Patient: "Doctor, sometimes my eyes seem to tear and water."

Doctor: "You have dry eyes."

This paradoxical response tends to confuse patients until the logic behind the answer is explained.

TWO TYPES OF TEARING

There are two types of tearing. One is baseline tearing -- a constant release of tears from the
lacrimal gland, located in the inner area of the upper lid.

The second type is "reflex tearing," a sudden outflow set off by irritation, emotions, bright lights, etc. that protects the eye by diluting or flushing out the offending substance.

Aging and some medications or medical conditions can reduce baseline tearing to the point that the eye tissues get dehydrated and irritated, provoking the reflex tearing that offers relief.

MAIN CATEGORIES AND TREATMENT OPTIONS

Dry eyes can be classified into three main categories, each of which require a different level of treatment.

Mild -- occasional dryness or grittiness. Symptoms can be relieved by over-the-counter re-wetting drops (also called artificial tears), used as needed.

Moderate -- symptoms occur regularly. Re-wetting drops used on a regular schedule (e.g. every 2 or 4 hours; the frequency will vary with the patient) may eliminate or greatly reduce symptoms. Symptoms may vary according to environmental conditions like humidity levels or type of heating or a/c unit.

Severe -- Constant irritation and burning with dehydrated eye tissues, sometimes accompanied by ailments like rheumatoid arthritis or Sjogren's Syndrome. These patients may need stronger prescription medication, both topical and oral, and the constant use of rewetting drops in the daytime and a thicker ointment at night.

CAN DIET HELP?

There is some evidence that an increase in Omega 3 fatty acids may help improve the quality of the tear film and reduce dye eye symptoms. Omega 3's can be found in flax seed, cold water fish (salmon, anchovies, sardines) and supplements.

FIRST STEP: EVALUATION

Before treatment can be started, an evaluation of one's health history should happen, to help determine the nature of the dry eye.

1. Evaluation - determine the extent of the dry eye
2. Medical - is there a medical condition that is causing the dry eye?
3. Ocular - is there a problem with tear production of any of the layers? Are there any lid or lash problems that may add to the irritation?
4. Medications - determine if one is taking any medications (anti-histamines, birth control pills, etc) that may contribute to the problem
5. Environmental - is the heating or cooling system removing humidity from the air?

WHICH BRAND OF ARTIFICIAL TEARS IS BEST?

Many companies offer different types of artificial tears, but no one brand is considered superior. It's more a trial and error to find the drop that works the best for you. Symptoms of dry eye can be treated and relieved, but it is rare that a permanent cure can be found.