What is Dry Eye?
Dry Eye occurs when your tears aren’t able to provide adequate lubrication for your eyes. This can be either because your eye doesn’t produce enough tears, or because the tears available are of poor quality.
Symptoms of Dry Eye:
Stinging or burning
Excess tearing
Stringy mucous
Redness
Foreign body sensation
Sensitivity to light
Sensation of heavy eyelids
Blurred vision
Difficulty with night driving
Difficulty tolerating contact lenses
What causes Dry Eye?
Tears are a complex mixture of water, fatty oils and mucous. When you blink, your lids spread the tears over the eye. This keeps the eye’s surface smooth and clear, providing good vision. Tears also help to prevent infection.
For some, the cause of dry eye is decreased tear production. For others it’s increased tear evaporation and an imbalance in the make-up of your tears.
Causes of Decreased Tear Production
Aging
Autoimmune diseases, Diabetes, Thyroid disorders
Medications including antihistamines, decongestants, hormone replacement therapy, antidepressants, drugs for hypertension, acne, birth control and Parkinson’s disease
Laser eye surgery
Tear gland damage from inflammation or radiation
Causes of Increased Tear Evaporation or Imbalance
Wind, smoke or dry air
Blinking less often which often occurs when concentrating, ie. computer, reading or driving
Poor eyelid position
Clogged oil glands in the lid (Meibomian gland disorder) or inflammation of the lids (Blepharitis)
Risk Factors:
Age over 50
Women – hormonal changes due to pregnancy, using birth control pills or menopause
Wearing contact lenses
Seasonal allergies
How is Dry Eye Diagnosed?
There are several procedures that may be used to help determine the severity and cause of dry eye.
A comprehensive eye exam – this will include a thorough history of your overall health and symptoms experienced to help the doctor diagnose the cause of your dry eye. The doctor will also perform slit lamp biomicroscopy to examine the surface of the eye.
Schirmer Test – this test measures the volume of your tears. Strips of blotting paper and placed in the lower eyelids for 5 minutes. The doctor can then measure the amount of the strip saturated with tears.
Dyes – dyes are used to evaluate the condition of the surface of the eye. The doctor will look for areas of staining (dry patches) and can also measure how quickly the tears evaporate from the eye.
Possible Complications of Dry Eye:
Aside from the discomfort or aggravation people may experience from dry eye, there are several more serious complications that can occur.
Eye infections – without adequate tears to protect the surface of the eye, infections may result.
Damage to the surface of the eye – if untreated, severe dry eye can lead to corneal abrasions or scarring, corneal ulcers and/or permanent decline in vision.
Decreased quality of life – dry eye can make it difficult to perform everyday activities
Treatment:
Prevention
One of the best ways to treat dry eye, is to pay attention to the situations that are most likely to cause or aggravate your symptoms. Then try to avoid these situations. Here are some common triggers and some suggestions to help combat them.
Air blowing in your eyes – don’t direct hair dryers, car heaters, air conditioners or fans toward your eyes. Wraparound sunglasses or other protective eyewear is useful when outdoors to block wind and dry air.
Use a humidifier at home to add moisture to dry air.
Take breaks during long tasks, ie. computer use or reading
The “20/20” rule: after 20 minutes of performing the task, look 20 feet away and blink 20 times. This helps to spread more tears across the surface of your eyes.
Position your computer screen below eye level – this will help so that you don’t have to open your eyes as wide to view the screen. It may help slow the evaporation of tears.
Stop smoking or avoid smoke.
Use artificial tears even when your eyes feel fine.
Treat the Underlying Cause of Dry Eye
In some cases, treatment of the underlying health issue can help resolve or lessen symptoms. If a medication is contributing to dry eye, it may be possible for your physician to prescribe a different medication. If you have an eyelid condition, such as a droopy lower lid, it may be possible to have plastic surgery of the eyelids. If you have an autoimmune disease, having the best possible management of that disease may limit progression of dry eye.
Eye drops, gels, ointments (Over the counter)
Artificial tears may be all you need to control mild dry eye symptoms. Some need to use drops only once a day, some several times a day. There are several considerations when buying something over the counter.
Preservative vs. Non-preservative drops
Preservatives are used in eye drops to prolong their shelf life. It is recommended not to use these drops more than 4 times a day. Sometimes the preservatives in the drops can cause more irritation.
Non-preservative drops are sold in single use vials. These are a better option if needing to use the drops more frequently.
Drops vs. gels or ointments
Gels are thicker than standard lubricating drops. They will last longer on the surface of the eye. Gels may cause some blur to your vision with initial instillation. Lubricating eye ointments are very thick and will coat the eye providing longer lasting relief. Ointments will definitely interfere with your vision and are best use at night before bed.
Drops that reduce redness
Drops that “get the red out” are not advised. These can cause irritation and rebound inflammation (more redness) in the long run. This variety of drops constricts the blood vessels on the surface of the eye, in essence, suffocating the eye. The only product on the market with is “safe” to use to relieve redness is a new eye drop made by Bausch & Lomb called Lumify.
Prescription Medications
Restasis (cyclosporine) and Xiidra (lifitegrast) are the only FDA approved prescription medications available to treat dry eye. Restasis aims to stimulate the lacrimal gland to produce more tears. Xiidra works to disrupt the cycle that produces inflammation.
Corticosteroids – suppresses inflammation on the surface of the eye. These are not used long term due to potential side effects.
Antibiotic drops, pills or ointments – these often help to control inflammation involving the lids and lid margins. Help to improve the function of the oil glands in the lid.
Punctal Plugs
Excess tears drain through the tear ducts in the upper and lower lid into the nose. Tiny silicone plugs can be placed in the openings to the tear ducts (the punctum). Closing these small openings will conserve both your natural tears and artificial tears you may have added. In severe cases, these drainage ducts can be closed permanently with thermal cautery.
Serum tears
For patients that have had limited improvement with other forms of treatment. These eyedrops are made from your own blood. To make them, a sample of your blood is processed to remove the red blood cells and then mixed with a salt solution. It is thought that serum tears are helpful because they contain diluted concentrations of vitamins and growth factors that are important for corneal health. Serum tears have been found to be effective, well tolerated and full of substances that artificial tears can’t replicate. However, they are not covered by insurance plans and can be costly.
Devices
There are several FDA approved devices available that may provide temporary relief from dry eye by stimulating glands and nerves associated with tear production. There are also devices that help unblock oil glands in the lid.
Special Contact Lenses
Scleral contact lenses are gaining popularity in the treatment of dry eye. These lenses can protect the surface of the eye and trap moisture.
Nutritional Supplementation
Further study is needed, and results have varied. Some feel that adding Omega-3 fatty acids to your diet may help relieve dry eye signs and symptoms. These are available in Fish and Flaxseed oil, and through diet, with foods such as salmon and sardines.
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