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What is Dry Eye?
Dry eye syndrome (DES) is a chronic condition that develops when your eyes do not produce and maintain enough tears to keep the eye’s surface lubricated resulting in multiple symptoms that range from person to person. This can be due to a reduction in tear production or increased tear evaporation from a lack of lipid in the tears that stem from oil glands in the eyelids. The effects can range from minor dryness and discomfort to pain, blurred vision and frequent infections.
Symptoms of dry eye syndrome can vary depending on the severity of the condition but can include:
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Dry, itchy eyes
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Burning or stinging
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Irritation
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Watery eyes
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Blurred vision
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Pain
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Foreign body sensation
The main function of tears is to maintain the health of the cornea of your eye by washing away foreign matter and ensuring that the surface of your eye remains moist, smooth and clear. Tears also rinse away dust particles from your eyes and contain enzymes that protect your eyes from bacteria that can cause infections.
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Dry eyes is a condition that develops when the amount of tears produced is not sufficient to maintain the moisture balance in your eye. This can result in that scratchy sensation, a continuous feeling of dryness, stinging and a sensation of a foreign body in your eye. Ironically in an effort to fight off the condition, dry eyes can cause you to produce excessive tears, which is why some people experience watery eyes.
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What causes Dry Eyes?
Dry eyes can occur naturally as a result of aging or hormonal changes, typically in women who are pregnant, taking oral contraceptives or going through menopause. In fact, women over 50 have a 50% greater risk of dry eye disease than men do of the same age. It can also result from taking certain medications that reduce tear production such as antihistamines, blood pressure medications and antidepressants.
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Environmental factors can also play a role in drying out the eyes and DED is common in areas where the climate is dry, dusty and windy. Home air conditioners or heating systems and excessive time spent staring at a computer or television screen can also dry out eyes and exacerbate symptoms due to the lack of blinking while staring at our screens.
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Individuals that suffer from certain medical conditions such as diabetes, blepharitis, lupus, arthritis and thyroid problems are more vulnerable to developing DED. Other causes can be due to eye surgery including LASIK, certain conditions in which the eyelids don’t close properly or extended contact lens use.
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Diagnosis of Dry Eye Disease (DED)?
Typically, dry eye disease can be diagnosed through a comprehensive eye exam and a description of your symptoms. On some occasions the eye doctor might decide to do a test that measures how quickly your tears evaporate from the surface of your eye. By instilling a simple dye called fluorescein (much like food coloring) the doctor is able to watch and count how long it takes the tears to start to break up after they’ve asked you to hold your eyes open after a blink.
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This is called TBUT or a Tear Break Up Time test. A low TBUT generally indicates a lipid (aka oil) deficiency in the tears resulting from oil glands in the eyelids not functioning properly. In another type of test, called a Schirmer test, a strip of filter paper is placed under the lid of the eye, and you will be asked to close your eye for five minutes. Following the test, the amount of moisture on the strip will be measured. Schirmer tests are performed less frequently than a TBUT test.
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Treatments for Dry Eyes
OptiLIGHT by Lumenis
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TearCare®
TearCare® is a 15-minute in-office procedure used to treat meibomian gland disorders. The sterile single-use flexible eyelid devices gently adhere to the contours of the patient’s eyelids and apply low heat. SmartLidTM technology works in conjunction with the blinking eye to facilitate natural meibum expression as the meibum melts. The TearCare® procedure is usually repeated every two years or every year. After TearCare®, we may prescribe a corticosteroid such as Inveltys or Lotemax SM for use twice per day.
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PROKERA®
PROKERA® is a therapeutic device used by eye doctors around the world to protect, repair and heal damaged eye surfaces. PROKERA® is made by clipping a piece of amniotic membrane tissue in between two rings made out of a clear, flexible material. Eyes treated with PROKERA® have quicker healing, less pain, less scarring, and less inflammation. The amniotic membrane in PROKERA® is thin and clear like the tissue on the surface of your eye and protects your eye’s damaged tissue while inserted.
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Artificial Tears/Prescription Drops
Many mild forms of DED can be alleviated using artificial tears or lubricant eye drops to make up for the lack of natural tears usually produced by your eyes. If over-the-counter drops don’t alleviate your symptoms, your doctor might prescribe prescription drops that actually stimulate tear production or steroids for short-term relief.
Punctal Insert
More severe cases of dry eyes might be treated with a punctal insert which is a tiny insert containing a slow-release lubricating substance that is placed inside the lower eyelid.
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Hot Compress Mask
Since DED is often related to eyelid inflammation known as blepharitis your doctor may prescribe a heated hot compress mask, specialty eyelid scrubs and sometimes an antibiotic ointment.