Dry eye syndrome is a condition characterized by issues with tear production in the eyes. This can manifest as either an inability to produce enough tears or tears evaporating too quickly. Such problems can lead to dry and inflamed eyes. This prevalent condition often arises with age, particularly in women.

Tears consist of water, fats, proteins, mucus, and infection-fighting cells produced by various glands located in the upper eyelid and the mucous membrane covering the white part of the eye. The tear film is composed of three vital layers: the oily (lipid) layer, the watery (aqueous) layer, and the mucous-like (mucin) layer. Each component plays a specific role; tear lipids prevent evaporation and enhance lubrication, while mucin helps to distribute the tears evenly across the eye’s surface.

Importance of Tears

Tears are crucial for providing lubrication, keeping the eyes clean and free from dust, protecting the eye against infection, and stabilizing vision.

Symptoms

For most individuals, the symptoms of dry eyes are usually mild. Still, they can become painful and irritating in more severe cases. Common symptoms include:

  • Heavy Eyelids: This sensation often results from eye fatigue and dryness, making the eyelids feel unusually weighty and challenging to keep open.
  • Eyes feeling sore, gritty, or dry: This discomfort is due to a lack of adequate lubrication on the eye surface, often described as having sand or grit in the eyes.
  • Eyelids sticking together upon waking: A common issue where the eyelids adhere due to dryness and crusting around the eyes during sleep, making it challenging to open the eyes in the morning.
  • Blurred vision that improves after blinking: Dry spots on the cornea can cause intermittent blurring of vision, which temporarily clears after blinking as tears spread over the eye’s surface.
  • Periods of excessive tearing followed by dryness: The eyes may produce excess tears in response to irritation from dryness, but this overproduction doesn’t alleviate the underlying dryness issue.
  • Burning Sensation: A persistent feeling of burning in the eyes can be a sign of chronic dryness, often exacerbated by environmental factors like wind or smoke.
  • Red eyes: Inflammation and lack of moisture can lead to redness in the eyes, often accompanied by a feeling of heat or burning.
  • Irritation when wearing contact lenses: Dry eyes can make contact lens wear uncomfortable, as the lenses can exacerbate dryness and irritation.

If you continuously experience these symptoms, it is advisable to consult an eye specialist.

Causes

Several factors can lead to dry eye syndrome, including the natural aging process, overuse of contact lenses, eyelid problems, or blepharitis (a joint and usually mild chronic inflammation of the eyelid rims). Certain prescription drugs can also have dry eye as a side effect.

  • Aging process: As we age, the body produces fewer tears, leading to dry eyes. Hormonal changes, particularly in women during menopause, can also contribute to reduced tear production.
  • Overuse of contact lenses: Long-term or improper use of contact lenses can mediate with the natural lubrication of the eyes, causing dryness and discomfort.
  • Eyelid problems: Conditions such as blepharitis or entropion (inward-turning eyelids) can affect the tear film and lead to dry eyes.
  • Prescription drugs: Medications like antihistamines, decongestants, antidepressants, and certain blood pressure medications can reduce tear production, leading to dryness.

Dry eye symptoms can worsen in hot, dry, or windy climates, high altitudes, and environments with air conditioning, central heating, or cigarette smoke. Often, a combination of these factors contributes to the condition.

Precautions

  • Avoid medications that can cause or exacerbate dry eyes: Consult your doctor about alternatives if you are taking medications known to cause dry eyes, such as antihistamines or antidepressants.
  • Use a humidifier at home or work to reduce dryness: Maintaining indoor humidity levels can help keep your eyes moist. Aim for a humidity level of 30-50%.
  • Blink more often and gently squeeze your eyelids together when using digital displays: Regular blinking helps spread tears evenly over your eyes. Follow the 20-20-20 rule: every 20 minutes, look at something 20 feet away for at least 20 seconds.
  • Take breaks every hour if you do a lot of computer work: Frequent breaks reduce eye strain & allow your eyes to rest and rehydrate.
  • Adjust your computer screen position below eye level to reduce tear evaporation: Position your screen so you look slightly downward, which helps keep more of your eye surface covered and reduces tear evaporation.
  • Stop smoking and avoid smoky areas: Smoke can irritate your eyes and aggravate symptoms. Quitting smoking and avoiding exposure to smoke can improve your eye health.
  • Wash your face and eyelids gently before bedtime to remove bacteria. Clean eyelids can prevent infections that may contribute to dry eyes. Use a mild soap or baby shampoo diluted with water to clean your eyelids.
  • Wear high-quality sunglasses outdoors to block UV rays: Sunglasses with UV protection can shield your eyes from harsh sunlight and wind, which can cause or worsen dry eyes.
  • Reduce indoor humidity with air conditioning and heating systems: While maintaining a balanced humidity level is crucial, excessive dryness caused by air conditioning or heating can be mitigated by using a humidifier or keeping a window slightly open.
  • Be aware that certain medications: like antihistamines, antidepressants, some blood pressure medications, and birth control pills, can increase the risk of dry eye syndrome. If you suspect your medication is causing dry eyes, discuss alternatives with your healthcare provider.
  • Reducing screen time and increasing outdoor activities can help prevent pediatric dry eye disease. Encourage children to take regular breaks from screens and spend more time playing outside to promote better eye health.

Dry Eye Tests

Diagnosing chronic dry eye syndrome requires one or more tests by an eye specialist. Symptoms alone are not a reliable indicator, as they can vary from person to person. A thorough examination by an eye specialist can determine the presence & severity of the syndrome. The specialist can also recommend the best treatment for your condition. Some standard tests include:

  • Schirmer’s Test: Measures the volume of tears produced by placing a small strip of filter paper under the lower eyelid. The amount of moisture absorbed by the paper over a set period indicates tear production levels.
  • Tear Breakup Time (TBUT): Assesses the stability of the tear film by applying a special dye to the eye. The time it takes for dry spots to appear on the cornea is measured, indicating how quickly the tear film breaks up.
  • Ocular Surface Staining: Uses dyes like fluorescein or lissamine green to highlight areas of damage or dryness on the eye’s surface, helping to identify the extent and location of dryness.
  • Tear Osmolarity Test: Measures the salt concentration in tears, with higher osmolarity indicating dry eye syndrome.
  • Meibomian Gland Evaluation: Examines the function and structure of the meibomian glands, which produce the oils in tears. Dysfunction in these glands can contribute to dry eye symptoms.

Treatment

If your medication is causing dry eye syndrome, your general physician may prescribe treatment for your dry eyes. Usually, artificial tears in the form of drops, gels, and ointments can help ease the symptoms. However, these are not permanent solutions, so regular use is necessary to reduce symptoms significantly. Other treatments include:

  • Prescription Eye Drops: Medications like cyclosporine (Restasis) or lifitegrast (Xiidra) can help increase tear production and reduce inflammation in the eyes.
  • Punctal Plugs: Small, sterile devices inserted into the tear ducts to block drainage and retain moisture on the eye surface. These can be temporary or permanent, depending on the severity of the condition.
  • Warm Compresses and Eyelid Massage: Helps to unclog the meibomian glands and improve the quality of the tear film, providing relief from dry eye symptoms.
  • Omega-3 Fatty Acids: Dietary supplements can reduce inflammation and improve tear quality. Foods rich in omega-3s, such as fish and flaxseeds, can also be beneficial.
  • Moisture Chamber Glasses: Specially designed eyewear that creates a humid environment around the eyes, reducing tear evaporation and providing relief.

Dry eye is generally not severe but can sometimes become problematic, requiring lifelong treatment. If symptoms change, consult an eye specialist for proper curative measures. In severe cases where treatments by a general physician fail, surgery may be necessary. One surgical technique is punctal occlusion, which uses small plugs to seal your tear ducts.

Conclusion

Dry eye syndrome, though common, can significantly impact quality of life if left untreated. Understanding its causes, symptoms, and treatment options can help manage the condition effectively. Always consult with an eye specialist for an accurate diagnosis and appropriate treatment plans tailored to your specific needs. Early intervention and proper management can prevent complications and improve overall eye health, ensuring a better quality of life.