Dry Eye

A Common Condition

Dry eye is characterized by low tear production or poor tear quality and can range in severity from very mild to very severe and debilitating.

Age, sex, eye disease, systemic disease, medications, prior eye surgery, environmental factors, contact lens use, and many other factors can contribute to the symptoms of dry eye. A normal tear film contains three layers (mucus, aqueous, and lipid), and these layers must be in proper balance to maintain healthy hydration of the eye.

Symptoms

Symptoms of dry eye can include stinging, burning, pain, grittiness, foreign body sensation, redness, discomfort when wearing contact lenses, difficulty keeping your eyes open and excessive tearing. Though it may sound counter-intuitive, tearing can occur in dry eye due to a reflexive over-tearing response to the irritation from dryness. These reflex tears are not properly balanced, and will not “fix” the dryness. Dry eye symptoms will often be worse at the end of the day and while doing visually demanding activities such as reading, driving, computer work, or watching television.

Causes

Dry eye can be caused by many things but certain factors are common in many cases. Women are at greater risk for dry eye, and this can occur especially in times of hormonal change such as pregnancy or menopause. Tear production also decreases with age.

Autoimmune diseases such as lupus, rheumatoid arthritis and Sjogren’s syndrome can lead to decreased tear secretion from the lacrimal gland (the gland that produces the aqueous layer of the tear film). Diabetes and herpes eye infections can disrupt corneal sensation, which can cause dry eye. Rosacea can cause inflammation and blockage of oil glands in the eyelid that make the oily layer of the tear film, resulting in disruption of tear film balance.

Other diseases such as blepharitis, abnormal eyelid anatomy and previous eye surgery also can contribute to dry eye. Wearing contact lenses if you have dry eye can be uncomfortable, and even detrimental to eye health if your eyes are red or painful.

Several medications can contribute to dry eye by reducing tear secretion. Common culprits include diuretics (used for blood pressure control), antihistamines and anti-depressants.

Environmental factors such as low humidity, heaters, air conditioning and windy conditions can all exacerbate dry eye by speeding tear evaporation from the surface of the eye. Irritants such as smoke and perfumes also can worsen dry eye symptoms.

Treatment Options

A variety of treatment options exist for dry eye, and the right choice will depend on the cause(s) and severity of your dry eye. Artificial tears are available without prescription and can help add lubrication to the eye. Various thicknesses (tears, gels ointments) exist, as well as preservative-free formulations, which are especially good for sensitive eyes. Artificial tears can be used as often as necessary to relieve dry eye symptoms.

Punctal plugs are a treatment option that can help conserve your own tears. Each eye has a drainage system that starts from the inner corner of the eye and drains tears into the nose. A variety of tiny plugs can block this drainage system and help your eye keep tears longer. Punctal plugs are inserted during an office visit, a procedure that is quick and painless.

A prescription eye medication can help some patients increase tear production. Prescription tear inserts also may be helpful in more severe forms of dry eye.

Omega-3 fatty acids can be helpful in certain forms of dry eye and are found naturally in fish such as salmon and anchovies, as well as in dietary supplements and flax seed oil. If you have concurrent blepharitis or rosacea, your doctor may recommend warm compresses and eyelid hygiene or an antibiotic ointment or pill for a period of time.

Increasing the humidity of your environment can help, as dry air can worsen dry eyes. Air blowing toward your eyes can cause excessive tear evaporation, so avoid heater/air conditioners in the car blowing at your face or ceiling fans at home. Wrap-around glasses may help protect your eyes on windy days. Increase artificial tear use while doing prolonged computer work or reading.