Health Information – 9

9. Dry eyes

Definition
Dry eyes occur when your tears aren’t able to provide adequate moisture for your eyes. Tears can be inadequate for many reasons. For example, dry eyes may occur if you don’t produce enough tears or if you produce poor-quality tears.

Symptoms :
Signs and symptoms of dry eyes, which usually affect both eyes, may include:
• A stinging, burning or scratchy sensation in your eyes
• Stringy mucus in or around your eyes
• Increased eye irritation from smoke or wind
• Eye fatigue after short periods of reading
• Sensitivity to light
• Difficulty wearing contact lenses
• Periods of excessive tearing
• Blurred vision, often worsening at the end of the day or after focusing for a prolonged period .

Cause:
Dry eyes are caused by a lack of adequate tears. Your tears are a complex mixture of water, fatty oils, proteins and electrolytes. This mixture helps make the surface of your eyes smooth and clear, and it helps protect your eyes from infection. For some people, the cause of dry eyes is an imbalance in the composition of their tears. Other people don’t produce enough tears to keep their eyes comfortably lubricated. Eyelid problems, medications and other causes, such as environmental factors, also can lead to dry eyes.

Poor tear quality
The tear film has three basic layers: oil, water and mucus. Problems with any of these layers can cause dry eyes symptoms.
• Oil. The outer layer of the tear film, produced by small glands on the edge of your eyelids (meibomian glands), contains fatty oils called lipids. These smooth the tear surface and slow evaporation of the middle watery layer. If your oil glands don’t produce enough oil, the watery layer evaporates too quickly, causing dry eyes. Dry eyes are common in people whose meibomian glands are clogged. Meibomian dysfunction is more common in people with inflammation along the edge of their eyelids (blepharitis), rosacea and other skin disorders.
• Water. The middle layer is mostly water with a little bit of salt. This layer, produced by the tear glands (lacrimal glands), cleanses your eyes and washes away foreign particles or irritants. If your eye produces inadequate amounts of water, the oil and mucus layers can touch and cause a stringy discharge.
• Mucus. The inner layer of mucus helps spread tears evenly over the surface of your eyes. If you don’t have enough mucus to cover your eyes, dry spots can form on the front surface of the eye (cornea).

Decreased tear production
Dry eyes can occur when you’re unable to produce enough tears. The medical term for this condition is keratoconjunctivitis sicca (ker-uh-to-kun-junk-ti-VIE-tis sik-uh).

You may not produce enough tears if you:
• Are older than 50. Tear production tends to diminish as you get older. Dry eyes are common in people older than 50.
• Are a postmenopausal woman. A lack of tears is more common among women, especially after menopause. This may be due in part to hormonal changes.
• Have a medical condition that reduces your tear production. Dry eyes are also associated with some medical conditions such as diabetes, rheumatoid arthritis, lupus, scleroderma, Sjogren’s syndrome, thyroid disorders and vitamin A deficiency.
• Have had laser eye surgery. Refractive eye surgeries such as laser-assisted in-situ keratomileusis (LASIK) also may cause decreased tear production and dry eyes. Symptoms of dry eyes related to these procedures are usually temporary.
• Have tear gland damage. Damage to the tear glands from inflammation or radiation can hamper tear production.

Eyelid problems
Blinking spreads a continuous thin film of tears across the surface of your eyes. If you have an eyelid problem that makes it difficult to blink, tears may not be spread across your eye adequately or your tears may evaporate too quickly, causing dry eyes. Eyelid problems can include an out-turning of the lids (ectropion) or an in-turning of the lids (entropion).

Medications that cause dry eyes
Medications that can cause dry eyes include:
• Certain types of drugs used to treat high blood pressure, such as central-acting agents and diuretics
• Antihistamines and decongestants
• Birth control pills
• Certain antidepressants
• Pain relievers, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve)
• Isotretinoin-type drugs for treatment of acne Other dry eyes causes

Other causes of dry eyes include:
• Wind
• High altitude
• Dry air
• Tasks that require concentration, such as working at a computer, driving or reading.

Risk factors
Factors that make it more likely that you’ll experience dry eyes include:
• Increasing age
• Being a woman
• Taking medications that can cause dry eyes
• Having laser eye surgery
• Undergoing radiation therapy, such as is used to treat cancer, aimed at the eyes
• Eating a diet that is low in vitamin A, which is found in liver, carrots and broccoli, or low in omega-3 fatty acids, which are found in fish, walnuts and vegetable oils.

Complications:
Most people don’t experience complications caused by dry eyes. Complications that can occur include:
• More frequent eye infections. Your tears protect the surface of your eye from infection. Without adequate tears, you may have an increased risk of eye infection.
• Scarring on the surface of your eye. If left untreated, severe dry eyes may lead to eye inflammation, scarring on the surface of your cornea and vision problems.

Tests and diagnosis
After the diagnosis, the doctor sets out to treat the patient in a very systematic manner. This would include a set of appropriate Panchakarma treatments and Rasayana therapies .
The Panchakarma Treatments are meant to flush out the toxins, They are classified as pre-purification, main purification and post purification phases and include various types of therapies like oil massages, fermented liquid massages, medicinal enemas, herbal purification methods.

After body purification rasayana therapies along with Netra Kriya-kalpa’s were started such as:
1.Sekam :- An eye wash using medicated kashayam.
2.Anjanam :- An application of medicine in the form of paste to he eye.
3.Aschotanam :- An adminestration of eye drops to the eye.
4.Tharpanam :-  Keeping medicated ghee over the eye for a stipulated period, making concentric boundary around the orbit.
5.Puttapakam :- Keeping medicaments prepared out of plant extracts,Fats & certain minerals  over the eye for a stipulated period, making concentric boundary around the orbit.

*In all the above kriya-kalpa different types of drugs are selected by your doctor according to the doshas involved.

Oral medication:
The oral medicine used for treating the disease will be extracts of pure medicinal herbs, leaves, spices etc. These are prepared specifically to restore the lost balance and to provide the needed inputs to improve the condition of patient. kashayams and Arishtam – herbal decoctions and fermentations lehyams – semi solid formulation are commonly prescribed.

Diet :
Brinjal, Lady finger, Jackfruit, Curd, Pickles, Lemon, Oily-Spicy food should be avoided .
Include a variety of colorful fruits and vegetables in your diet .The antioxidant vitamins in the fruits and vegetables contribute to eye health. Eating a variety of colors ensures that you’re getting a variety of vitamins.
Choose healthy fats. Healthy unsaturated fats, such as the fats found in olive oil, may help protect your vision. Choose these healthy fats over saturated fats, such as butter, and trans fats, such as partially hydrogenated oils found in packaged foods.
Choose whole grains over refined grains . Choose whole grains, such as whole-wheat bread, over refined grains, such as white bread.
Add fish to your diet . Fish contain omega – 3 fatty acids that may help reduce the risk of vision loss related to macular degeneration. Fish that contain high levels of omega-3 fatty acids include salmon, sardines and tuna. Omega-3 fatty acids can also be found in supplements and nuts, such as walnuts.

Lifestyle and home remedies
If you experience mild or occasional dry eyes symptoms, you may be able to manage your condition with over-the-counter eyedrops and frequent eyelid washing.
Eye drops . Preservatives are added to some eyedrops to prolong shelf life . You can use eyedrops with preservatives up to four times a day. But using the preservative drops more often can cause eye irritation. Nonpreservative eyedrops come in packages that contain multiple single-use vials. After you use a vial, you must throw it away. If you rely on eyedrops more than four times a day, nonpreservative drops are safe.
Drops vs. ointments. Lubricating eye ointments coat your eyes, providing longer lasting relief from dry eyes. But ointments are thick and can cloud your vision. For this reason, ointments are best used just before bedtime. Eyedrops can be used at any time and won’t interfere with your vision.
How often you need to put eyedrops in your eyes will depend on your symptoms. Some people need to put drops in every hour, and some need eyedrops only once a day.

Washing your eyelids to control inflammation
For people with blepharitis and other conditions that cause eyelid inflammation that blocks the flow of oil to the eye, frequent eyelid washing with thriphala kashyam may help. To wash your eyelids:
• Apply a warm washcloth to your eyes. Wet a clean cloth with warm water. Hold the cloth over your eyes for five minutes. Re-wet the cloth with warm water when it cools. Gently rub the washcloth over your eyelids to loosen any debris.
• Use a mild soap on your eyelids. Use baby shampoo or another type of soap recommended by your doctor. Put the soap on your clean fingertips and gently massage your closed eyes near the base of your eyelashes. Rinse the soap completely away. Your doctor may recommend that you do this daily, even when you don’t have dry eyes symptoms. Stopping this daily routine may cause your dry eyes to return.

Prevention
If you experience dry eyes, pay attention to the situations that are most likely to cause your symptoms. Then find ways to avoid those situations in order to prevent your dry eyes symptoms. For instance:
Avoid air blowing in your eyes. Don’t direct hair dryers , car heaters, air conditioners or fans toward your eyes.
Wear glasses on windy days and goggles while swimming . The wraparound style of glasses may help reduce the effects of the wind. Goggles protect your eyes from chemicals in pool water that can dry your eyes.
Add moisture to the air. In winter, a humidifier can add moisture to dry indoor air.
Consider eyeglass shields to protect your eyes . Safety shields can be added to the tops and sides of eyeglasses to block wind and dry air from getting to your eyes. Ask about shields where you buy your eyeglasses. Swim goggles may create the same effect.
Take eye breaks during long tasks. If you’re reading or doing another task that requires visual concentration, take periodic eye breaks. Close your eyes for a few minutes. Or blink repeatedly for a few seconds to help spread your tears evenly over your eye.
Position your computer screen below eye level . If your computer screen is above eye level , you’ll open your eyes wider to view the screen. Position your computer screen below eye level so that you won’t open your eyes as wide. This may help slow the evaporation of your tears between eye blinks.
Stop smoking and avoid smoke. If you smoke, stop. Ask your doctor for help devising a quit-smoking strategy that’s most likely to work for you. If you don’t smoke, stay away from people who do. Smoke can worsen dry eyes symptoms.

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