Cornea and Dry Eye

What Is Dry Eye?

Dry eye syndrome is a common condition in which the eyes produce an abnormally low volume of tears. Tears perform an important function for the eye, keeping it clean and lubricated, providing nutrition, and establishing a smooth surface through which the eye refracts light.

What are the Symptoms of Dry Eye?

Typical symptoms of dry eye include a dry or gritty sensation, scratchiness, itching, burning, pain, eyelid heaviness, intermittent blurred vision and intermittent tearing. Symptoms are usually worse later in the day after prolonged use of the eyes, and in conditions of heat, wind and low humidity.

Many patients with dry eye syndrome complain of intermittent tearing. Normally, the lids produce a small amount of tears to keep the eyes lubricated and healthy. If this tearing is of poor quality or of insufficient quantity to keep the eyes healthy, a message will be sent to the brain to cause a reflex flow of tears from the main tear gland. This is usually a large volume of watery tears that may not provide adequate lubrication. In other cases, the eyes may attempt to make up for poor quality tears with an increased quantity of tears. In either case, artificial lubricants can help decrease the tearing.

How Does NSES Treat Dry Eye?

Dry eye syndrome is rarely a serious problem, but it is almost always a nuisance. Treatment initially begins with artificial lubricants, usually drops given 3 to 6 times a day. Warm, wet soaks with a clean washcloth can also be used when the eyes are especially irritated. Artificial tears work best when given on a scheduled basis rather than in response to symptoms. After beginning therapy with artificial tears, it may take several weeks of continuous use before long lasting improvement in symptoms is achieved.

More severe cases of dry eye may require the use of an ointment or gel at bedtime, and/or the use of preservative-free artificial tears every hour or two during the day. Patients with severe symptoms may also consider closure of the tear drainage system (punctual occlusion), which allows the patient’s own tears to remain on the eye longer.

All artificial tears are not created equal. Many have preservatives that can cause further irritation, especially if used frequently. Gently preserved artificial tears may be used up to 4-6 times a day. If more frequent use is required or for especially sensitive eyes, non-preserved tears should be used.

What is Corneal Disease?

Corneal disease is a serious condition affecting the cornea that can cause clouding, vision distortion and eventual blindness. The cornea is like the clear front window of the eye that transmits light to the interior of the eye and allows us to see clearly. There are many types of corneal disease. The three major types are keratoconus, Fuchs’ endothelial dystrophy and bulls keratopathy.

Keratoconus is a weakening and thinning of the central cornea. The cornea develops a cone-shaped deformity at a pace that can be rapid, gradual or intermittent. Keratoconus usually occurs in both eyes, but can occur in only one eye.

Fuchs’ endothelial dystrophy is a hereditary abnormality of the inner cell layer of the cornea called the endothelium. In a healthy eye, this layer pumps fluids out of the cornea, keeping it thin and crystal clear. An unhealthy endothelium does not properly pump fluids causing the cornea to swell and become cloudy which decreases vision.

Bullous keratopathy is a condition in which the cornea becomes permanently swollen. Damage to the inner layer of the cornea, the endothelium, causes a buildup of excess fluid in corneal tissue.

What are the symptoms of corneal disease?

The exact symptoms of corneal disease often depend on the type. When the cornea protrudes or steepens (keratoconus), vision becomes increasingly blurred and contact lens wear, which is often an early treatment for the disease, becomes difficult. The irregular shape of the cornea makes it difficult for the contact to stay on the eye. Fuchs’ endothelial dystrophy and bullous keratopathy may cause glare at night or in bright sunlight. As these conditions progress, vision may become foggy or blurry in the morning but improve as the day goes on. As the disease worsens, vision stays blurry later into the day or may not clear up at all.  Corneal diseases can be very painful.

If you are experiencing one or more of these symptoms, contact North Suburban Eye Specialists to set up an appointment with one of our experienced optometrists.

What causes corneal disease?

Corneal disease may be caused by one or more of the following factors:

• Bacterial, fungal or viral infections are common causes of corneal damage
• The aging process can affect the clarity and health of the cornea
• Bullous keratopathy occurs in a very small percentage of patients following cataract or intraocular lens implant surgeries
• Heredity
• Contact lens use
• Eye trauma
• Certain eye diseases, such as retinitis pigmentosa, retinopathy of prematurity, and vernal keratoconjunctivitis
• Systemic diseases, such as Lebe’s congenital amaurosis, Ehlers-Danlos syndrome, Down syndrome and osteogenesis imperfecta

How is corneal disease diagnosed?

Using a slit lamp and advanced diagnostic technology such as corneal topography, your doctor can detect early cataracts, corneal scars, and other problems associated with the front structures of the eye. After dilating your eyes, your doctor will also examine your retina for early signs of disease – including certain corneal diseases.

How is corneal disease treated?

As with any serious eye infection, corneal disease should be treated immediately. Although corneal transplant is almost always the necessary treatment to restore vision when the cornea becomes clouded, there are other measures that can be taken to prolong vision in the early stages of disease such as special contact lenses or medication.

To catch and treat corneal disease early, schedule regular eye exams at North Suburban Eye Specialists to protect your vision.