Everybody who spends time watching the computer screen a few hours a day has, at some time or the other, suffered from “dry eyes”. Dry eyes, these days, is an occupational disease that leads to drying up of tears because of prolonged computer monitor viewing
Even when our eyes are not crying from emotional upheaval or tearing (watering) from slicing onions, there is a thin layer of tears that bathes the external surface of the eye and the inner lining of the eyelids. It is not easy to distinguish a dry eye from an eye that is irritated due to an allergy or infective condition. This is why it may be best that you leave the diagnosis of dry eye to your eye care physician (optometrist or ophthalmologist). However, once you know you have dry eye, you should also know how to deal with it by altering your diet, your environment, and by good communication with your eye care practitioner. There is a type of dry eye experienced almost only during sleep, worst at awakening, but quickly disappearing as the body revs up for daily activity. We are talking here of the common dry eye that is worst during the day.
Some key symptoms
The key symptoms of dry eye include a burning sensation combined with a gritty sensation—as though there were sand in the eye. This could alternate with sudden tearing of the eyes. Suddentearing is better known as “reflex” tearing and it occurs when the corneal nerves give feedback to the lacrimal (tear) gland telling it to produce more tears. As a result of this feedback mechanism, many people with a complaint of watery eyes actually are suffering from dry eye.
Some diagnostic tests
There are several diagnostic tests for dry eye that are conducted by eye care practitioners. The simplest and least invasive test is called the Non-Invasive Tear Break-Up Time (NITBUT) test. In this, the mires (targets) of an instrument such as a keratometer are reflected from the surface of the cornea. The patient is asked to blink and thereafter to hold the blinks for as long as possible. The time taken until the reflection of the mires starts to distort is recorded as the NITBUT. A normal value should exceed 30 seconds for most people. When the dye fluorescein is used with a slit-lamp, the TBUTshould exceed 15 seconds for a normal ocular surface. Other clinical tests include assessment of the tear meniscus and the Schirmer test, among others.
How do tears serve the eye?
The tear film serves the following objectives: lubrication between the eye and the eyelids; a uniform refracting (optical) surface over the cornea; protection of the eye from bacteria by the enzyme lysozymeand immune factors; protection of the eye from dust and pollen; nourishment of the eye with various nutrients; and prevention of dessication (drying) of the ocular surface.
Structure and composition of the tear film
The tears form a uniform film of thickness about a hundredth of a millimeter over the surface of the eye. The tear film is thickest immediately following a blink, which serves to spread the tears uniformly. The tear film is composed
of 3 layers: the mucoprotein (also called mucin) layer is closest to the cornea and fills the gap between the processes of epithelial cells. The middle layer is the aqueous layer and is the thickest, consisting of water and dissolved salts, especially potassium. The outer layer is composed of lipids and serves to prevent evaporation.
Formation and drainage of tears
Tears are formed by various glands and individual cells located on the eye surface and around the eyeball. The lacrimal gland produces the aqueous component of tears and is located above and temporal to the eyeball. The upper and lower eyelids contain about 30 meibomian glands each that secrete the lipid component of tears. The mucin layer of tears is produced by goblet cells located within the conjunctiva, the membrane that lines the white part ofthe eye and the inner surface of the eyelids. Drainage of tears occurs through two small apertures called puncta, located in the nasal corner of the eyelids. The pucta drain the tears into canaliculi which meet and open into the nasolacrimal duct, thus draining the tears into the nasal cavity. This is why you can taste eye drops after about a minute after instillation.
Populations at risk for dry eye
• Arthritis: Patients with arthritis are particularly at risk for dry eye. Arthritis is an autoimmune condition in which the body attacks its own tissues. Anti-bodies can destroy tear glands, joints, and salivary glands, producing the triad of symptoms of dry eye, arthritis and dry mouth observed in Sjogren’s syndrome. Supplements such as glucosamine, chondroitin and MSM may help under a doctor’s supervision.
• Contact lens users: Contact lenses can disturb the tear film, especially in those patients who have a tendency for dry eye. It is wise prior to contact lens fitting, to evaluate the tear film and rule out dry eye. There are some types of contact lenses that are better suited for the patient with dry eye. Ask your eye care practitioner about these options.
• Post-LASIK patients: Laser In-Situ Keratomileusis is conducted routinely at a number of surgical facilities. One major side effect of LASIK is a postsurgical dry eye that can persist for several months. This type of dry eye is produced by the severing of corneal nerves that give feedback to the lacrimal gland by way of the brainstem.
• Computer users: When working at a computer, the inter-blink interval tends to increase so the eyes become dry. Make it a habit to blink at least once every 5 to 10 seconds while working at the PC. You may also wear specially designed spectacle lenses that protect from electromagnetic radiation. Periodic artificial tear drops may be needed, but try to avoid those with strong preservatives.
• Post-menopausal women and older adults: Many olderadults have dry eye and needto use lubricating eye drops tokeep the eyes moist. Postmenopausalwomen may considersupplementing herbs thatimprove hormone levels suchas damiana.
• Medication users: Certain medications such as those used for allergies, psychiatric indications and birth control
can cause dry eye and dry mouth. Talk to your doctor for alternatives.
• Alcohol users: Avoid distilled liquors and if you drink wine or beer do not exceed 3 drinks a week.
Environmental risk factors
Dry air, caused by air-conditioning, heating, dry weather, or airplane travel can worsen a dry eye condition. Smoking and pollution are best avoided. Where possible, use a humidifier or apply lubricating eye drops to relieve symptoms. Excessive carpeting may produce fumes or particulate matter that may further irritate the eyes.
A hair mineral analysis reveals important information for those suffering from dry eye. The body exports minerals to the hair in quantities that reflect (for the most part) body tissue stores
Causes and deficiencies associated with dry eye
In recent years, oral supplementation of omega-3 fatty acid (including flax seed oil, also called linseed or “alsi”) has been recommended. However, by itself it does not provide adequate reversal of the syndrome. Part of the problem
is that what is needed is a balance of the omega-3 fatty acids with the omega-6 fatty acids. This balance can be measured in a simple blood test of the essential plasma phospholipid fatty acids profile. Too much omega-3 promotes hemorrhaging, too much omega-6 promotes clotting. But even balancing adequate omega-3 with adequate omega-6 is not the whole answer. A hair mineral analysis reveals important information for those suffering from dry eye. The body exports minerals to the hair1 in quantities that reflect (for the most part) body tissue stores. We have found that in dry-eyes syndromes, sodium2 and potassium are deficient when measured in hair and tears are very low in sodium and potassium3. In 1978 Ned Paige of Canada reported that many patients with dry-eye syndrome could be helped with large doses of pyridoxine (vitamin B6). In December 1983 Graeme Wilson and associates reported that calcium, magnesium, potassium, and sodium are essential and sufficient minerals in tears for the maintenance
of corneal epithelium integrity. Lane (1984) found mean hair K was 9 ppm for cases vs 65 for controls and that the single most significant nutrient intake associated with both of these syndromes is deficiency of folic acid derived from food. Second most significant is excessive intake of table sugar. A low intake of ascor-bic acid (vitamin C) and vitamin B6 are third and fourth most significant.
Feeding your tears: a diet for dry eye
A diet rich in fresh ripe fruit, salads and some raw vegetables will provide adequate calcium, magnesium, potassium, B6 and folic acid essential for the aqueous layer of the tear film. Supplementation with vitamin C (about 500 mg) may be necessary but take it at a time at least 4 or more hours apart from your multivitamin-mineral formula. For those who prefer natural sources, try juicing fresh amla with a citrus blend. The lipid layer is nourished by essential fatty acids, particularly omega-3 fatty acids such as those present in flax seeds. A tablespoon of the seeds can be ground dry in the blender or the oil (about 2 tsp for an adult) can be added to food at the table (but do not cook with it). The cells that produce the mucin layer are dependent on the availability of folic acid, for as simple a reason as that the body requires folic acid to make each new cell in the body. Folic acid and magnesium are present together in raw dark leafy greens (such as baby spinach) that can be taken as a salad if washed properly. Bananas are a great source of potassium as are most fresh fruit. A separate supplement of vitamin B6 (approximately 40 mg) may be sufficient for most adults and may confer cardiovascular, metabolic, and cognitive benefits as well. Among ayurvedic remedies, raw or steamed asparagus (shatavari) and Indian Bedellium (guggul) may be helpful (taken by mouth) for dry eye. Needless to say, avoid dehydrating foods such as potato chips and deficit-inducing foods such as table sugar.
Lid massage
Lid massage stimulates blood flow to the upper and lower eyelids and prevents blockages in these glands. A good way to conduct lid massage is to dip the clean fingertips in warm to hot water and gently rub the lids individually without touching the eyeball. First rub the lower lid from the nasal corner to the middle and then to the temporal corner and back. Then rub the upper lid in the same way. Some excess oily secretion may follow, which can be wiped. Perform lid massage at least twice daily, especially on waking and at bedtime.
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