Dry Eyes

Dry eye syndrome (DES) is a chronic condition that develops when your eyes do not produce enough tears to keep the surface of the eye lubricated, resulting in symptoms that vary from person to person. This may result from reduced tear production or increased tear evaporation caused by a lack of oil from glands in the eyelids. The effects can range from minor dryness and discomfort to pain, blurred vision, and frequent infections.

Symptoms of dry eye syndrome vary depending on the severity of the condition and can include:

• Dry, itchy eyes
• Burning or stinging
• Irritation
• Watery eyes
• Blurred vision
• Pain
• 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 and contain enzymes that protect against bacteria and infection. Dry eye is a condition that develops when tear production is insufficient to maintain a balanced moisture level. This can cause a scratchy feeling, dryness, stinging, or the sensation of a foreign body in the eye. Ironically, dry eye can trigger excessive tearing, which is why some people experience watery eyes.

Dry eyes can occur naturally due to aging or hormonal changes, especially 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 dry out the eyes, and DED is common in dry, dusty, and windy climates. Air conditioning, heating systems, and extended screen time can dry out the eyes and worsen symptoms due to reduced blinking.

Individuals who have conditions such as diabetes, blepharitis, lupus, arthritis, and thyroid disorders are more likely to develop DED. Other causes include eye surgery, such as LASIK, conditions in which the eyelids do not close properly, and extended contact lens use.

Eye doctors typically diagnose dry eye disease through a comprehensive eye exam and a review of 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 can watch and count how long it takes the tears to start breaking up after they’ve asked you to hold your eyes open after a blink. This test is called TBUT, or tear break-up time. A low TBUT may indicate an oil deficiency caused by poorly functioning eyelid glands. In a Schirmer test, a strip of paper is placed under the eyelid to measure tear production over five minutes. Following the test, the eye doctor will measure the amount of moisture on the strip. Eye doctors perform Schirmer tests less frequently than they perform TBUT tests.

There are many treatment options for dry eye, depending on 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.

Your eye doctor may treat more severe cases of dry eye with a punctal insert, a small device placed in the lower eyelid to release lubrication. 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. In severe cases, your eye doctor may use punctal plugs to reduce tear drainage and keep the eyes hydrated.

In some cases, adjusting medications may reduce symptoms. Your doctor may recommend limiting contact lens use or switching to a different type to reduce dryness.

If the cause of your dry eyes is external or environmental, eliminating it may resolve the problem and alleviate the symptoms. Avoid dry or smoky environments, direct airflow from heaters or fans, and wear protective eyewear in dusty or windy conditions. Use a humidifier to add moisture to dry indoor air. When using a computer or watching television, blink regularly, as screen use reduces the natural blink rate. Also, avoid rubbing your eyes as this can further irritate them. Staying hydrated by drinking at least eight to 10 glasses of water per day can also help.

Dry eye disease does not usually cause permanent vision loss, but treatment can improve comfort and moisture. 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.