Dry Eyes

Overview

Dry eyes, also known as dry eye disease, is a common condition where your tears aren't able to provide adequate lubrication for your eyes. This can occur due to insufficient tear production or poor-quality tears. The tear instability leads to inflammation and damage of the eye's surface, causing discomfort and a range of symptoms such as a stinging or burning sensation, stringy mucus, sensitivity to light, eye redness, and blurred vision. Dry eyes can be caused by various factors, including age, gender, certain medical conditions, medications, and environmental factors like wind, smoke, or dry air. Treatments for dry eyes include lifestyle changes and eye drops, which may need to be used indefinitely to manage symptoms.

Understanding the disease

Symptoms

The symptoms of dry eyes include a stinging, burning, or scratchy sensation in the eyes, stringy mucus in or around the eyes, sensitivity to light, eye redness, a sensation of having something in the eyes, difficulty wearing contact lenses, difficulty with nighttime driving, watery eyes, blurred vision, and eye fatigue.

Risk Factors

Risk factors for developing dry eyes include:

1. Being older than 50, as tear production tends to diminish with age.
2. Being a woman, particularly during hormonal changes due to pregnancy, birth control pills, or menopause.
3. Having a diet low in vitamin A, found in liver, carrots, and broccoli, or low in omega-3 fatty acids, found in fish, walnuts, and vegetable oils.
4. Wearing contact lenses or having a history of refractive surgery.

Development

Dry eyes can develop due to various reasons that disrupt the healthy tear film. The tear film consists of three layers: fatty oils, aqueous fluid, and mucus. Problems with any of these layers can cause dry eyes. Some reasons for tear film dysfunction include:

1. Decreased tear production: Dry eyes can occur when you're unable to produce enough liquid tears. This condition is called keratoconjunctivitis sicca (ker-uh-toe-kun-junk-tih-VY-tis SIK-uh). Common causes of decreased tear production include aging, certain medical conditions such as Sjogren's syndrome, allergic eye disease, rheumatoid arthritis, lupus, scleroderma, graft vs. host disease, sarcoidosis, thyroid disorders, or vitamin A deficiency. Some medications, such as antihistamines, decongestants, hormone replacement therapy, antidepressants, and medicines for high blood pressure, acne, birth control, and Parkinson's disease can also contribute to decreased tear production. Additionally, corneal nerve desensitivity caused by contact lens use, nerve damage, or laser eye surgery can lead to dry eyes.
2. Increased tear evaporation: The oil film produced by small glands on the edge of your eyelids (meibomian glands) may become clogged. Blocked meibomian glands are more common in people with rosacea or other skin disorders. Causes of increased tear evaporation include posterior blepharitis (meibomian gland dysfunction), eyelid problems such as the lids turning outward (ectropion) or inward (entropion), and conditions like eye allergies, preservatives in topical eye drops, wind, smoke, dry air, and vitamin A deficiency.

Assessment and Diagnosis

Triage

You should see a doctor if you have prolonged signs and symptoms of dry eyes, including red, irritated, tired, or painful eyes, or if you have other concerns about your eye health. Your healthcare provider can take steps to determine what's bothering your eyes or refer you to a specialist.

Diagnosis

To diagnose dry eyes, a comprehensive eye exam including a history of your overall health and eye health is necessary. Your eye care specialist may perform several tests to determine the cause of your dry eyes, such as the Schirmer tear test, which measures tear production, and tests to determine the quality of your tears. Additionally, tear osmolarity tests, tear samples, and imaging tests like sialogram and salivary scintigraphy may be used to diagnose dry eyes. It's essential to be well prepared for your appointment by listing any symptoms, personal information, and medications you're taking, and asking relevant questions to your healthcare provider.

Management and Treatment

Complications

The potential complications of dry eyes are eye infections, damage to the surface of the eyes leading to inflammation, corneal ulcers, and vision loss if left untreated, and decreased quality of life due to difficulty in performing everyday activities.

Prevention

While there is no definitive answer to prevent dry eyes entirely, you can take several measures to reduce the risk or minimize symptoms. Some of these include:

1. Position your computer screen below eye level: This helps prevent excessive eye strain and the need to open your eyes wider, which can accelerate tear evaporation.
2. Stop smoking and avoid smoke: Exposure to smoke, especially if you smoke yourself, can exacerbate dry eye symptoms. Quitting smoking and avoiding smoke-filled environments can help alleviate dry eyes.
3. Use artificial tears regularly: If you have chronic dry eyes, using eye drops even when your eyes feel fine can help keep them well-lubricated.
4. Adopt a healthy diet: Eating foods rich in vitamin A, such as liver, carrots, and broccoli, and those high in omega-3 fatty acids, like fish, walnuts, and vegetable oils, can help maintain eye health.
5. Wear sunglasses: UV light exposure can increase tear evaporation, so wearing sunglasses can help protect your eyes from sun damage.
6. Stay hydrated: Drinking enough water can help maintain overall eye health and may contribute to healthy tear production.
7. Avoid contact lenses if possible: If you experience dry eyes, consider using glasses instead of contact lenses, as lenses can worsen dry eye symptoms.
8. Be mindful of certain medications: Some medications, like antihistamines and blood pressure medications, can contribute to dry eyes. Consult your healthcare provider to discuss alternatives or potential solutions.
9. Manage conditions that can cause dry eyes: Treating underlying health issues, such as autoimmune diseases, eyelid gland inflammation, or allergic eye disease, can help alleviate dry eye symptoms.
10. Limit screen time: Prolonged exposure to electronic devices can contribute to dry eye symptoms. Take frequent breaks to rest your eyes and follow the 20-20-20 rule: every 20 minutes, look at something 20 feet away for 20 seconds. By adopting these habits and being proactive in

Home Remedies

Home remedies for dry eyes may include:

1. Humidifying your environment: Using a humidifier in your home or office can help add moisture to the air and reduce dryness.
2. Avoiding wind and dust: Limiting your exposure to wind, smoke, and dry environments can help reduce irritation.
3. Wearing sunglasses: Wraparound sunglasses or glasses with side shields can help protect your eyes from wind, dust, and dry air.
4. Blinking regularly: Taking frequent breaks to blink and rest your eyes, especially during long periods of reading or screen time, can help keep your eyes lubricated.
5. Using a warm compress: Applying a warm compress, such as a warm washcloth, to your closed eyes for a few minutes can help soothe dry eyes.
6. Eating a balanced diet: Consuming a diet rich in vitamins A and omega-3 fatty acids, found in foods like liver, carrots, broccoli, fish, walnuts, and vegetable oils, may help support eye health.
7. Staying hydrated: Drinking plenty of water can help maintain overall eye health and moisture.
8. Taking breaks during long tasks: Taking periodic breaks to rest your eyes and blink can help prevent dryness during prolonged periods of reading, working on a computer, or performing other visually demanding tasks. Remember, these home remedies may help alleviate symptoms, but it's essential to consult with an eye care professional if your dry eye symptoms persist or worsen.

Treatment

Treatments for dry eyes may include lifestyle changes and eye drops. Some lifestyle changes that can help alleviate dry eyes are:

• Positioning your computer screen below eye level
• Stopping smoking and avoiding smoke
• Using artificial tears regularly
• Avoiding air blowing in your eyes
• Adding moisture to the air with a humidifier
• Wearing wraparound sunglasses or protective eyewear
• Taking eye breaks during long tasks
• Being aware of your environment and taking precautions when in dry areas such as high altitudes, deserts, or airplanes Eye drops can also be used to provide lubrication and alleviate dry eyes. It's important to consult with a healthcare provider to determine the best course of treatment for your specific case.

Preparing for medical consultation

To prepare for an appointment for dry eyes, you should:

1. List any symptoms you are experiencing, including those that may seem unrelated to dry eyes.
2. Provide key personal information, such as any recent life changes.
3. Make a list of all medicines, vitamins, and supplements you are taking.
4. Prepare a list of questions to ask during the appointment, including:
   • What is the most likely cause of my dry eyes?
   • Do I need any tests?
   • Can dry eyes get better on their own?
   • What are my treatment options?
   • What are the potential side effects of each treatment?
   • How can I best manage other health conditions with dry eyes?
   • Is a generic medicine available for the medicine you're prescribing me?
   • Do you have any brochures or printed material that I can take with me?
   • What websites do you recommend?
   • Do I need to plan for a follow-up visit?
5. Expect your doctor to ask questions about your symptoms, family history, nonprescription eye drops tried, and the time of day your symptoms are worse. Remember to bring this list of questions and any other relevant information to your appointment to ensure you get the most out of your consultation.