You may recall we discussed a holistic view on “dry eyes” a few weeks ago. I used an expression earlier today with a patient that hit home as she was struggling to understand how her Sjogren’s Syndrome connected her dry mouth and lips to her dry eyes. The common link was chapped eyes. “I know what you mean by chapped lips”, she said. “But what are chapped eyes?” I explained that the fancy term for the condition in conjunctival folds, but it was easier to show her a picture.
With fluorescein dye, you can see folds in the conjunctiva appearing as little dark waves on the white part of the eye. The eye above has minimal stain. Contrast this with the appearance of the eye below, which has considerably more staining and radial as well as lid parallel conjunctival folds.
The lips are covered with a mucous membrane lining similar to the bulbar conjunctiva. One can have a beautiful looking cornea, but a bone dry sclera that contributes to a sense of ocular fatigue or discomfort and invariably shows conjunctival folds and staining patterns. Everyone develops modest lid parallel conjunctival folds with age. It’s like sagging skin or furrows in your brow. But the dense staining pattern, particularly with radial folds, means the conjunctival lining is excessively evaporated – much as one experiences with chapped lips.
Patients who have excessive dryness around the eye, excema, or rosacea are particularly prone to conjunctival folds. Topical lubricant in the form of gel, and sometimes ointment, are the analog of Chapstick. Omega-3-fatty acids in the from of fish oil supplementation can aid dryness from within to combat surface evaporation. And of course, drinking water to promote hydration aids both conditions from the inside out.
– Leonard J. Press, O.D., FCOVD, FAAO