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. On some occasions the eye doctor might decide to do a test that 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. 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. In another type of test, called a Schirmer test, a strip of filter paper is placed under the lid of the eye and you will be asked to close your eye for five minutes. Following the test the amount of moisture on the strip will be measured. Schirmer tests are performed less frequently than a TBUT test.
Treatment for Dry Eyes At EyeCare Associates
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. If over-the-counter drops don’t alleviate your symptoms, your doctor might prescribe prescription drops that actually stimulate tear production or steroids for short-term relief.
More severe cases of dry eyes might be treated with a punctal insert which is a tiny insert containing a slow-release lubricating substance that is placed inside the lower eyelid. 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. Finally, punctal plugs might be recommended for severe cases which would be inserted into the tear ducts to reduce the tear drainage in your eyes to keep them from drying out.
In cases where discontinuation or switching to different medications is possible this can eradicate symptoms. 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.
Interview with Dr. Rapp
Can you provide an overview of the kinds of dry eye treatments you offer?
If somebody doesn’t really complain to me too much and I see signs of dry eye during the eye exam, I’ll offer eye drops. Even if they don’t want to use it every single day — it’s just to have something in their house.
We generally start out with some type of artificial tear or lubricant eye drops. When they tell me their eyes are so dry that it burns or it messes with their vision and that they can’t see very clearly, then we start to talk about other techniques besides just using the drops.
But drops are always part of the protocol. I frequently talk about how the eyelids are a big component of dry eyes because we have oil glands in the eyelids. Whether it’s inflammation, wearing masks, or wearing lots of makeup, the oil glands of the eyelids don’t work effectively and that leads to dry eye.
Fish oils can help reduce inflammation of the oil glands in the eyelids. Cleaning the eyelashes every time someone washes their face or takes a shower, specifically pushing on the eyelids, warming up the eyelids and then pushing on the eyelids and lashes to help express those oils so that you can use your own natural lubrication to improve the tear quality.
Once you’ve done that, then the patient can begin worrying about pharmaceuticals that can take away the inflammation and improve tear quality.
If the patient is highly symptomatic and is complaining of severe discomfort, then I’d have them come back for a follow up and discuss other treatment options.
I offer a highly effective treatment known as punctal plugs. It involves putting a dissolvable plug into the tear duct. It stays in place for a couple of months and literally holds onto the natural tears that are inside the eyes. It’s almost as though you were to plug up the drain of a sink, then the water would just stay in the sink for more time. So the patients’ own natural tears lubricate their eyes, and that, in addition to the warm compresses, massaging the eyelids, and using artificial tears, is often sufficient.
The third tier of treatment might be prescription medications, but a lot of times people already feel relief before then.
The only downside is that the patient needs to come in every couple of months for me to insert those plugs, but that’s something that takes a couple of seconds to do. Fortunately, insurance covers it.