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| Photo from medscape.com |
Dry eye disease is a frequent ailment in which your tears are unable to adequately lubricate your eyes. Tears can be insufficient and unstable for a variety of causes. Dry eyes, for example, can occur if you don’t produce enough tears or if your tears are of low quality. This tear instability causes inflammation and damage to the surface of the eye.
Dry eyes are unpleasant. Your eyes may sting or burn if you have dry eyes. Dry eyes can occur in a variety of scenarios, including flying, being in an air-conditioned room, riding a bike, or staring at a computer screen for several hours.
Dry eye treatments may make you feel more at ease. These treatments may include dietary adjustments as well as eyedrops. To control the symptoms of dry eyes, you’ll most likely need to perform these steps indefinitely.
WHAT ARE THE SYMPTOMS OF DRY EYE DISEASE?
Signs and symptoms, which generally affect both eyes, may include:
- Stinging, burning, or scratchy feeling in your eyes
- Mucus in or around your eyes that is stringy
- Light sensitivity
- Redness of the eyes
- A feeling that something is in your eyes
- Wearing contact lenses is difficult.
- Difficulty driving at night
- Watery eyes are the body’s reaction to the irritation of dry eyes.
- Eye strain or blurred vision
WHAT ARE THE CAUSES OF DRY EYE DISEASE?
A range of factors that impair the healthy tear film might cause dry eyes. The tear film is composed of three layers: fatty oils, aqueous fluid, and mucus. Normally, this combination keeps the surface of your eyes moisturized, smooth, and clear. Dry eyes can be caused by issues with any of these layers.
Tear film malfunction can be caused by a variety of factors, including hormonal changes, autoimmune disease, irritated eyelid glands, or allergic eye disease. Dry eyes can be caused by decreased tear production or increased tear evaporation in some persons.
Reduced tear production
Dry eyes can occur when your body does not create enough water (aqueous fluid). Keratoconjunctivitis sicca is the medical word for this condition. The following are some of the most common causes of decreased tear production:
- Aging
- Sjogren’s syndrome, allergic eye disease, rheumatoid arthritis, lupus, scleroderma, graft vs. host disease, sarcoidosis, thyroid diseases, or vitamin A insufficiency are all medical conditions that should be avoided.
- Certain medications, such as antihistamines, decongestants, hormone replacement therapy, antidepressants, and treatments for high blood pressure, acne, birth control, and Parkinson’s disease, are contraindicated.
- Corneal nerve sensitivity induced by contact lens use, nerve injury, or that caused by laser eye surgery, but symptoms of dry eyes associated with this technique are usually transient.
Increased tear evaporation
The oil film formed by the meibomian glands (small glands on the margin of your eyelids) may become stuck. People with rosacea or other skin problems are more likely to have blocked meibomian glands.
The following are some of the most common causes of excessive tear evaporation:
- Posterior blepharitis (meibomian gland dysfunction)
- Blinking less frequently, which is common in some illnesses, such as Parkinson’s disease, or when concentrating on specific tasks, such as reading, driving, or working at a computer.
- Eyelid issues, such as the lids turning outward (ectropion) or inward (entropion)
- Eye allergies
- Preservatives in topical eyedrops
- Wind, smoke, or stale air
- A lack of vitamin A
WHAT ARE THE RISK FACTORS FOR DRY EYE DISEASE?
The following factors increase your chances of experiencing dry eyes:
- Being over the age of 50. Tear production tends to decrease with age. Dry eyes are more common in adults over the age of 50.
- Being a lady. A lack of tears is more typical in women, especially if they are going through hormonal changes such as pregnancy, using birth control pills, or going through menopause.
- Eating a diet deficient in vitamin A (found in liver, carrots, and broccoli) or omega-3 fatty acids (found in fish, walnuts, and vegetable oils).
- Wearing contact lenses or having had refractive surgery in the past.
WHAT ARE THE COMPLICATIONS OF DRY EYE DISEASE?
People with dry eyes may encounter the following complications:
- Eye infections: Your tears guard the surface of your eyes against infection. You are more likely to get an eye infection if you do not have enough tears.
- Damage to your eyes’ surface: Severe dry eyes, if left untreated, can cause eye irritation, corneal abrasion, corneal ulcers, and vision loss.
- Reduced quality of life: Dry eyes can make it harder to do routine tasks like reading.
HOW IS DRY EYE DISEASE DIAGNOSED?
The following tests and procedures may be done to determine the reason of your dry eyes:
- A thorough eye examination: An eye exam that includes a thorough history of your overall health as well as your eye health will assist your doctor in determining the cause of your dry eyes.
- A test to determine the volume of your tears: The Schirmer test may be used by your doctor to assess your tear production. Blotting strips of paper are placed under your lower eyelids for this test. Your doctor measures the amount of strip soaked by your tears after five minutes.
The phenol red thread test is another method for assessing tear volume. In this test, a thread containing pH-sensitive dye (tears affect the color of the dye) is placed over the lower eyelid, wetted with tears for 15 seconds, and tear volume is assessed.
- A test to measure the quality of your tears: Other examinations employ eyedrops containing specific dyes to measure the surface quality of your eyes. Your doctor examines your corneas for staining patterns and time how long it takes for your tears to evaporate.
- A tear osmolarity test: This test determines the particle and water content of your tears. There will be less water in your eyes if you have dry eye illness.
- Tear samples will be analyzed for dry eye disease signs such as higher matrix metalloproteinase-9 or reduced lactoferrin.
WHAT ARE THE TREATMENTS FOR DRY EYE DISEASE?
Most persons with infrequent or mild dry eye symptoms can get by with over-the-counter eyedrops (artificial tears). If your symptoms are severe and persistent, you have additional options. What you do is determined upon the cause of your dry eyes.
Some therapies aim to reverse or manage the condition or factor causing your dry eyes. Other therapies can improve the quality of your tears or prevent them from draining too quickly from your eyes.
Taking care of the underlying cause of dry eyes
In certain circumstances, fixing an underlying health issue can help alleviate dry eye symptoms. For example, if a drug is causing your dry eyes, your doctor may suggest switching to a different medicine that does not produce that side effect.
If you have a disorder that causes your eyelids to turn outwards (ectropion), your doctor may recommend you to an eye surgeon who specializes in eyelid plastic surgery (oculoplastic surgeon).
Medications
The following prescription drugs are used to treat dry eyes:
- Eyelid irritation medications: Inflammation around your eyelids can prevent oil glands from secreting oil into your tears. Antibiotics may be prescribed by your doctor to minimize inflammation. Antibiotics for dry eyes are often given orally, while some are administered as eyedrops or ointments.
- Tear-inducing drugs: Cholinergics (pilocarpine, cevimeline) are medications that help stimulate tear production. These medications are available in the form of tablets, gel, or eyedrops. Sweating is one of the possible adverse effects.
- Eyedrops derived from your own blood: These are referred to as autologous blood serum drops. If you have severe dry eye symptoms that do not respond to conventional treatments, they may be an alternative. A sample of your blood is treated to eliminate the red blood cells before being combined with a salt solution to form these eyedrops.
- Eyedrops to control cornea inflammation: Corneal inflammation can be treated with prescription eyedrops containing the immune-suppressing drug cyclosporine (Restasis) or corticosteroids. Because of the potential for negative effects, corticosteroids are not recommended for long-term use.
- Eye implants that function similarly to artificial tears: If artificial tears aren’t helping your moderate to severe dry eye issues, another alternative could be a tiny eye implant that appears like a clear grain of rice. You insert the hydroxypropyl cellulose (Lacrisert) insert between your lower eyelid and your eyeball once a day. The insert slowly dissolves, producing a chemical used in eyedrops to lubricate your eye.
Other procedures
Other treatments for dry eyes that may be used include:
- Closing your tear ducts to prevent tear loss: This treatment may be recommended by your doctor to prevent tears from leaving your eye too quickly. This can be accomplished by partially or totally blocking your tear ducts, which ordinarily drain tears.
Tiny silicone plugs can be used to seal tear ducts (punctal plugs). These are detachable. Alternatively, tear ducts can be blocked using a heat-based method. This is a more permanent method known as thermal cautery.
- Making use of special contact lenses: Inquire with your doctor about modern contact lenses meant to aid dry eyes.
Some patients who suffer from severe dry eyes may benefit from special contact lenses that protect the surface of the eyes and retain moisture. These are referred to as scleral lenses or bandage lenses.
- Unclogging the oil glands: Warm compresses or eye masks used on a daily basis can aid in the removal of clogged oil glands. A thermal pulsation device is another option for unclogging the oil glands, but it is uncertain whether this treatment is superior to warm compresses.
- Using light therapy and massage to the eyelids: Intense-pulsed light treatment, followed by eyelid massage, has been shown to help persons with severe dry eyes.
HOME REMEDIES FOR DRY EYE DISEASE
You may be able to control your dry eyes by cleaning your eyes frequently and using over-the-counter (OTC) eyedrops or other items that lubricate your eyes. If you have a long-term (chronic) disease, apply eyedrops even if your eyes feel OK to maintain them lubricated.
Choosing and Using OTC Dry Eye Products
Eyedrops (artificial tears), gels, and ointments are among the nonprescription medicines available for dry eyes. Consult your doctor about which option is best for you.
Artificial tears may be all that is required to alleviate moderate dry eye symptoms. Some people require drops multiple times per day, while others just need them once.
When choosing an OTC product, keep the following aspects in mind:
- Preservative vs. nonpreservative drops: Some eyedrops contain preservatives to extend their shelf life. You can use preservative-containing eyedrops up to four times each day. However, applying the preservative drops more frequently can cause eye irritation.
Nonpreservative eyedrops are sold in batches of many single-use vials. You discard a vial after using it. Nonpreservative eyedrops are safe if you use them more than four times each day.
- Ointments vs. drops: Lubricating eye ointments coat your eyes, providing comfort from dry eyes for a longer period of time. However, these products are thicker than eyedrops and can cause blurred vision. As a result, ointments are best administered right before bedtime. Eyedrops can be used at any time and will not impair your vision.
- Redness-reducing drops: It is advisable to avoid using them as a treatment for dry eyes because they can cause irritation.
Cleaning your eyelids to reduce inflammation
Frequent and gentle eyelid washing may benefit persons with blepharitis and other disorders that produce eyelid irritation and limit the passage of oil to the eye. To clean your eyelids:
- Place a warm towel over your eyes: Warm water should be applied to a clean cloth. For five minutes, place the cloth over your eyes. When the fabric has cooled, rewet it with warm water. Rub the washcloth gently over your eyelids, including the base of your eyelashes, to remove any debris.
- Apply a gentle soap on your eyelids: Use baby shampoo or a gentle soap. Gently massage your closed eyelids around the base of your eyelashes with your clean hands. Rinse well.
