Dry Eye Syndrome

Dry eye syndrome is a chronic lack of sufficient lubrication and moisture in the eye.

Its consequences range from subtle but constant irritation to ocular inflammation of the anterior (front) tissues of the eye.

Dry eyes also are described by the medical term, keratitis sicca, which generally means decreased quality or quantity of tears. Keratoconjunctivitis sicca refers to eye dryness affecting the cornea and conjunctiva.

Dry Eye Syndrome Symptoms

Persistent dryness, scratching and burning in your eyes are signs of dry eye syndrome. These symptoms alone may prompt your eye doctor to diagnose dry eye syndrome.

But sometimes your eye doctor may want to measure the amount of tears in your eyes. A thin strip of filter paper placed under the lower eyelid, called a Schirmer test, is one way to measure tear production.

Another symptom of dry eyes is a “foreign body sensation,” the feeling that something is in the eye.

And it may seem odd, but sometimes watery eyes can result from dry eye syndrome, because the excessive dryness works to overstimulate production of the watery component of your eye’s tears.

What Causes Dry Eyes?

Tears bathe the eye, washing out dust and debris and keeping the eye moist. They also contain enzymes that neutralize the microorganisms that colonize the eye. Tears are essential for good eye health.

In dry eye syndrome, the eye doesn’t produce enough tears, or the tears have a chemical composition that causes them to evaporate too quickly.

Dry eye syndrome has several causes. It occurs as a part of the natural aging process, especially during menopause; as a side effect of many medications, such as antihistamines, antidepressants, certain blood pressure medicines, Parkinson’s medications and birth control pills; or because you live in a dry, dusty or windy climate.

If your home or office has air conditioning or a dry heating system, that too can dry out your eyes. Another cause is insufficient blinking, such as when you’re staring at a computer screen all day.

Dry eyes are also a symptom of systemic diseases such as lupus, rheumatoid arthritis, ocular rosacea or Sjogren’s syndrome (a triad of dry eyes, dry mouth and rheumatoid arthritis or lupus).

Long-term contact lens wear is another cause; in fact, dry eyes are the most common complaint among contact lens wearers.

Recent research indicates that contact lens wear and dry eyes can be a vicious cycle. Dry eye syndrome makes contact lenses feel uncomfortable, and the rubbing of the lenses against the conjunctiva seems to be a cause of dry eyes.

Incomplete closure of the eyelids, eyelid disease and a deficiency of the tear-producing glands are other causes.

Tears are composed of three layers:

• the outer, oily lipid layer;
• the middle, watery, lacrimal layer;
• and the inner, mucous or mucin layer.

Each layer is produced by different glands near the eye. The lacrimal gland located above the outer corner of the eye produces the lacrimal layer, for example. So a problem with any of those sources can result in dry eyes.

Dry eye syndrome is more common in women, possibly due to hormone fluctuations. A recent study also indicates that that risk of dry eyes among men increases with age.

Recent research suggests that smoking, too, can increase your risk of dry eye syndrome.

With increased popularity of cosmetic eyelid surgery (blepharoplasty) for improved appearance, dry eye complaints now occasionally are associated with incomplete closure of eyelids following such a procedure.

Treatment for Dry Eyes

Dry eye syndrome is an ongoing condition that may not be completely curable (depending on the cause), but the accompanying dryness, scratchiness and burning can be managed. Your eye care practitioner may prescribe artificial tears, which are lubricating eye drops that may alleviate the dry, scratching feeling.

Punctal plugs help keep moisture on the eye by keeping tears from draining too quickly.

Left: Artificial tears help dry eyes feel better; don’t confuse them with formulas that just reduce redness. Salmon is a good source of omega-3 fatty acids, which may reduce your risk for dry eyes. Sardine, herring and cod liver oils are even better, or try a supplement.

Restasis eye drops (cyclosporine in a castor oil base) go one step further: by helping your body produce more tears. Restasis treatment is the first of its kind.

Another option for dry eye treatment is called Lacrisert, a tiny insert filled with a lubricating ingredient (hydroxypropyl cellulose). The insert is placed just inside the lower eyelid, where it continuously releases lubrication for the eye throughout the day.

Sometimes people use the eye drops that “get the red out” to treat their dry eyes. This won’t work unless the eye drops also contain artificial tears, and the original “get-the-red-out” formulation doesn’t. These drops can reduce or eliminate the redness temporarily, but they don’t treat the cause of the redness, whether it’s dryness, environmental irritation or some other problem.

Not only that, but the vasoconstrictors in those formulas that reduce redness by contracting the eye’s blood vessels are addictive, in the sense that over time, more and more is needed to achieve the same effect. With frequent use, the effect diminishes after a while — the blood vessels simply won’t constrict as much as they did when you first used the drops.

If you wear contact lenses, be aware that many eye drops, especially artificial tears, cannot be used while your contacts are in your eyes. You’ll need to remove them before using drops and wait 15 minutes or even longer (check the label) before reinserting the lenses.

If your eye dryness is mild, then contact lens rewetting drops may be sufficient to make your eyes feel better, but the effect is usually only temporary.

Check the label, but better yet, check with your optometrist or ophthalmologist before buying any over-the-counter eye drops. It will probably save you a lot of money, because he or she will know which formulas are effective and long-lasting and which ones are not, as well as which eye drops will work with your contact lenses.

If the problem is environmental, wear sunglasses when outdoors, to reduce exposure to sun, wind and dust. You may want to try the kind that has a foam or other seal at the sides and/or a close-fitting, wrap-style frame to keep wind and dust from getting behind the lenses and in your eyes.

Indoors, an air cleaner can filter out dust and other particles from the air, while a humidifier adds moisture to air that’s too dry because of air conditioning or heating.

Temporary or permanent silicone plugs in the lacrimal (tear) ducts keep tears in your eye from draining away as quickly. Called lacrimal plugs or punctal plugs, they can be inserted painlessly while you’re in the eye doctor’s office and normally are not felt once inserted.

Texas Cities Dominate Top Dry Eye Hot SpotsREDBANK, N.J., June 2006 — The National Women’s Health Resource Center has named the top 100 dry eye hot spots in the United States based on information compiled from the National Oceanic and Atmospheric Administration’s Climatic Data Center and the Environmental Protection Agency.

Factors used in the selection process included temperatures, humidity, wind, altitude, pollutants and ocular allergens.

The top 20 U.S. cities named as dry eye hot spots are:

1. Las Vegas, Nevada 2. Lubbock, Texas* 2. El Paso, Texas* 4. Midland/Odessa, Texas 5. Dallas/Fort Worth, Texas 6. Atlanta, Georgia 7. Salt Lake City, Utah 8. Phoenix, Arizona 9. Amarillo, Texas 10. Honolulu, Hawaii

11. Oklahoma City, Oklahoma 12. Albuquerque, New Mexico 13. Tucson, Arizona 14. Norfolk, Virginia 15. Newark, New Jersey 16. Boston, Massachusetts 17. Denver, Colorado 18. Pittsburgh, Pennsylvania 19. Bakersfield, California* 19. Wichita, Kansas*

*Cities were tied for these spots.

A new type of punctal plug made of acrylic is a small rod that becomes a soft gel when exposed to your body heat after insertion. It is designed to swell and conform to the size of your tear drainage canal. Advantages of this type of plug are that one size fits all, so measurement is unnecessary, and nothing protrudes from the tear duct that could potentially cause irritation.

Dry eyes can become red and irritated, causing a feeling of scratchiness.

Another new kind of punctal plug is made of a hydrogel that expands into a soft, pliable gel in the tear drainage canal. It has no cap, and should it need to be removed, the eye care practitioner can simply flush it out with saline solution.

With some people, however, punctal plugs aren’t effective enough, so their tear ducts need to be closed surgically (punctal cautery).

Doctors sometimes recommend special nutritional supplements for dry eyes. Studies have found that supplements containing certain essential fatty acids (linoleic and gamma-linolenic) can decrease dry eye symptoms.

You also could eat more cold-water fish, such as sardines, cod, herring and salmon, which contain omega-3 fatty acids. Some eye doctors specifically recommend flaxseed oil to relieve dry eye.

Drinking more water can help, too (see sidebar).

If medications are the cause of dry eyes, discontinuing the drug generally resolves the problem. But in this case, the benefits of the drug must be weighed against the side effect of dry eyes. Sometimes switching to a different type of medication alleviates the dry eye symptoms while keeping the needed treatment. In any case, never switch or discontinue your medications without consulting with your doctor first!
~All About Vision~

For questions, or schedule an appointment, contact:
Premier Eyecare of Edmond, Julie Moore, O.D., #405.513.8150
http://www.okpremiereyecare.com

A Look at Reading and Vision

When Michael or Jennifer has trouble reading, parents and teachers need to investigate many different possible causes.

Because a combination of problems, rather than just one, is usually at the root of a reading difficulty, all possible causes should be explored.

One that is sometimes overlooked is the child’s vision. This may happen because the child appears to be able to see, does not complain about his or her eyes, has passed a school vision screening or has not had a comprehensive eye examination.

To See to read

Reading requires the integration of a number of different vision skills: visual acuity, visual fixation, accommodation, binocular fusion, convergence, field of vision, and form perception. Of these, only one is checked by the typical school eye chart test.

Limited eye examinations may cover only one or two. And symptoms of reading related vision problems are often not noticeable to parent, teacher or child.

A comprehensive optometric examination, however, does cover these vision skills. It is a must for every child who is having trouble reading.

Visual Acuity

Visual acuity is the ability to see objects clearly. It is usually the only skill assessed in a school vision screening. The typical school eye chart is designed to be seen at 20 feet and measures how well or poorly the child sees at that distance.

If a problem is discovered in the screening, the child should be referred for a thorough optometric examination.

Visual Fixation

Fixation is the skill utilized to aim the eyes accurately. Static fixation is the ability to focus on a stationary object when reading a word or working a math problem. Saccadic fixation is the ability to move the eyes quickly and accurately across a page to read a line of print.

Pursuit fixation is the ability to follow a moving object with the eyes.

These complex operations require split second timing for the brain to process the information received and to track the path of the moving object.

Accommodation

Accommodation is the ability to adjust the focus of the eyes as the distance between the individual and the object changes. Children frequently use this vision skill in the classroom as they shift their attention (and focus) between their book and the chalkboard for sustained periods of time. Being able to maintain focus at near for sustained periods of time is important for reading, writing and also taking tests.

Binocular Fusion

Binocular fusion refers to the brain’s ability to gather information received from each eye separately and form a single, unified image. A child’s eyes must be precisely aligned or blurred or double vision, discomfort, confusion or avoidance may result.

If that occurs, the brain often subconsciously suppresses or inhibits the vision in one eye to avoid confusion. That eye may then develop poorer visual acuity (amblyopia or lazy eye).

Convergence

Convergence is the ability to turn the two eyes toward each other to look at a close object. School desk work is one instance in which a child depends on this vision skill.

Field of Vision

Field of vision is the wide area over which vision is possible. It is important that a child be aware of objects in the periphery (left and right sides and up and down) as well as in the center of the field of vision. Near central or Para-central vision is important for reading ability.

Perception

Visual perception is the total process responsible for the reception and understanding of what is seen. Good visual perception is necessary for successful school achievement.

Form perception is the ability to organize and recognize visual images as specific shapes. The shapes the child encounters are remembered, defined and recalled when development of reading skills begin.

Regular optometric care can help assure that a child will have the visual skills necessary for successful classroom performance.

Treating reading-related vision problems

The optometrist examines these vision skills and determines how well the child is using them together. When a vision problem is diagnosed, he or she can prescribe glasses, vision therapy or both.

Vision therapy has proved quite effective in treating reading-related vision problems. It involves an individualized program of training procedures designed to help a child acquire or sharpen vision skills that are necessary for reading.

Treating reading problems

Because reading problems usually have multiple causes, treatment must often be multidisciplinary. Educators, psychologists, optometrists and other professionals must confer and work together to meet each child’s needs.

The optometrist’s role is to help the child overcome the vision problems interfering with the ability to read.

Once this is accomplished, the child is then more capable of responding to special education efforts aimed at treating the reading problem itself.
~ American Optometric Association ~

For more information, or to schedule a comprehensive eye exam, contact:

Premier Eyecare of Edmond, Julie Moore, O.D.  #405.513.8150

Toys, Games, and Your Child’s Vision

Developing vision at playtime

There are some children’s games that call for blindfolds or “not peeking until…” or hiding from sight.

However, most of the time your child is at play his or her eyes are a part of the action.

You can find a lot of ways to use playtime activities, games and toys to help your child, regardless of age, to learn or sharpen many different vision skills. And it can be done without interfering with the carefree fun and joy of playtime.

How toys and games can help

From the moment of birth, you child is learning to see. He or she progresses from the newborn’s blurry world of light and dark to the school-age child’s sophisticated ability to handle complex vision tasks. Toys, games and playtime activities help by stimulating this process of vision development. Sometimes, though, despite all your efforts, your child may still miss a step in vision development.

That is why comprehensive optometric care beginning as early as 6 months of age is so important. Your doctor of optometry can identify vision skill areas in need of attention and diagnose vision problems in their early stages, before they have a chance to interfere with your child’s total development or learning ability.

He or she may prescribe glasses or vision therapy or suggest specific activities or toys you can use at home to help with your child’s problems.

Toy-buying tips

Inexpensive homemade toys and simple childhood games can be just as effective as purchased toys in helping children develop and improve their vision skills.

When buying toys, select those that are well-made and appropriate to the child’s age and level of maturity. Manufacturers often give suggested ages for a toy, but, keep the individual child in mind because children develop at different rates.

Buy the proper safety equipment for older children and be certain they wear it when participating in eye hazardous sports and when using chemistry sets, shop tools, BB guns, sleds or other items with potential to cause eye injuries. Most eye injuries suffered by children occur during play or sports activities and can be prevented.

Consider this list

Here is a list of toys and activities that can help your child develop or improve various vision skills.

Those suggested for birth through 5 months of age will help stimulate your baby’s sense of sight.

Those suggested for older age groups will help develop or sharpen your child’s general eye movement skills; eye-hand coordination skills necessary for writing and sports; shape and size discrimination skills needed for reading; and visualization and visual memory skills needed for comprehension and for the ability to visualize abstract things.

Birth Through 5 Months Toys: Sturdy crib mobiles and gyms; bright large rattles and rubber squeak toys. Activities: Peek-a-boo; patty-cake.

6 Months Through 8 Months Toys: Stuffed animals; floating bath toys. Activities: Hide-and-Seek with toys; read to child.

9 Months Through 12 Months Toys: Sturdy cardboard books; take-apart toys; snap-lock beads; blocks; stacking/nesting toys. Activities: Roll a ball back-and-forth; read to child.

One-Year Olds Toys: Bright balls; blocks; zippers; rocking horse; riding toys pushed with the feet. Activities: Throwing a ball; read to child.

Two-Year Olds Toys: Pencils, markers, crayons; bean bag/ring toss games; peg hammering toys; sorting shapes/sizes toys; puzzles; blocks. Activities: Read to child; outdoor play; catch.

3 to 6 Years Toys: Building toys with large snap-together components; stringing beads; puzzles; pegboards; crayons; finger paint; chalk; modeling clay; simple sewing cards; large balls; match-up-shape toys; tricycle; connect-the-dot games; sticker boots/games. Activities: Climbing, running; using balance beam; playground equipment.

7 Years and Older Toys: Bicycle; jump ropes; pogo sticks; roller skates; different size and shape balls; target games; more sophisticated building toys; puzzles; remote-controlled toys; timed shape/size sorting games; plastic disks for tossing between players. Activities: Active sports; cycling.

This list of toys and activities is not complete. There are many other ways you can aid your child’s vision development and teach him or her good eye safety and vision care habits. Use your creativity and imagination. Computer learning programs and games can be very useful, if available. Also, ask your optometrist to suggest other specific toys and activities.

For questions, or a comprehensive eye exam. contact:
Dr. Julie Moore, Premier Eyecare of Edmond, #513.8150

Adult Vision: 19 to 40 Years of Age

Most adults, aged 19 to 40, enjoy healthy eyes and good vision. The most common eye and vision problems experienced by people in this age group are due to visual stress and eye injuries. By taking proper steps to maintain a healthy lifestyle and protect your eyes from stress and injury, you can avoid many eye and vision problems.

Good vision is important as you pursue a college degree, begin your career, or perhaps start and raise a family. Here are some things you can do to help maintain healthy eyes and good vision:

• Eat Healthy — As part of a healthful diet, eat five servings of fruits and vegetables each day. Choose foods rich in antioxidants like leafy, green vegetables and fish.
• Don’t Smoke — Smoking exposes your eyes to high levels of noxious chemicals and increases the risk for developing age-related macular degeneration (AMD) and cataracts.
• Get Regular Exercise — Exercise improves blood circulation, increases oxygen levels to the eyes and aids in the removal of toxins.
• Wear Sunglasses — Protect your eyes from harmful ultraviolet (UV) rays when outdoors. Choose sunglasses with UVA and UVB protection, to block both forms of ultraviolet rays.
• Get Periodic Eye Examinations — Although vision generally remains stable during these years, some problems may develop without any obvious signs or symptoms. The best way to protect your vision is through regularly scheduled professional eye examinations.

The American Optometric Association recommends that adults aged 19 to 40 receive an eye exam at least every two years. If you are at risk for eye problems due to a family history of eye disease, diabetes, high blood pressure or past vision problems, your doctor of optometry may recommend more frequent exams. In between examinations, if you notice a change in your vision, contact your doctor. Detecting and treating problems early can help maintain good vision for the rest of your life.
~American Optometric Association~

For a comprehensive eye exam, or questions regarding your vision, contact:

Premier Eyecare of Edmond, Dr. Julie Moore, #405.513.8150