Dry Eyes

Do you suffer from eye burning, dryness, tearing, crusting, or chronically red eyes?  Millions of Americans with dry eye syndrome and ocular surface disease endure these types of symptoms every day. Fortunately, help is available at Ticho Eye Associates.

Dry Eyes Diagram

Not all tearing is the same

There are essentially two types of tears: a basal tear that you get every time you blink, and a reactive tear which is produced when the eyes irritated or with an emotional reaction. The most important type of tear is the basal tear which is produced every time one blinks.

Normal tear production is critical to eye health, by washing away debris, and keeping the cornea surface moist and smooth enough to provide excellent focusing for better vision.  Normal tears also contain minute amounts of natural antibiotics, to help prevent infections.

The three types of dry eyes

With age, particularly in women, and in certain diseases, such as Sjogren’s syndrome, basal tear production is reduced.   Symptoms of tear underproduction tend to be worse later in the day when evaporation and activities of daily life aggravate the situation. With tear underproduction, the eye will often feel burning or irritated. In reaction to this dryness and irritation, tearing may be stimulated. Thus, when you can get the paradoxical situation of tearing due to dry eyes.

The second category of dry eye problems is due to relative tear instability. Tears consist essentially of three parts: the main component is water (aqueous). Human tears also contain mucus and oil (lipid).  These non-water components are essential to maintaining the stability of the tear. If the balance between the three layers of tear components is thrown off, by a variety of diseases, the tear may not rest appropriately on the ocular surface, and instead, spill over the eyelid.  There are many conditions where the balance of tear components is disrupted: these include Meibomian gland disease, chemical toxicity, and certain autoimmune conditions. Inflammation from a variety of causes me to affect the ocular surface, disrupting tear gland stability. In many situations, therefore, anti-inflammatory eye drops may be effective.

The third class of conditions affecting the ocular surface and tear stability includes eyelid disorders. The eyelid is essentially a windshield wiper that flushes tears down the drain (tear duct). If the eyelid is an inefficient wiper, from laxity or malposition, for example, the tears may simply overflow over the eyelid margin, rather than going down the drain. In many older individuals, the conjunctiva mucous lining of the eye surface is folded over (conjunctival chalasis), again causing an obstruction to proper tear flow.

How to evaluate dry eyes and ocular surface disease (OSD)

There are many different reasons why your eyes may feel dry, burning, or tearing.  To sort out the cause, the professional at Ticho Eye Associates may measure the number of tears produced, check how salty the tears are (tear osmolarity), image the eyelid oil glands, and see how the cornea surface has been altered.

Click the links below to take the OSDI questionnaire, which aids in quickly assessing how the symptoms of dry eye are affecting visual functionality. The OSDI index score is a great tool in helping your doctor devise the best treatment plan for dry eye symptoms associated with the ocular surface disease.

OSDI and Questionnaire

Download the App:


How to treat dry eyes and ocular surface disease

Treatment of dry eye symptoms, therefore, is tailored to each patient’s individual situation. These treatments may include replacing the deficient tear production with artificial tears, reducing surface irritation with anti-inflammatory drops, cleaning the ocular surface with warm compresses and lid scrubs, or surgically altering the lids. In the past several years, there have been many exciting developments in the field of dry eye and ocular surface disease.

New medications are available, special devices to clean the ocular surface may be appropriate, and light therapy may be advised to directly treat the oil glands in the eyelids. The specialists at Ticho Eye Associates are particularly trained to offer these new treatment modalities. We are one of the only centers in the area with phototherapy treatment capability — to non-invasively heal eyelid skin and oil glands with selective wavelength light therapy.