Dry eye is a condition in which a person doesn't have enough quality tears to lubricate and nourish the eye. Tears are necessary for maintaining the health of the front surface of the eye and for providing clear vision. Dry eye is a common and often chronic problem, particularly in older adults. As of recently and with widespread computer and smartphone usage, Dry Eye Disease is being diagnosed across a younger population as well as more mature adults. People with dry eyes may experience irritated, gritty, scratchy or burning eyes; a feeling of something in their eyes; excess watering; and blurred vision. Advanced dry eyes may damage the front surface of the eye and impair vision.
When the normal amount of tear production decreases or tears evaporate too quickly from the eyes, symptoms of dry eye can develop. This can be caused by numerous environmental factors, medical conditions, side effects of various medications, and age-related changes.
Common Causes of Dry Eye
- Age - Dry eyes are a part of the natural aging process. The majority of people over age 65 experience some symptoms of dry eyes.
- Gender - Women are more likely to develop dry eyes due to hormonal changes caused by pregnancy, the use of oral contraceptives and menopause.
- Medications - Certain medicines, including antihistamines, decongestants, blood pressure medications and antidepressants, can reduce tear production.
- Medical conditions - People with rheumatoid arthritis, diabetes, and thyroid problems are more likely to have symptoms of dry eyes. Also, problems with inflammation of the eyelids (blepharitis), inflammation of the surfaces of the eye, or the inward or outward turning of eyelids can cause dry eyes to develop.
- Environmental conditions - Exposure to smoke, wind and dry climates can increase tear evaporation resulting in dry eye symptoms. Failure to blink regularly, such as when staring at a computer screen for long periods of time, can also contribute to dry eyes.
- Other factors - Long-term use of contact lenses can be a factor in the development of dry eyes. Refractive eye surgeries, such as LASIK, can decrease tear production and contribute to dry eyes. LASIK is an amazing procedure that provides patients relief from the use of glasses/contact lenses; however, if you're not a good candidate for the procedure, side effects of dry eye will extend past the expected post-operative healing period.
Primary Approaches to Manage and Treat Dry Eye Disease
- Adding tears - Mild cases of dry eyes can often be managed using over-the-counter artificial tear solutions as needed (meaning 2-3 drops in each eye per day). Preservative-free artificial tear solutions are recommended because they contain fewer additives, which can further irritate the eyes. I like brands such as Refresh, Systane, Blink, and TheraTears (most of which have preservative free options available). Some OTC artificial tears are more viscous than others; subsequently, depending on the severity of the symptoms, you can choose which one to administer to relieve the symptoms.
People with dry eyes that don't respond to artificial tears alone will need to take additional steps to treat their dry eyes.
- Conserving tears - Keeping natural tears in the eyes longer can reduce the symptoms of dry eyes. This can be done by blocking the tear ducts through which the tears normally drain. Plugs are an easy in- office procedure that takes only a few minutes to complete.
- Increasing tear production - Your optometrist can prescribe eye drops that increase tear production. Mediations such as Restasis, Xiidra, or Cequa can help produce tears with consistent use over a period of weeks to months (depending on the medication).
- Treating the contributing eyelid or ocular surface inflammation. Your optometrist might recommend prescription eye drops or ointments, warm compresses and lid massage, or eyelid cleaners to help decrease inflammation around the surface of the eyes. Ocusoft brand lid scrubs and cleansers work great for most blepharitis patients. In addition, tea-tree oil cleansers can be administered in-office to treat the eyelashes that can host microscopic bugs (demodex) that cause the inflammation. Avenova is a brand of cleanser that works well to reduce this inflammation.
- In office treatments - Various procedures are now done in office by your optometrist to increase tear production by heating oil glands to secrete the necessary lipids to maintain the ocular surface. (Lipiflow, iLux, MeiboFlo, etc).
- BlephEx - This in-office treatment cleans the lash line of demodex bugs and reduces the inflammation causing dryness/grittiness for patients.
Steps to Reduce Dry Eye Symptoms
- Remember to blink regularly when reading or staring at a computer screen for long periods of time.
- Apply the “20-20-20 Rule”: Take a 20 second break every 20 minutes by looking 20 ft across the room!
- Increase the humidity in the air at work and at home.
- Wear sunglasses outdoors, particularly those with wraparound frames, to reduce exposure to drying winds and the sun.
- Nutritional supplements containing essential fatty acids may help decrease dry eye symptoms in some people. Ask your optometrist if taking dietary supplements could help your dry eye problems. Taking an omega-3 fatty acid nutritional supplement may also help.
- Avoiding becoming dehydrated by drinking plenty of water (8 to 10 glasses) each day.