Dry Eye Syndrome: Causes, Symptoms, Treatments
Tears are necessary to lubricate the eye, bring oxygen to the cornea, and fight germs that could cause an eye infection. Tears also wash away dirt and other debris and help us to see well overall.
Dry eye syndrome occurs when there is inadequate lubrication of the eyes. However, there is a wide range of possible causes of dry eye. There is also a wide range of dry eye severity.
For some, it might just be a minor annoyance treatable with eye drops, but if severe enough, the condition can cause corneal abrasions, ulcers, and other serious complications.
More About Tears
Tears have three main components:
1. An oily or lipid part to moisturize the eye and keep tears from evaporating away too soon
2. A watery or aqueous part
3. A mucus part, called mucin, produced by the conjunctiva that coats the white of the eye
All three components are produced separately and only combine when released. Meibomian glands in the eyelids produce the lipid part of the tears, and the watery part is produced by the lacrimal glands of the upper eyelids.
Mucin acts to help the tears cling to the eye and helps them spread evenly over the area.
Other Terms for Dry Eye
These terms include keratitis sicca, dryness and irritation of the cornea, keratoconjunctivitis sicca for dryness of both the cornea and conjunctiva, and dysfunctional tear syndrome, which may involve low tear quality and not necessarily low tear quantity.
Causes of Dry Eye
Aging
The condition is more common in people over 50.
Menopause
Women past menopause have a higher risk for dry eye than men in their age group.
Indoor environment
Air conditioning, fans, and forced heating may reduce the indoor air’s humidity and contribute to dry eye.
Outdoor environment
Wind, high altitudes, and dry climates may cause dry eye.
Air travel
Air circulating in the passenger area of planes is typically very dry and not helpful for dry eyes.
Contact lenses
Dry eye is a primary reason why people give up wearing contacts. Some people simply can’t adjust and cannot tolerate dry eyes caused by contact lenses.
Computer and phone screens
When we use these devices, we don’t blink as much, reducing the movement of tears over the eyeball. This may lead to dry eyes.
Smoking
Not only is this associated with dry eye, but it’s also linked to serious eye diseases like macular degeneration, cataracts, and uveitis.
Masks
Wearing masks, especially for long periods, forces the exhaled air to exit over the top of the mask and the eyes. Eyeglasses may intensify this effect even more.
Allergies and medications
In a kind of catch-22, allergies can cause dry eyes, but some of the medications used to treat them can also cause dry eyes. Several medications cause dry eye: diuretics, certain heart medications, blood pressure medications, antidepressants, hormones, and antihistamines.
LASIK
Dry eye can be a side effect of LASIK eye surgery, but it’s typically self-limiting and clears on its own. Be sure to tell your LASIK surgeon if you have dry eye problems before the surgery. Dry eye can influence the outcome of both LASIK and cataract surgery.
Lagophthalmos
This means an eyelid that doesn’t close properly. This is especially serious during sleep and may result in an ulcer on the cornea if left untreated. This type of eye condition may be caused by aging, nerve damage, eye infections, and eyelid surgery.
Dry Eye Symptoms:
There are several dry eye symptoms, including:
A feeling of grit or sand in the eye
Red, sore, and dry eyes
Blurry or fuzzy vision
Sensitivity to light
Burning and itching eyes
Mucus
A heavy, aching sensation in the eyes
Intolerance of contact lenses
Watering
Watering occurs in some cases of dry eye because the eye tries to compensate for the dryness by producing more aqueous tears. However, without the lipids, these tears will fail to lubricate the eyes properly.
This may be seen in cases of meibomian gland dysfunction, a common cause of evaporative dry eye. The lacrimal glands can also fail to produce enough aqueous tears. When this happens, it’s called aqueous deficiency dry eye.
Treatment for Dry Eye
Your eye doctor will determine the best treatment for you, but there are quite a few different dry eye treatments:
Lubricant Eye Drops
These are available over the counter and may be called artificial tears. Brands vary widely in composition and quality. In general, these products’ effectiveness is determined by their viscosity. This refers to the thickness of the formula.
The higher the viscosity, typically the longer the product will last and the better it will work. The thicker fluids and gels may cause blurry vision and are best for bedtime.
Some brands may be better suited for your particular case of dry eye than others. Your eye doctor will help you select the best product for you.
Restasis
This is a prescription eye drop usually used twice daily. It’s not a lubricant. It works by fighting the inflammation associated with many kinds of dry eye. This medication may take several months to reach full effectiveness.
Xiidra
Although not chemically related to Restasis, this drug reduces the inflammation that can cause dry eye.
Xiidra may work faster than Restasis. Studies have found that Xiidra can significantly reduce dry eye symptoms after only two weeks of use.
Steroid Eye Drops
These also work by fighting inflammation, and they typically work very well and reasonably fast. Safe for short-term use, these medications carry serious risks for prolonged use. This may include cataracts and glaucoma.
Lacrisert
This is a slow-release lubricant pellet inserted under the lower lid. It looks something like a grain of rice. It releases soothing lubricant to the eyes for about 24 hours. It’s effective and recommended for cases of moderate to severe dry eye.
Punctal plugs may also help dry eye by keeping tears from washing down to the tear ducts. These are inserted into the puncta, tiny holes in the eyelids that lead to the tear ducts.
Omega 3 fatty acids, borage, and flaxseed oil supplements may also help in some cases of dry eye.
Home Remedies
Try to remember to blink more often, especially while at the computer. Every 20 minutes, look away from the computer at a distant object for at least 20 seconds.
Thoroughly clean all traces of eye makeup away daily. This will help prevent clogging of the meibomian glands.
Keep your eyelids clean with a solution of diluted baby shampoo. Apply with a warm washcloth and rinse thoroughly. This will discourage infections of the eyelids.
A home humidifier may also help ease dry eye. Always wear UVA and UVB-rated wraparound sunglasses to protect your eyes from glare and outdoor irritants.
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