Dry/watery eyes

Around ten percent of our population feels severely reduced in their quality of life due to dry or watery eyes. The symptoms include tired eyes, a foreign body sensation, a feeling of sand in the eyes, scratching, redness of the eyes, burning, blinding (sensitivity to light), swollen or sticky eyelids. Increased tears are also often an expression of dryness, especially when cold or after a gust of wind. The symptoms of dry eyes increase due to wearing contact lenses, working at computer or night, and with increasing age.

What is the most common cause of dry or watery eyes?

The tear fluid that moisturizes the eye is produced by the lacrimal gland and released as a watery tear film into the upper conjunctival sac. In a healthy eye, this watery tear film is evenly covered by an oil film. This oil film is produced by the meibomian glands in the eyelid margins and released onto the surface of the eye with every blink of the eye. A complete and intact oil film protects the tear film from evaporation and keeps the surface of the cornea moist and smooth.

The mechanism of dry or watery eyes is well known and usually depends heavily on the state of the meibomian glands and on the flora on the edges of the eyelids. Clogged meibomian glands (meibomian dysfunction) and eyelid inflammation due to bacterial or demodex mites (blepharitis) disrupt the oily protective film and the tear fluid evaporates quickly. As a result, the surface of the eye dries out and cold or drafts can lead to a typical paradoxical overreaction of the lacrimal gland with pronounced lacrimation.

We now know that age, sex hormones, diet and certain skin diseases play an important role in the development of the so-called Sicca syndrome. However, the exact cause is not fully understood. Quite often, eyelid inflammation can lead to hail or barley lead.

How can dry or watery eyes be treated successfully?

The optimal approach is a proven step-by-step principle, where therapy can be gradually intensified:

• Artificial eye drops or long-lasting eye gel replace the natural tear film
• Eyelid care improves the natural composition of the tear film and can be carried out independently or by a second person. The meibomian glands in the eyelids are activated by heating, then massaged or spread out and then cleaned

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Local drug treatments

Depending on the severity of the meibomian gland dysfunction of the inflammation, different medications are used after treatment

• Posiformin disinfectant eye ointments^Ⓡ
• Fucithalmic^Ⓡ Eye ointment contains antibiotics to keep the unbalanced bacterial flora in shaft
• Tobradex^Ⓡ In addition to antibiotics, eye ointment also contains cortisone to treat the inflammatory response locally
• Food supplements such as fish oil and linseed oil have a positive effect on the inflammation of the eyelid margins and on the tear film
• Intensive pulsed light therapy (IPL/e-eye^Ⓡ) stimulates the meibomian glands and reduces diseased blood vessels in the eyelids, which release inflammatory hormones. To achieve a significant effect, we recommend four sessions (not part of the TARMED service catalog).

Treatment for parasite infestations or associated skin diseases

In these diseases, eye dryness or eyelid inflammation is particularly severe and requires special measures accordingly:

• Demodex mites are parasites that can infect the meibomian glands and use drugs based on tea tree oil (Naviblef^Ⓡ) be treated
• Rosacea (copper rose) is a facial skin condition similar to acne and can cause dry eyes. A course of antibiotic tablets can be used as a treatment
  

Dry eyes due to reduced tear production

More rarely, the cause of dry eyes is not due to the meibomian glands, which influence the quality of the tear film, but to the lacrimal glands, which produce too little tear fluid. In this case, we speak of a so-called Sjögren's syndrome.

This is a rheumatic systemic disease where all mucous membranes are affected by dryness. Cyclosporin eye drops and punctum plugs help here. Close cooperation with a rheumatologist is beneficial in cases of pronounced Sjögren's syndrome with systemic involvement.

• cyclosporine 0.05% (Ikervis^Ⓡ) Eye drops suppress the immune system in a very mild way and alleviate inflammation on the surface of the eye (not part of the TARMED service catalog)
• Self-serum eye drops contain, among other things, the body's own growth factors, which are particularly long-lasting to moisturize and regenerate the eye surface

Other minimally invasive methods help to reduce the outflow of reduced tear fluid so that tears stay on the eyes longer:

• Punctum plugs are small silicone plugs that close the drain of tears on the lacrimal spot and can be removed at any time. As a result, the tear fluid remains on the surface of the eye longer (not part of the TARMED service catalog)
• Botox injections paralyze the muscle pump in the tear ducts and thus prevent outflow (not part of the TARMED service catalog

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