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
- advancing age
- computer/ cell phone/any screen use
- oral medications – antihistamines, antidepressants, high blood pressure, birth control, hormone meds
- poor hydration
- lack of omega 3 in diet
- incomplete blink
- dry environment- heating in winter, retirement homes, hospitals
- dry dusty windy environmental conditions
- fan in car for prolonged drives
- laser eye surgery
- arthritis, lupus, diabetes, thyroid
- eyelid anomalies
- automimmune disease
- hormones, bcp, menopause- females
Diagnosis of Dry Eye Disease
Typically, dry eye disease can be diagnosed through a comprehensive eye exam and a description of your symptoms.
TBUT- Tear Break Up Time- measures how quickly your tears evaporate from the surface of your eye. By instilling a simple dye called fluorescein (much like food coloring) the doctor is able to watch and count how long it takes the tears to start to break up after they’ve asked you to hold your eyes open after a blink. A low TBUT generally indicates a lipid (aka oil) deficiency in the tears resulting from oil glands in the eyelids not functioning properly.
TEAR OSMOLARITY – dry eyes have a higher concentration of salt which causes stinging, burning and irritation. Osmolarity is measured electronically and gives your optometrist a measure of severity and type of dry eye
CORNEAL STAINING- Dye is used to show if the eye is ‘chapped’ or ‘chafed’ on the surface. This causes a feeling like something is in the eye and this grittiness instigates exaggerated blinking, rubbing, feeling that you need to close your eyes.
EVALUATION FOR BLEPHARITIS, DEMODEX OR LID DISEASE – the lid margin has 70 meibomian glands at the location of the eyelashes. Signs of acne, dandruff, excess bacterial load or mites is evaluated with microscopy.
TEAR MENISCUS/ SM TUBE QUANTITY TESTING- the tear level as well as the quantity of tears can be measured with micoscopic examination as well as holding a sterile, specialized paper to the ocular surface and measuring how much tear flow occurs in 5 seconds
TREATMENT FOR DRY EYE DISEASE (DED)
There are many treatment options for dry eyes which are highly dependant upon the cause and severity of the condition. Many mild forms of DED can be alleviated using artificial tears or lubricant eye drops to make up for the lack of natural tears usually produced by your eyes. Unpreserved drops are recommended as extra chemicals used to preserve the solution may irritate the eye if used more than three times/day. Depending on severity, your optometrist may recommend drops, geldrops, gel or ointment as lubricants. If over-the-counter drops don’t alleviate your symptoms, your doctor might prescribe prescription drops that actually stimulate tear production, steroids for short-term relief, or an antibiotic if the meibomian glands show signs of bacterial overload.
More severe cases of dry eyes can be treated with a punctal plugs which would be inserted into the tear ducts to reduce the tear drainage in your eyes to keep them from drying out. Immunomodulatory prescription eyedrops, such as Restasis, which stimulate your tear production may be prescribed. Restasis takes 3 months for full effect but has had wonderful success for patients who find their dry eye debilitating. Steroid eyedrops may also be used for short term pulses to alleviate inflammation caused by dryness.
Since DED is often related to eyelid inflammation known as blepharitis your doctor may prescribe a heated hot compress mask, specialty eyelid scrubs and sometimes an antibiotic ointment. 1000-2000 mg of Omega 3, taken orally, will often be very successful after taking for 6 weeks and maintaining use. Ask your optometrist about the different forms of Omega 3. We only carry the triglyceride form which has significantly higher absorption rates and therefore less burping or gastrointestinal upset.
Blocked meibomian glands cause the tears to evaporate very quickly. An inoffice procedure cleans the blocked glands and gives them a fresh start. A very watery eye may be caused by a blockage in the drainage connecting the eye to the nose. Rinsing out the tear ducts can be performed in office or a referral can be made if the tear duct is too small or a pemanent blockage is found.
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, fans, (particularly directed toward the eyes) and smoky environments. Wear eye protection such as wrap around glasses or goggles when in dusty or windy areas. Sunglasses will protect the eyes from wind as well. 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.
In cases where discontinuation or switching to different medications is possible this can eradicate symptoms. If you wear contact lenses, daily disposable are the best solution. Scleral contact lenses are a new design of contact lens which bathes the eye in lubricant all day long. Scleral lenses will act as a bandage for a dry eye and allow the dry eye to heal and often vision can improve significantly. See more information on scleral lenses under contact lenses.
Dry eye disease can cause intermittent blurred vision. It can make your life miserable. Luckily, we now have many more treatments available which work really well. It’s also important to realize that this is a chronic disease that needs consistent treatment. The earlier you treat your dry eye, the better. Waiting too long can cause the glands to die off which is much more difficult to treat. Your doctor will work with you to create a long term strategy to keep your eyes as comfortable as possible.