Watering as a symptom of Dry Eye??? Sounds weird right??? How can a condition called “Dry” Eye have a symptom of “Watering”???? In reality, Watering is the most common complaint seen in patients suffering from dry eye.Infact, in most dry eye patients, watering is the presenting symptom and the main reason why a person seeks medical attention. We also commonly see dry eye in patients planned for cataract surgery & spectacle removal surgery
It is estimated that 7 in every 10 people suffer from some degree of dry eye at any point in time. This is even more common in the urban population and is growing day-by-day.
Why is dry eye so common today??
To understand this condition, we need to know a few facts about our tears. You probably know that our tears are made and secreted by a tear gland, or lacrimal gland. We have a main lacrimal gland that is above the eye, and several smaller glands scattered throughout conjunctiva, the clear membrane that covers the white part of the eye as well as lining the inside of the eye lids. These glands produce the water part of the tears, and when you cry, a large amount is produced. This is the water or aqueous layer of the tear film.
There is another layer covering this water layer and that layer is actually made of fat (lipids). This layer acts as a surfactant, i.e it helps in uniform spreading of the tear and prevent the evaporation of the water layer, and, in other words, seals the moisture. It turns out, that majority, or 70% of all dry eye cases are caused by deficiency or problem with the fat layer.
What actually happens when the fat (lipid) layer is faulty???
When there is a deficiency in the lipid layer of the tears, the surfactant effect is lost. So tear spreading with every blink becomes erratic. The tears, which are meant to cover the whole surface of the eye between the blinks, tends to have various dry spots or tends to gravitate towards the lower lid. This particular effect may lead to either,
- Early drainage of the tear through the tear ducts leading to discomfort or more commonly,
- Overflow of tears from the lid margins which presents as “watering”
Hence sometimes, “Dry eye is characterised by a watering eye”
Inflammation and Dry Eye:
Inflammation is another process which plays an important role in dry eyes. Many studies show an increased presence of inflammatory markers in the tears of dry eye patients. It is estimated that inflammatory cells further disrupts the quality of tear film dynamics leading to a more unstable tear film. This leads to a vicious cycle of degraded tear film quality and it is now believed that this component of the disease, too, needs to be treated.
Both lipid disruption and inflammation change the dynamics of the naturally occurring tear film.
In other words, dry eye is clearly a problem of QUALITY and not of QUANTITY. Although the quantity of the tear produced in normal, it is the poor quality of the tear which is the problem.
How do we treat Dry Eye???
Dry eye is a manageable condition. As the tear film is exposed to the environment throughout the day, it does take some patience and discipline to get the desired results. Warm compress is one of the traditional methods of treatment which is effective even today and can be started at home without the supervision of a physician provided he or she has been explained the procedure before.
Artificial tear drops are the mainstay of dry eye management. But most of the times just prescribing an artificial tear drops is not enough. Treating the inflammatory cycle is equally important. Usually it’s the combination of the two which give the best results in dry eye patients.
In conclusion, it is important for everyone to understand what dry eye actually means to understand its symptoms. Maybe dry eye is more commonly seen today because of the change in diet, lifestyle and general habits of people and hence we need to increase awareness about dry eyes among our patients. This will go a long way to address this widespread condition.
MD MS FPRS (NN) FICO (UK) FAICO
Senior Consultant, Cataract & Cornea Refractive Surgeon,
Ghodbunder Road, Thane W