the redness.

A commonly used artificial tear brand is Refresh, which comes in a variety of strengths and formulations. The brand's Refresh Endura (preservative-free tears) and Refresh Dry Eye Therapy (preserved artificial tears) are the first products for dry eye that treat all three layers of the tear film: They deliver oil to the tear's lipid layer (to minimize evaporation); water to the tear's aqueous layer (to keep the eyes wet); and an ocular lubricant to the tear's mucin layer (to keep the cornea lubricated).

Artificial tears also come with and without preservatives. Many people are sensitive to preservatives in artificial teardrops, making their use intolerable. So choose brands without preservatives if your eyes are especially sensitive.

Preventing Chronic Dry Eye
There is no cure for chronic dry eye, and no way to prevent it. But you can help prevent evaporation of your tears by avoiding environments that can cause dryness, such as hair dryers, rooms with low humidity and wind. Also remember to blink, especially when you're using a computer. Consciously blinking repeatedly helps spread your own tears more evenly.

Placing a humidifier in rooms when you're using indoor heat and wearing wrap-around glasses when outside may also help. You should also quit smoking, if you smoke, and stay away from smokers, since cigarette smoke can be very bothersome.

And pay attention to your diet. Certain foods and drinks dehydrate your body-and your eyes. Chocolate, colas, coffee and tea all contain caffeine, which robs your body of moisture. To keep fluids flowing, drink plenty of water (six glasses daily if possible).

Questions to Ask Your Health Care Professional

1. Could my eye symptoms be chronic dry eye?
2. Is a disease causing my chronic dry eye?
3. Can any of the medications I take contribute to chronic dry eye?
4. What can I do to reduce my discomfort from dry eye?
5. What treatments are available to treat my symptoms?

Resources

Lighthouse International
1-800-829-0500
www.lighthouse.org
A worldwide resource on vision impairment and vision rehabilitation, providing education, research, advocacy and rehabilitation.

National Eye Institute
301-496-5248
www.nei.nih.gov
Provides patients, professionals and the general public with information, fact sheets and other publications on eye diseases and disorders.

Prevent Blindness America
1-800-331-2020
www.preventblindness.org
A volunteer organization dedicated to eye health and safety.

The Sjögren's Syndrome Foundation
1-800-475-6473
www.sjogrens.org
Provides patients and the general public with information about the disease.

Women's Eye Health Task Force
www.womenseyehealth.org
Provides information about women's eye health.

References

Begley CG, Chalmers RL, Abetz L, Venkataraman K, et al. The relationship between habitual patient-reported symptoms and clinical signs among patients with dry eye of varying severity. Invest Ophthalmol Vis Sci 2003;44:11;4753-61.

Begley CG, Caffery B, Chalmers RL, Mitchell GL. Use of the Dry Eye Questionnaire (DEQ) to measure symptoms of ocular irritation in patients with aqueous tear deficient dry eye. Cornea (21)7; 664-70 (2002).

Additional References

The National Eye Institute
The Cornea and Corneal Disease
www.nei.nih.gov

The American Optometric Association
www.aoa.org

The Mayo Clinic. Dry Eyes
www.mayoclinic.com

Anderson DH, Mullins RF, Hageman GS, Johnson LV. A role for local inflammation in the formation of drusen in the aging eye. Am J Ophthalmol. 2002 Sep; 134(3):411-31.

The Statistics. Women's Eye Health Task Force http://www.eri.harvard.edu

Schaumberg DA, Sullivan DA, Buring JE, Dana MR. Prevalence of dry eye syndrome among U.S. women. Am J Ophthalmol. 2003 Aug;136(2):318-26.

Schaumberg DA, Buring JE, Sullivan DA, Dana MR. Hormone replacement therapy and dry eye syndrome. JAMA 2001 Nov7; 286(17):2114 -9.

This publication and the DRY EYE HOT JOBS rankings are part of a NWHRC educational initiative, sponsored by Allergan, Inc.