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Farhad Naseh, MD Sara Tavassoli, OD
Ghada Orkubi, MD Tamara Mendez, OD
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Dry eye is a medical condition that affects an estimated 20 million people in the United States alone. Dry eye most often results from inadequate lubrication of the eye. Symptoms may be occasional discomfort or chronic and potentially vision-threatening, whether mild or painful. Only your eye care specialist can properly diagnose your dry eye problem.
The Importance of Eye Lubrication:
Tears and Tear Film
Good vision starts with a good tear film that must constantly be produced and spread over our eyes to keep them moist.

Tear film:
Bathes, refreshes and protects the surface of the eye from the irritating effects of dirt, dust, and other airborne particles
Protects from infection
Helps to create a smooth surface so vision stays clear and undistorted
Keeps eyes lubricated and comfortable

If you have an abnormal or deficient tear film, the quality of your vision may be diminished.

Tears are made up of 3 components: lipid, aqueous and mucins. and they must be in balance to create the moisture that keeps our eyes comfortable. If any is missing or damaged, the tear film is compromised and the eye moisture will be depleted causing the eyes to feel dry and irritated.
Chronic dry eye can occur when the tear glands don’t produce the right quantity/quality of tears to keep the eyes lubricated and protected.

Chronic Dry Eye
Blinking spreads the tear film over the eye. If the tear film is inadequate, dry spots can occur causing discomfort and damage to the corneal cells on the surface of the eye. You may not know that you have damaged corneal cells but your eyes may feel dry with a burning sensation. Your eye care specialist will be able to see the surface damage during an eye exam.

Corneal cells can heal quickly if they are diagnosed early and treated with a dry eye lubricant that protects the cells and allows moisture to remain on the surface longer.

Common Causes of Dry Eye
There are many causes of Dry Eye. These can be attributed to a number of different factors:
Aging: As we grow older, our eyes produce tears that have less natural oil in them.
Menopause: Females entering menopause are among the most prone to dry eye.
Autoimmune Disorders: Diseases such as rheumatoid arthritis, lupus, multiple sclerosis, thyroid and Sjogren's syndrome can cause inflammation in the tear-producing lacrimal gland.
Environment: Excessive heat or air conditioning, fans, dry or windy climates, smoke, airplanes, and lack of sleep can all cause dry eye.
Work Environment: Outside wind, dust, heat, or smog can cause dry eye. Focusing on a computer screen for extended periods is also a common cause.
Medications: Numerous medications can cause dry eye. Be sure to tell your eye care specialist about all the medications you are taking.
Eye Medications: Preservatives in artificial tears and anti-glaucoma drops may be toxic to the cells on the surface of the eye and contribute to dry eye.
Contact Lens Wear: Wearing contact lenses can contribute to dry eye.
Several television ad campaigns encourage patients to inform their doctors and pharmacists about all the medications they are taking in order to avoid harmful drug interactions. This is good advice for patients on artificial tears as well.

An ocular medication is much more than just the active drug it contains. Its other components may present difficulties for some patients. This is especially true for patients who are using artificial tear products, suffer chronic eye diseases like dry eye or glaucoma, or require post-surgery dosing of medication drops.

Eye drops are composed of unique mixtures of:
the active drug and its drug delivery system
a preservative
a viscosity increasing agent
a vehicle by which all the above ingredients are "carried"

Of these, it’s the preservative that is most often considered to be the culprit in damaging the top layer of .the cornea leading to disruption when drops are used often. This sequence leaves the surface of the eye unable to keep the tear film in place and can lead to ocular surface disease. If you are using certain medication drops or wear contact lenses it is even more important to have tears that are preservative free.

Common chemical preservatives found in ophthalmic drops are:
Benzalkonium chloride (BAK)
Disodium EDTA

BAK is the most prevalent and its cytotoxicity is well-documented. Reports have shown that BAK can accumulate in ocular tissue and can cause different types of cell death with frequent dosing. It’s thought that patients at greatest risk for BAK-induced adverse effects are those suffering from dry eyes. Because of the lack of natural tears in these patients, the BAK in each eye drop is not as diluted as it would be in a patient with normal tear formation. This may damage the corneal epithelium (top layer of the eye) contributing to ocular surface disease. (Using more than 4 – 6 drops per day increases the likelihood of BAK-induced adverse effects.)

Non-preserved Drops
Studies have shown preservative-free preparations are safe to use in patients, especially with frequent dosing.

Non-preserved artificial tears have an extra advantage over preserved ones. They may be the best choice for patients immediately following eye surgery (LASIK) due to increased viscosity and pH buffering, which makes the drops more comfortable to use. Preservative-free Oasis TEARS™ and Oasis TEARS™ PLUS eliminate the source of toxic irritation caused by preservatives.
Maryland Eye Institute 6 Montgomery Village Ave. Suite 103 Gaithersburg, MD 20879 Phone: (301) 840-2208 Fax: (301) 840-2210

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