When we think about eye problems and eye diseases, it’s usually not the surface issues that come to mind, but the deeper concerns inside the eye.
However, what affects the outside of our eyes may be just as important as what lies beneath.
Problems such as dry eyes, eyelid bumps, overly teary eyes and eye spasms are not only annoying, but also can make a difference in how well we see.
And even if some of these surface eye and eyelid issues seem simple, the cause may be a little more complicated, and may take a doctor’s diagnosis and prescription to cure.
Dry eyes are probably the most frequent complaint heard by ophthalmologists and can actually be a significant problem when it comes to good vision.
“It can affect your vision because refraction is helped by the tear layer,” says Dr. Catherine Pham, an ophthalmologist in Monterey, California.
Tears help us see more clearly by creating a smooth optical surface on the front of the cornea, the transparent tissue that covers the front of the eye. People with dry eyes may suffer from blurry vision, which tends to worsen at the end of the day or after focusing for a prolonged period, according to MayoClinic.com.
Even without that problem, dry eyes are a definite annoyance, since they often sting or feel irritated, are overly sensitive to light, fatigue easily, and give the sensation of something constantly being in the eye.
Pham says that dry eyes can affect us at any age, although older people tend to be more susceptible.
The reason why this problem is so common is that there are multiple causes, among them medication side effects, pollen allergies, eyelid inflammations, and sometimes as a symptom of other disorders.
Dr. Philip Penrose, an ophthalmologist with the Monterey Bay Eye Center, says the various causes of dry eyes can be separated into two basic categories: Those where the body isn’t producing enough tears, and the second, where the tears are evaporating too quickly.
“The evaluation by the doctor is the most effective way of teasing out which of these dry eye categories is the cause and treating appropriately,” he says. “Each group is treated differently.”
People may not be aware that medications often contribute to dry eyes, including over-the-counter cold and allergy remedies that contain antihistamines.
And pollen allergies themselves can also cause dry eyes, so using these medications compounds the problem, Pham says.
Another frequent cause of dry eyes is menopause, and women in that age group may experience overall dryness affecting the mouth, skin and eyes, Penrose says.
Pham also notes that age in general can also be a factor – older people may have weakened lower eyelids that are less able to pump tears away, leading to less tear creation.
Less common is the diagnosis of Sjogren’s syndrome, an autoimmune disease which affects the body’s moisture-producing glands.
Artificial tears are helpful for people who aren’t making enough of their own; for more severe cases, anti-inflammatory eyedrops may be prescribed, which will help the glands that produce tears work more efficiently.
Patients suffering from the other type of dry eyes, tear evaporation, may experience this problem as a side effect of rosacea, a skin disorder which affects the nose, cheeks and eyelid margins.
“The blood vessels in the lid margin dilate and plug the orifices of important glands that produce a component of the tear,” said Penrose. “This component prevents rapid evaporation of the tear so if the substance is not present, the eyes quickly dry.”
Strangely enough, this type of dry eye may actually lead to excessive tear production and overflow because of the way the body responds to it. Penrose notes that an oral antibiotic can help alleviate the ocular rosacea that causes this problem.
Another cause of excess tear production is obstruction of the eye’s drainage path. If the drainage is plugged, tears will overflow.
This may be treated with anti-inflammatory medications or a surgical procedure in more extreme cases, says Penrose.
Pham said another cause of dry eyes is an inflammation of the glands on the eyelid margin. The condition, called blepharitis, also prevents the glands from making a component essential to tear production, similar to the problem caused by rosacea.
Blepharitis is treated with warm compresses, an antibiotic ointment and steroid eyedrops, Pham says.
Another condition that can range from mildly annoying to sight-impairing is blepharospasm, an involuntary contraction of the muscles around the eye that cause tics or winks.
This, too, can have many potential causes, one of which is dry eyes. Penrose says that dry eyes, and other inflammatory disorders of the eyeball surface, can lead to this condition. Once the dry eye or inflammatory issue is resolved, the spasm goes away.
Pham said that she has found some blepharospasm is simply caused by insufficient sleep or stress, and will go away on its own.
For cases where the cause of the blepharospasm is unknown, Botox may be injected to relax the muscles around the eye and keep them from contracting.
“Botox’s effect unfortunately lasts only, on average, three months so the multiple injections must be repeated regularly,” says Penrose. “Some of the risks of Botox include overtreatment and consequent drooping of the lids that will last the same three months.”
Eyelids are also subject to lumps and bumps that may not affect vision but are unsightly. Called a chalazion, one can occur when glands along the edge of the eyelid become plugged – the same glands affected by rosacea and leading to dry eye problems.
“Consistent warm compresses applied to the affected area in most cases lead to reopening of the gland and drainage, resolving the issue,” said Penrose. “This may take a few weeks to completely resolve so patience is crucial.”
Rarely, after weeks of warm compresses the bump persists and requires either a steroid injection or an incision and drainage from the inside of the lid, he notes.
Dr. Catherine Pham, (831) 649-3337; Dr. Philip Penrose, www.montereybayeyecenter.com or (831) 372-1500.
Interviews with Dr. Catherine Pham and Dr. Philip Penrose, June 2013