Dry eye syndrome (DES) is a chronic condition that develops when your eyes do not produce and maintain enough tears to keep the eye’s surface lubricated resulting in multiple symptoms that range from person to person. This can be due to a reduction in tear production or increased tear evaporation from a lack of lipid in the tears that stem from oil glands in the eyelids. The effects can range from minor dryness and discomfort to pain, blurred vision and frequent infections.
Symptoms of Dry Eye Disease
Symptoms of dry eye syndrome can vary depending on the severity of the condition but can include:
- Dry, itchy eyes
- Burning or stinging
- Watery eyes
- Blurred vision
- Foreign body sensation
The main function of tears is to maintain the health of the cornea of your eye by washing away foreign matter and ensuring that the surface of your eye remains moist, smooth and clear. Tears also rinse away dust particles from your eyes and contain enzymes that protect your eyes from bacteria that can cause infections. Dry eyes is a condition that develops when the amount of tears produced is not sufficient to maintain the moisture balance in your eye. This can result in that scratchy sensation, a continuous feeling of dryness, stinging and a sensation of a foreign body in your eye. Ironically in an effort to fight off the condition, dry eyes can cause you to produce excessive tears, which is why some people experience watery eyes.
Causes of Dry Eye Disease
Dry eyes can occur naturally as a result of aging or hormonal changes, typically in women who are pregnant, taking oral contraceptives or going through menopause. In fact, women over 50 have a 50% greater risk of dry eye disease than men do of the same age. It can also result from taking certain medications that reduce tear production such as antihistamines, blood pressure medications and antidepressants. Environmental factors can also play a role in drying out the eyes and DED is common in areas where the climate is dry, dusty and windy. Home air conditioners or heating systems and excessive time spent staring at a computer or television screen can also dry out eyes and exacerbate symptoms due to the lack of blinking while staring at our screens.
Individuals that suffer from certain medical conditions such as diabetes, blepharitis, lupus, arthritis and thyroid problems are more vulnerable to developing DED. Other causes can be due to eye surgery including LASIK, certain conditions in which the eyelids don’t close properly or extended contact lens use.
Diagnosis of Dry Eye Disease
Typically, dry eye disease can be diagnosed through a comprehensive eye exam and a description of your symptoms. Your eye doctor may do a simple test that measures how quickly your tears evaporate from the surface of your eye. By instilling a dye called fluorescein (much like food coloring) the doctor is able to watch and determine how long it takes the tears to start to break up after a blink. This is called TBUT or a Tear Break Up Time test. A low TBUT generally indicates a lipid (aka oil) deficiency in the tears resulting from oil glands in the eyelids not functioning properly. Once a diagnosis of Dry Eye Disease is determined, our office may schedule you for a Comprehensive Dry Eye Work up where more specific testing is performed to determine the cause and severity of your Dry Eye. By doing this, the doctor can then tailor a treatment regimen specific to your case. Dry Eye is a multifactorial disease and there are a multitude of treatment options. One treatment that works for one person may not work for you.
Treatment for Dry Eyes
There are many treatment options for dry eyes which are highly dependent upon the cause and severity of the condition. There are four components of DED that are focused upon in controlling this condition: (1) Obstruction of the lids oil glands known as Meibomian glands, (2) managing the natural Bacterial Biofilm accumulated on the lashes and lid margin, (3) Inflammation of the eye, and (4) Tear Film Insufficiency.
Many mild forms of DED can be alleviated using artificial tears or lubricant eye drops. Some drops help replace the oily component of your tears, others the watery component, others the mucous component, and others are a combination of these components. Recent research has developed eye drops based on nanotechnology for greater effectiveness. Your doctor can recommend which eye drop is best for you based on your type and severity of DED. In more severe cases, your doctor might prescribe prescription drops that suppress or modulate the inflammatory cells in the tears that cause discomfort and damage the eyes surface.
Since DED is often associated with eyelid inflammation known as blepharitis your doctor may prescribe a heated hot compress mask, specialty eyelid scrubs, and sometimes an antibiotic ointment. Oral antibiotics are also used to improve inflammation of the oil glands and if the DED is associated with ocular rosacea. Finally, punctal plugs may be inserted into the tear ducts to reduce the tear drainage in your eyes to keep them from drying out. However, this is not recommended until the inflammation of the eye is controlled.
Your doctor may also recommend that you limit or refrain from contact lens use for a certain amount of time or switch to a different brand or type of contact lens which will reduce dehydration.
Preventing Dry Eyes
If the cause of your dry eyes is something external or environmental, eliminating that cause may solve the problem and resolve the symptoms. Avoid dry environments, hair dryers, heaters and fans, (particularly directed toward the eyes) and smoky environments and wear eye protection such as wrap around glasses or goggles when in dusty or windy areas. Use a humidifier to add moisture to dry indoor air. If working on computer or watching television, make sure to blink purposefully as our natural tendency is to reduce our blink rate when staring at a screen. Also avoid rubbing your eyes as this can further irritate them. Staying hydrated by drinking at least 8 to 10 glasses of water per day can also help.
Dry eye disease won’t have a permanent effect on your vision, but there is no reason to endure dry, itchy and uncomfortable eyes, especially since there are so many treatment options to increase moisture and comfort. It’s also important to realize that this is a chronic disease that needs consistent treatment. Your doctor will work with you to create a long term strategy to keep your eyes as comfortable as possible.