About Your Tears

In order to understand the causes of Dry Eyes, it is important to have an understanding of your tears and tear film.

The tear film is actually made up of three distinct layers. The innermost layer called the mucous layer, which directly coats the eye and helps the tear film “stick” to the eye. The mucous layer is produced by Goblet cells in the conjunctiva or  “skin of the eye”. The middle layer, called the aqueous layer, is composed primarily of saline and electrolytes, and brings moisture and oxygen to the cornea. The Lacrimal Gland produces the aqueous layer, which is located under the outer portion of your upper eyelid. The outermost layer of the tear film is called the lipid layer, and it is responsible for preventing the tear film from evaporating. The tiny tubular glands in your eyelids produce the lipid layer.  All three layers are critical to having and maintaining a normal tear film. If any of the three layers of the tear film are deficient you may suffer the symptoms of dry eyes.

Dry Eye is an eye condition in which there is a deficiency of the tear film that is due to either an insufficient production of one’s own natural tears or an excessive evaporation of tears. Whether you suffer from insufficient production of tears or excessive evaporation of tears, or both, you may experience a decrease in the quantity and quality of your tear film resulting in the surface of the eye being affected.

Insufficient Tear Production

There are many potential reasons that you may not produce a sufficient quantity of tears. A number of systemic conditions such as Sjorgren’s Syndrome or autoimmune connective tissue diseases such as Rheumatoid Arthritis and Lupus Erythematosis may decrease the quantity of tears that you produce. Patients with Sjorgren’s Syndrome may experience dry eyes as well as a dry mouth and arthritis.

Diseases or inflammation of the tear gland, called the Lacrimal Gland, will also cause patients to produce too few tears to maintain a normal and healthy tear film. Other factors that can effect the Lacrimal Gland contribute to an inadequate production of your own natural tears include long term contact lens wear, past eye infections, certain allergies and even vitamin deficiencies.

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Excessive Evaporation of Tears

There are a number of factors that can result in excessive evaporation of your tears. These can include environmental factors such as being exposed to forced hot air heat at home or at work, dry climates in general, air travel, reduced blinking from contact lens wear, reduced blinking from looking at a computer screen or reading for long periods of time, air pollution or even just blowing your hair dry.

Your tears may evaporate too quickly if you suffer from low-grade eyelid inflammation, called Blepharitis. Within your eyelids are tiny tubular glands called Meibomian Glands. Any inflammation of the eyelids such as from Blepharitis of any type, or a condition called Ocular Rosacea (http://www.emedicine.com/OPH/topic115.htm), can cause the Meibomian Glands to stop secreting their oily film. This oily film is required as an outer layer of the tear film to prevent evaporation. Without the oily layer being present, it is very likely that you will experience a rapid evaporation of tears and symptoms of Dry Eyes.

This is an especially common problem for perimenopausal women as it is believed that 75% of women in this age group have some presence of facial rosacea. This along with the general hormonal changes occurring during this time, make perimenopausal woman particularly susceptible to dry eyes (http://www.agingeye.net/dryeyes/dryeyesinformation.php).

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Finally, your tear film may evaporate too quickly if the tears are not properly spread and replenished over the surface of the eye because of poor eyelid movement This may be due to a number of factors including:

• Improper or incomplete closure of your eyes during sleep
• Eye “bulging” conditions that may be related to thyroid problems
• Loss of tone or shape of the eyelids so that they turn in or turn out

 The physicians and staff of Center for Sight will use every necessary diagnostic procedure to help identify the source of your dry eyes and offer you the best possible solution.

If you or a family member or friend suffer from dry eyes or dry eye syndrome please take a moment to request an appointment by calling Center for Sight in Fall River, Massachusetts at 508.677.0041 or Woonsocket, Rhode Island at 401.769.6323.

Center for Sight is conveniently located for patients in need of diagnosis and treatment of dry eyes in Massachusetts and Rhode Island and from Attleboro, Fairhaven, Fall River, Franklin, Mansfield, Marion, Mattapoisett, Medfield, Milford, New Bedford, North Attleboro, North Dartmouth, Norton, Oxford, Rehobeth, Somerset, Swansea, Taunton, Walpole, Whitinsville, Woonsocket, Providence, Smithfield, Westport, Lakeville, Dighton, Little Compton, and Tiverton.

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