Dry Eye

Useful Terms

Dry Eye = inadequate supply or quality of tear film in the eye to keep its surface smooth and clear, and thus well and comfortable

Common Symptoms

  • A sensation of burning, inflammation, stinging, and/or scratchiness in the eye (s)
  • Extreme tearing
  • Redness
  • Stringy mucus excretions in or around the eye (s)
  • Exacerbated irritation when exposed to smoke, wind, or other elements
  • Fatigue within the eyes
  • Increased light sensitivity
  • A sensation of a foreign body within the eye (s)
  • Great difficulty and discomfort in wearing contact lenses for extended periods of time
  • Blurred and impaired vision, usually becoming worse either after focusing the eyes for an extended period of time or at the end of the day
  • A feeling of being unable to keep the eyes open for long

Risk Factors

  • Advanced Age
  • Radiation Eye Therapy
  • Extensive-Wear Contact Lenses
  • Sensitivity to Certain Climates
  • Gender

    •  More common in women, especially during pregnancy and menstruation and after menopause
  • Sjögren’s Syndrome

    • A chronic autoimmune disorder that is marked by the destruction of those glands that are responsible for the production of tears and saliva
  • Other Diseases

    • The co-occurrence of other conditions such as lupus, rheumatoid arthritis, and some thyroid diseases may lead to the development of dry eyes
  • Medication

    • There are some over-the-counter and prescription treatments that could reduce the amount of tear secretion in the eye (s)
  • Laser Surgery

    • LASIK and other refractive surgeries that may result in the decreased ability of sensation in the cornea could lead to dry eye
  • Dieting

    • Those diets that are low in Vitamin A, which is crucial for having and maintaining good vision, or Omega-3 fatty acids, which are vital for normal vision development in children and help protect the eyes from certain diseases, may lead to the contraction of dry eye

Causes

  • Poor Quality of Tears

    • The film of tears within the eyes are composed of three key layers:

      • 1) Oil
      • 2) Water
      • 3) Mucus
    • Any flaws or defects in any of these layers can result in the causation of dry eye
    • 1) Oil

      • The outer layer produced by the meibomian glands, the oil glands in the eyelids
      • The glands release lipids in order to smooth out the tear surface and slow down evaporation of the water layer of the tears
      • Inadequate oil production leads to a rapid evaporation of the water layer, which results in dry eye (s)
      • The condition is common in those people whose meibomian glands are clogged or impaired, such as with the diseases blepharitis, rosacea, and other skin diseases
    • 2) Water

      • The middle layer of tear film that is composed of mostly water with a small bit of salt
      • It is produced by the lacrimal (tear) glands and is responsible for the cleansing of the eyes via the removal of any foreign bodies or irritants
      • Inadequate water production results in the possible contact of oil and mucus layers, which may lead to stringy mucus secretions in or around the eye (s)
    • 3) Mucus

      • The inner layer of tear film that helps distribute tears evenly over the surface of the eye
      • Inadequate mucus production leads to the formation of dry spots on the corneal surface
  • Inadequate Production of Tears

    • The medical designation of this condition is keratoconjunctivitis sicca
    • This may be due to several factors:

      • 1) Advanced Age

        • The condition is common in those who are older than 50 since tear production slows down throughout the aging process
      • 2) Post-Menopause

        • There is a lack of tears duel largely in part to hormonal changes
      • 3) Other Medical Conditions

        • The conditions aforementioned have already laid the groundwork for dry eye (s) to also develop
      • 4) Laser Eye Surgery

        • If this types of procedure causes dry eye (s), then the symptoms that are experienced are only temporary
      • 5) Damaged Lacrimal Glands

        • Inflammation or radiation can cause sufficient damage to these glands that tear production is retarded
  • Problems with the Eyelids

    • The process of blinking involves a continuous, even distribution of tear film across the surface of the eye
    • Problems such as an in-turning / out-turning of the eyelids (entropion / ectropion, respectively) can make blinking difficult and result in an effective spread of the tear film or rapid evaporation of the tears, which leads to dry eye (s)
  • Medication

    • Hormone Replacement Therapy
    • High Blood Pressure Drugs and Treatments
    • Certain Antidepressants
    • Antihistamines and Decongestants
    • Isotretinoin-type Drugs for Acne Treatment
  • Blinking Less Often

    • Many tasks require a level of concentration that causes one to blink far less often than normal
    • These tasks may include reading, driving, computer work, etc.

Diagnosis

  • Comprehensive Eye Examination

    • Some cases of dry eye (s) only requires the routine comprehensive eye examination for accurate diagnosis
  • Measurement of Tear Production

    • The Schirmer test involves the blotting of paper strips and placing them underneath the lower eyelids
    • After 5 minutes of initial placement, the ophthalmologist can measure the amount of the paper strips that were soaked by tears
  • Measurement of Tear Quality

    • There are some eyedrops that contain special dyes that can aid in the determination of the condition of the surface of the eye
    • The ophthalmologist checks for the staining patterns on the corneal surface and measures the amount of time it takes for the tears to evaporate

Treatment

  • Artificial Tears

    • These are used to treat those who experience a mild form of the condition and available without the need for a prescription
    • They can be used for improved lubrication and moisture maintenance
  • Preservative-Free Eyedrops

    • This treatment method is similar to artificial tears in that it is best suited for those who only experience the milder symptoms of the condition
    • This is an alternative to those who are allergic to the chemicals contained within artificial tears and/or need to use artificial tears at least six times a day
    • Additionally, these can be used as often as needed, from once or twice a day to as often as numerous times within an hour
  • Treatment of the Underlying Cause

    • Dry eye (s) can be undone by treating that which initially caused it
    • If the condition was caused by a medication, then it is advised to switch to a different medication to avoid that unfortunate and annoying side effect
    • For those cases in which it was caused by problems with the eyelids, then the ophthalmologist can recommend the patient to an oculoplastic surgeon, who specializes in plastic surgery of the eyelids
    • If the source of causation was an autoimmune disorder, such as Sjögren’s syndrome, then the patient may be recommended to a doctor who specializes in that particular disorder
  • Medication

    • Antibiotics

      • When inflammation of the eyelids causes the meibomian glands to malfunction, antibiotics in eyedrop, ointment, or pill form can be prescribed to reduce that inflammation
    • Prescription Eyedrops

      • Eyedrops that contain corticosteroids or cyclosporine (immune-suppressing medication) can mitigate corneal inflammation
    • Prescription Eye Inserts

      • Those who experience a moderate to severe form of the condition and cannot use artificial tears can resort to using these
      • The inserts are placed between the lower eyelid and eyeball once a day
      • These inserts slowly dissolve and secrete           a substance that’s usually utilized in eyedrops to lubricate the eye
  • Closing of the Tear Ducts

    • This method serves as a means of preventing tears from leaving the eye too speedily
    • This is usually done with a partial or complete closing of the tear ducts
    • The tear ducts are plugged with small silicone plugs that preserve both the tears and any additional artificial tears

      • These plugs can be removed or left alone inside
    • Thermal cautery is another, more permanent alternative

      • The area around the tear ducts is anesthetized and contacted by a hot wire
      • This serves to contract the tissues in the area and scars it in order to close it
  • Special Contact Lenses

    • This treatment method is for those who experience a severe form of the condition and its symptoms
    • Special contact lenses known as bandage lenses or corneal shields can be used as a barrier of sorts for the eyes by trapping moisture close to the eyes as a means of alleviating the symptoms
  • Unblocking Blocked Oil Glands

    • LipiFlo is a recent innovation that helps with clearing the blocked meibomian glands
    • Because it’s recent, it many not yet be widely available
    • A device that looks like an eyecup is placed over the eye and provides a gentle and warm massage to the lower eyelid
    • This process takes no more than 15 minutes and the patient can go home directly afterwards
    • The results will usually be seen a few days after the treatment has been applied