One of the most common complaints to the eye doctor is “my eyes burn, sting and tear”. My question to this patient is, “do they feel gritty and sandy”? My first thought is to look for blepharitis. Blepharitis is a longstanding problem caused by an infection of the oil glands and lashes follicles that line the lid margin. The lid margin has oil glands that secrete oil to lubricate, making eyes feel moist. If the eyes become dry, they will burn, sting, and tear. As a reflex, the eyes burn and cause the lacrimal gland to secrete water in the form of tears. These tears only provide temporary relief. It surprises patients to learn that their eyes are dry when they are constantly full of water and tearing. However, if you have very dry, chapped hands they would not get much relief by running water over them. It would only help by applying a cream or lotion to the dry hands. The oil film is very important for comfort.
Chronic lid infections can cause the destruction of oil glands due to the inflammation. Bacteria can build up around the lash and shed particle in the eyes causing a foreign body sensation. This can be managed by scrubbing the lids daily. Just like brushing your teeth this daily hygiene is recommended for life. Commercial products are available, however, a clean washcloth or gauze soaked with water and a small amount of baby shampoo are as effective. By using the index finger in the cloth and pulling the lower lid down, looking up away from the lid to avoid abrading the eye, the lid margin can be gently scrubbed. The upper lid is held up while looking down the upper lid margin can be scrubbed. This is better accomplished by feel rather than by trying to look in the mirror. It may be necessary to apply an antibiotic ointment or to take an oral antibiotic.
Another cause of dry eyes is related to sleeping under a ceiling fan. The lids do not completely close and this causes excessive evaporation of the tear film. I have been told many times by patients how much improvement it makes to turn the ceiling fan off. Taking a high-quality fish oil supplement (omega 3 fatty acid) will reduce inflammation and improve the production of the oils in the glands. I prefer Ocean Bluefish oil which does not give a fishy odor to the breath as some supplements do. Over the counter, artificial tears used 3 to 4 times a day will help soothe the eyes. I recommend trying different ones to see which is preferred.
Some medications will cause dry eyes. Over the counter antihistamines, diuretics to treat hypertension, antidepressants and sleeping pills may be a factor. A loss of hormones may also be a factor. It may be necessary to prescribe anti-inflammatory eye drops. In addition, the small channels that drain the tears from the eyes to the nose may be blocked with small plugs.