Formula Medical Group
Apple Valley, CA

James Krider, MD

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Dry eyes - Lacrimal gland dysfunction

What are dry eyes?

Dry eyes occur when the external part of the eyeball receives inadequate moisture due to a deficiency in tear production by the lacrimal glands, which are located above and to the right of either eye, just below the eyebrows. The condition is usually chronic, and it invariably affects both eyes.

Dry eyes can occur at any time in life, but people in middle age (especially women) are more likely to develop them thanchildren and young adults.


  • A burning, irritated, hot, or gritty sensation in the eyes.
  • Redness in the whites of the eyes.
  • Sensitivity to bright light .

What causes dry eyes?

Sometimes dry eyes arise as an independent disorder, in which case their underlying cause remains unknown.

In other cases, the condi­tion arises in conjunction with certain rheumatic disorders, particularly rheumatoid arthritis and systemic lupus erythematosus, both of which are autoimmune disorders in which the immune system attacks the body's own tissues. When dry eyes are secondary to these disorders, the condition is known as Sjogren's syndrome and it is accompanied by a decreased output of saliva. Less commonly, dry eyes are caused by an allergy to eye drops or an eye ointment.

How are dry eyes diagnosed and treated?

Your eye doctor (ophthalmologist) can conduct several tests to measure the fluid level in your eyes and evaluate lacrimal gland function. He or she examines your eyes through a mechanism called a slit lamp to assess the conjunctiva, the cornea, and the adequacy of the tear opening from the lacrimal gland. The examination also involves a Schirmer's test, in which the doctor places a standardized strip of filter paper between your lower eyelid and your eyeball. This paper remains in place for 5 minutes, after which the degree of moisture absorbed is evaluated. Abnormally low Schirmer's test results on two different days are required to confirm a diagnosis of dry eyes. The mainstay of treatment is to lubricate the eyes artificially.

What can I do myself?
You should not attempt to treat dry eyes with commercial eye

Normally tears are produced in the lacrimal glands and drain out through a duct to the nasal passages

Normally tears are produced in the lacrimal glands and drain out through a duct to the nasal passages

drops or any other preparations before consulting an eye doctor.

When should I see my doctor?
Any persistent sensation of dryness, irritation, burning, or grittiness should prompt you to make an appointment with your eye doctor.

What will the doctor do?
In the infrequent cases when dry eyes are caused by an allergy to eye drops or an eye ointment prescribed for some other condition, discontinuation of the medication should promptly restore the normal moisture level in the eyes.

In most cases, however, you must lubricate your eyes with artificial tears containing methylcellulose or polyvinyl alcohol. By placing these drops in your eyes every day, they supplement your own tears and make your eyes more comfortable. Although this course of self-care must continue throughout the rest of your life, it resolves the discomfort of dry eyes and helps avoid further problems, including possible vision loss.

If artificial tears fail to arrest the problem, your eye doctor may prescribe soft contact lenses. The high moisture content of these lenses helps lubricate the eye. Frequent application of saline eye drops throughout the day enhances the effectiveness of soft contact lenses.

Further therapy is rarely necessary, but in severe cases, the doctor may recommend an eyelid operation called partial tarsorrhaphy. This procedure involves sewing together part of

Artificial tears are a mainstay of treatment.
Artificial tears are a mainstay of treatment.

the eyelids to shorten the eyelid opening. It helps protect the eyes by reducing the loss of tears through evaporation.

The course of dry eyes

If dry eyes are not treated promptly, they may become highly sensitive to light, a condition known as photophobia. Superficial keratitis, which destroys cells in the epithelium (a specialized tissue that lines many body organs) may result in spasmodic blinking due to contraction of the muscles around the eye.


  • Although dry eyes may be itchy, it is essential to avoid rubbing them. Bacteria and irritants on the fingers can quickly infect dry eyes.
  • If you wear soft contact lenses to enhance your eyes' moisture content, scrupulously follow your doctor's cleaning regimen.


Untreated dry eyes can also lead to progressive corneal ulceration and scarring, which ultimately impair vision.

In some people, dry eyes herald dryness of other fluids in the body. Such people may go on to experience a dry mouth, insufficient digestive juices, and a decrease in the fluids that normally lubricate the joints.

Even if dry eyes can be controlled easily by frequently using artificial tears, those who have been diagnosed with this condition should see an eye doctor for regular check-ups.

Are dry eyes dangerous?
Normally not, if they are treated promptly. However, if they go untreated or fail to respond to treatment, dry eyes can progress to severe vision loss.

What can I do to avoid dry eyes?

Since the underlying cause remains unknown, no preventive action can be taken.

This article was last reviewed November 23, 2005 by Dr. James Krider.
Reproduced in part with permission of Home Health Handbook.

Lupus erythematosus
Rheumatoid arthritis
Sjogren's sydndrome

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