Dry Eye Syndrome

Thursday, Jan 2, 2020 by Nisha Gupta, MD

This month we will discuss dry eye syndrome (DES). Millions of Americans suffer from dry eye symptoms. It is a common reason for seeking a consultation with an eye doctor.

What is dry eye syndrome?

Dry eye syndrome is a disease of tears and the ocular surface. There is a normal tear film that keeps the eye surface lubricated. If this tear film is disrupted, one can have symptoms of dry eye syndrome.

What are some of the causes?

Causes of dry eye fall in two major categories. These are aqueous deficient and evaporative. Aqueous deficiency means that there are not enough tears produced by the body. This can happen with a condition known as Sjogren syndrome. It can also come from damage to the gland that makes tears or the ducts the tears travel through.

Evaporative is when tears are lost from the surface. Causes include Vitamin A deficiency, contact lens use, and issues with blinking. Issues with blinking can include a person not blinking enough (e.g. looking at a computer screen for a long period of time) or having a problem with the eyelids (e.g. the lower eyelid can turn outwards in older adults preventing the eye from fully closing during a blink).

The environment also plays a role in dry eye syndrome. Low humidity, wind, and dry air can cause dryness. Many medications also can cause dry eye symptoms including allergy medications, diuretics, and some anxiety and anti-depressant medications. Finally, eye surgery, like LASIK, can induce dry eye.

What are the symptoms of dry eye syndrome?

There is a wide spectrum of symptoms and severity in DES. They tend to be worse at the end of the day, in low humidity, dry environments, and winter months.

Symptoms include:

  • Discomfort/irritation
  • Blurry vision
  • Increased tearing (your body produces more tears as a response to the eyes being dry)
  • Gritty or sandy sensation
  • Burning sensation
  • Photophobia (sensitivity to light)
  • Red eye

How is it detected?

A thorough exam of the eyelids and eye surface is completed to look for signs of dryness and other diseases it may be associated with. Doctors look at the conjunctiva and cornea with drops that contain dyes to determine if any changes are present from DES. Other tests include the Schirmer’s test, which measures how many tears are produced from the eyes.

What are the treatments for dry eye syndrome?

Lubricating drops: These are eye drops that are like your own tears. These may be used throughout the day. Sometimes doctors recommend using preservative free tears if one has an allergy to the preservatives or is using the drops very frequently.

Gels and ointments: These are thicker versions of the tears. These can make the vision blurry so are usually used at night and can have a longer lasting effect than drops.

Prescription drops: Doctors may prescribe medications that increase the production of the tears. It takes a few months for these to begin working. Occasionally, steroids may be used for a short time if the eyes are very irritated.

Punctal plugs: Small plugs may be used to block the tear ducts in the eyelids. This helps to keep the tears on the eyes longer. The plugs are placed in the clinic. Some plugs will dissolve on their own in time while others can be removed if necessary.

Omega 3 vitamins: Studies have shown that these vitamins can help with dryness symptoms.

Humidifier: This will add moisture to the air especially in the winter months.

Other tips: Avoid any air blowing into the eyes including heat and air from air vents. Avoid running a ceiling fan. Take frequent breaks to prevent staring at computer screens, phones, TVs, books, and tablets.

Return next month for a discussion on a new topic!

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