Dry eye complaints are a common occurrence that can affect triathletes of any age. Like many disorders of the human body, ocular dryness is more likely to occur as a person ages and is especially prevalent among those 50 and older. When this ocular surface dryness becomes recurrent, the condition is diagnosed as dry eye syndrome.
In mild cases, this dryness can result in any or all of the following: redness, gritty sensation, burning, blurred vision and contact lens intolerance or discomfort. For those suffering from advanced dry eye syndrome the major symptom, ironically, is intermittent watering of one or both eyes. This watering results from a cascade of events beginning with dryness of the surface of the eye which leads to irritation and, ultimately, excessive (reflex) tear production. It is important to note that these reflex tears are biochemically different than the normal blinking tears that are produced 10-12 times per minute by our normal blink response. It's extremely important to point out that the tears produced in conjunction with normal blinking are also very influential upon the second topic of this article, namely ocular irritation and allergies.
With this in mind, let's look at the function and physiology of these tears and their associated blink mechanism. In an effort to maintain a moist and clean environment for the anterior surface of our eyes, the eyelids perform a brief involuntary closure every five or six seconds. During this involuntary blink, tears are secreted from various glands located on and behind the eyelids. While simple in description, this tear production and distribution cycle is actually a very complex anatomical and biochemical feat, providing the following important functions for the health of the cornea and sclera (clear and white structures, respectively, of the anterior eye surface):
- Flushing of debris and allergens
- Lubrication and hydration
- Antimicrobial agent
With new tears being produced each and every blink, one may question how the surface of the eye could possibly become dry. The answer to this is based upon many factors that affect the tear production/distribution cycle previously described. In a nutshell, these factors relate to either tear quality or quantity and include the following:
- base tear volume per blink (varies from person to person)
- environmental conditions (wind, temperature, air quality)
- eyelid disease (affects tear chemistry)
- mechanical side effects (contact lenses, corneal scars)
- medication side effects (antihistamines, diuretics)
- systemic disease (arthritis, lupus)
A thorough eye exam and systemic health history are of utmost importance when diagnosing and treating dry eye syndrome. In many cases multiple causes need to be considered.
This brings us to the most import part of our discussion: how to effectively treat your dry eye condition. In far too many cases, patients have been instructed to "try these drops" without further education, guidance or follow-up. Not surprisingly, the success rate of this approach is minimal at best. Just as no serious triathlete would find himself at the swim start without some sort of a plan for the upcoming endeavor, the same can be said of initiating treatment for dry eye disease. A sound treatment plan based upon clinical findings in addition to realistic treatment expectations provides a solid platform from which to initiate dry eye therapy. And just as in a triathlon, modifications to the original plan can be made as the event occurs.
The goal for dry eye treatment is to improve the comfort of your eyes as much as possible while utilizing the most user-friendly and cost-effective approach available. Although discussion of a dry eye treatment flowchart is beyond the scope of this article, a listing of the multitude of options will provide some familiarity with the choices available. Keep in mind that two or more therapies may be initiated at the same time.
- Artificial tears: Most common treatment, often more soothing when refrigerated.
- Eyelid hygiene also referred to as lid scrubs: Improves tear quality and quantity.
- Oral antibiotics: Function to improve the normal blinking tears.
- Steroid eye drops: Reduces inflammation often associated with dry eye syndrome.
- Restasis: Prescription eye drop to stimulate production of normal blinking tears.
- Dry eye vitamins: Helps to increase the durability of the tears.
- Punctal occlusion/ablation: Reduces drainage of the tears from the eye surface.
- Sunglasses/moisture goggles: Decreases evaporation from the eye surface.
As mentioned earlier, a strong relationship exists between tear function and the symptoms of ocular irritation and allergies. Causes of ocular irritation for triathletes include water, sweat, sunscreen, contact lenses, dust or some other foreign body entering the eye. The mainstay of ocular irritation treatment is a steroid eye drop or ointment, often in combination with an ophthalmic antibiotic. With respect to allergies, the offending agent is, of course, some sort of allergen (pollen, etc.) to which the individual is hypersensitive. This can be a seasonal or year-round issue depending on the allergen(s) as well as the climate. There are now several effective over-the-counter ocular decongestant/antihistamine eye drops available for mild allergic eye problems. More significant conditions may require a prescription antihistamine/mast cell stabilizer drop. Steroid eye drops are, again, a therapeutic option as well.
Because of the complexity of diagnosing and treating these ocular disorders it is in every triathlete's best interest to consult an experienced eye care provider before initiating any ophthalmic treatment.
Jeff LaFerla, OD FAAO is a graduate of the Indiana University School of Optometry. He completed a residency in contact lenses at the University of Missouri-St. Louis. Dr. LaFerla resides in Weatherby Lake, Mo., with his wife and two sons. He completed the iron distance Redman Triathlon in September 2009 in Oklahoma City. Email Dr. LaFerla at firstname.lastname@example.org.
This article originally was published in the summer edition of USA Triathlon Life magazine. USA Triathlon is proud to serve as the national governing body for triathlon--the fastest growing sport in the world - as well as duathlon, aquathlon and winter triathlon in the United States. Visit usatriathlon.org.