Dry Eyes

Dry eye syndrome (DES) develops when your eyes do not produce or maintain enough tears to keep the surface lubricated, leading to symptoms that vary from person to person. This can result from reduced tear production or increased evaporation due to a lack of oil from the eyelid glands. 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 may include:

• Dry, itchy eyes
• Burning or stinging
• Irritation
• Watery eyes
• Blurred vision
• Pain
• Foreign body sensation

Tears help maintain corneal health by washing away debris and keeping the surface moist, smooth, and clear. Tears also rinse away dust particles and contain enzymes that protect against bacteria that can cause infections. Dry eye is a condition that develops when tear production is not sufficient to maintain a proper moisture balance. This can cause a scratchy feeling, ongoing dryness, stinging, and the sensation of a foreign body in the eye. Ironically, dry eye can trigger excessive tearing, 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 dry out the eyes, and DED is common in dry, dusty, and windy climates. Air conditioning, heating systems, and prolonged 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.

Diagnosis of Dry Eye Disease

Eye doctors typically diagnose dry eye disease through a comprehensive eye exam and a review 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. The doctor applies a dye called fluorescein and measures how long it takes for your tear film to break up after a blink. This test is called the tear breakup time (TBUT). A low TBUT generally indicates a lipid (aka oil) deficiency in the tears resulting from oil glands in the eyelids not functioning properly. In a Schirmer test, the doctor places a strip of filter paper under your eyelid and asks you to close your eye for five minutes. After the test, the doctor measures the amount of moisture on the strip. Doctors perform Schirmer tests less frequently than TBUT tests.

Treatment for Dry Eyes

Many treatment options for dry eye depend on the cause and severity of the condition.

• We can manage mild cases of DED with artificial tears or lubricating eye drops. If over-the-counter options do not relieve symptoms, your doctor may prescribe medications that stimulate tear production or provide short-term relief.
• We can treat more severe cases with a punctal insert, a small device that releases lubricant inside the lower eyelid. Since DED often relates to eyelid inflammation known as blepharitis, your doctor may prescribe a warm compress, eyelid scrubs, or an antibiotic ointment.
• For severe cases, your doctor may insert punctal plugs to reduce tear drainage and keep your eyes moist.

If you can stop or switch medications, this may reduce symptoms. Your doctor may recommend limiting contact lens use or switching to a different type to reduce dryness.

Preventing Dry Eyes

If an external factor causes your dry eyes, removing it may improve your symptoms. Avoid dry environments, hair dryers, heaters, fans directed toward the eyes, and smoke. Wear protective eyewear in dusty or windy conditions. Use a humidifier to add moisture to dry indoor air. When working on a computer or watching television, blink regularly, as screen use often reduces your natural blink rate. Also, avoid rubbing your eyes, as this can further irritate them. Drinking 8 to 10 glasses of water each day can help.

Dry eye disease does not usually cause permanent vision loss, and treatment options can improve comfort and moisture. Dry eye disease is chronic and requires consistent treatment. Your doctor will develop a long-term plan to keep your eyes comfortable.