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Today in Health & Wellness
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The Medicine of Tears

By: Risa Caldoza, MD, FPAPSHPIThe Medicine of Tears

Angry? Happy? Afraid? Laughing out loud? Peeling an onion? Regardless of whatever intense emotion you are going through, you are most likely to cry, especially if you are of the fairer sex. Women cry about 50 times a year, while men merely 10 waterworks. And it can be any of the three types of tears – basal, reflex and psychic (break-up anyone?) tears. Your heart rate jacks up, you sweat, your breathing slows and you get that lump in your throat (called globus sensation).

Weeping is universal and cathartic. As early as 14th-century BC, Ras Shamra texts written in Canaanite clay tablets found in the ancient city of Ugarit spoke of a poem about the death of the earth God Ba’al. His sister, the goddess Anat, "continued sating herself with weeping, to drink tears like wine." Lo and behold, her tears brought Ba’al back to life. That’s how powerful tears are!

Tears may look like water but they are more complex – they contain salts, lipids, carbohydrates, vitamins, proteins, electrolytes, antibodies, and enzymes called lysozymes. Tears are killing machines for bacteria, stopping 95% of all bacteria in its tracks because of lysozymes.

Tears also have layers. An oily layer on the outside, which is produced by the Meibomian glands, smoothens the tear surface and reduces evaporation of tears. The middle watery layer (90% of the tear film volume), made by the lacrimal glands, bathes and polishes the eyes. This helps clean, protect, and transport nutrients and oxygen to the cornea (your eye's clear, protective outer layer). The inner mucus layer from the goblet cells helps to moisten the eye. Without it, the tears will not stick to the eye.

These three layers altogether are known as the tear film or precorneal film. With 14,000 blink cycles per day (4.2 million blinks a year) that lasts an average of 1/10th of a second each, the tear film spreads over the eye at a certain thickness (about 3 to 4 microns thick) and is maintained for a while. This is called tear stability.

A stable tear film makes good vision possible and makes blinking and eye movement easier. For example, a thin tear film may stop you from wearing contact lenses because your eyes need higher than normal amount of oxygen and wearing lenses will dry out your eyes.

Dry Eye Disease

A study in 2015 found that two out of 10 Filipinos in an urban community had dry eye disease (DED). Going by other names such as dry eye syndrome, dysfunctional tear syndrome (DTS), lacrimal keratoconjunctivitis (LKC) or keratoconjunctivitis sicca, this common condition happens when the eyes don't make enough tears or when tears evaporate too quickly. And we are not alone: studies show that around the globe, as high as 35% of various populations complain of this condition.

As we age, our risks of DED are higher. One in three people over the age of 65 has problems with dry eyes, with women suffering more than men. DED happens when the complicated tear production process is thrown out of whack. Some causes may include being in a hot or windy climate, underlying medical conditions such as inflammation of the eyelids, and side effects of medications such as anti-allergy drugs. Hormonal changes in women, such as menopause and pregnancy, are common factors too. About half of all people who wear contact lenses complain of having dry eyes. The condition is also one of the biggest issues following cataract surgery.

As the Internet-obsessed, social media-crazy Pinoys we are so labeled, maybe you have heard of Visual Display Terminal Exposure? Such a long name for using the computer and staring at your smartphone too much. The average Filipino spends nine hours (wow!) on the Internet every day. It is one of the culprits to why DED is on the rise worldwide. When we stare at screens for extended periods, our blink rate is slashed.

Although not serious, symptoms might be bothersome. Usually, both eyes get dry, sore, red and progressively worse throughout the day. Eyelids stick together upon waking up and there’s temporary blurred vision, which usually improves when you blink. Some complain of watery eyes, which happen when the eyes try to produce more tears to relieve the irritation. If you have extreme sensitivity to light, very painful or red eyes, and experiencing deterioration in your vision, these are warning signs of a more serious condition. Although chronic and incurable, you can find solace in your symptoms and control them adequately.

We’ve been trying to find relief from dry eyes since time immemorial.  Ancient treatment included exotic ingredients such as antimony, copper or manganese, and yellow frog gal (yuck!), but we have come a long way since then. Your eye doctor may give you eye drops, gels or ointments to lubricate the eyes or other medications such as corticosteroids to address any swelling. Sometimes, surgery may be needed to prevent tears from draining too fast.

The Art of Artificial Tears

Okay, you’ll be seeing words like saline-based, isotonic, hypotonic, benzalkonium chloride, hydrogel polymers, hyaluronic acid, and lipid-oil immersions and a whole host of hard-to-pronounce words when talking about artificial tears.  Artificial tears are normally the first line of defense for DED because of its noninvasive nature and low side-effect profile.

Artificial tears try to mimic the natural tear film or at improve at least one of its three layers. Its most common goal is to decrease dryness and keep the eyes moist. They may contain electrolytes to help heal the surface of the eyes or thickening agents to keep the solution on the surface of your eyes longer.

Artificial tears come in all forms, from gels, gel inserts to ointments and may be bought without a doctor’s prescription. Mild cases require the application of lubricant drops four times a day, while severe cases may require more aggressive treatment such as 10 to 12 times a day. If you have that funny taste in the mouth soon after putting them in, that’s normal.

When Jennifer Aniston was asked in an interview what her ‘addictions’ were, she answered that she was addicted to her eye drops. Be careful though – if artificial tear use extends more than 4-6 times per day, then it’s better to use a formulation that’s preservative-free.

So cry those tears, artificial or otherwise. Women, do you know that emotional tears have been found to reduce sexual arousal in men? Just food for thought.

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