Dry Eye Disease: Symptoms, Causes and Treatments for Relief

Dry eye disease or dry eye syndrome is a common and chronic health issue. An estimated 44 million Americans have it and many require professional eye care.

Our purpose here is to educate you by providing the latest information and encouraging you to make an appointment to get your eyes checked if you are having vision problems due to dry eyes, other eye issues, or if it’s just been a while since your last eye exam.

For those interested, the medical term for dry eyes is keratoconjunctivitis sicca (KCS), which is a Latin term for dryness of the cornea and conjunctiva. The cornea is the transparent part of the eye that covers the iris and the pupil and permits light inside the eye. The conjunctiva is a thin layer of tissue that covers the entire front of your eye, except for the cornea, and helps protect the eye.  We have a short summary of how we help our dry eye patients. 

 

Adults normally blink about 5-12 times per minute, which acts to spread tears evenly across the cornea. Tears are a natural lubricant that helps reduce eye infections, protect the cornea from foreign material, clean the eyes and maintain a smooth, clear surface. The excess tears from the eyes flow into tiny drainage ducts, called puncta, located in the inner corners of the eyelids. These drain to the back of your nose. If your tear production is low or you have poor quality tears, dry eyes may occur.

Dry eye disease can sometimes cause excessive tears to run down the cheeks, which may seem paradoxical. However, when the eye doesn’t get enough lubrication, this happens. This is when the eye signals to the nerve system to get more lubrication. The eye responds by flooding it with emergency tears. These tears, which are mostly water-based, do not possess the same lubricating properties or richness as normal tears. They will remove dirt from your eyes but not properly coat them, resulting in dry eye disease.

Dry Eye Syndrome symptoms can range from mild to severe. Over-the-counter drops might be sufficient to relieve mild symptoms, but if severe dry eyes aren’t treated promptly, the cornea can be damaged, leading to permanent vision issues. Therefore, it’s important to quickly diagnose and treat the problem. If you experience rapid vision changes, you should contact an optometrist immediately. Although dry eye syndrome is not curable at this time, it is possible to manage the condition with effective treatment once a diagnosis is made and its cause is determined. The objective of treatment is to keep you comfortable and prevent eye damage. Remember, it’s important to take good care of your eyes as they are the only ones you’ll ever have!

• Dryness in the eyes
• Eyes feel watery
• Feelings that dust or sand is in your eyes
• Foggy vision
• Eyes experience an itching or burning sensation
• Excessive tearing
• Objects go in and out of focus
• Sensitivity to light
• Eyes become red and inflamed
• Eyes often feel Tired
• Soreness or eye pain
• Wearing contact lenses becomes uncomfortable
• Your eyelids become flaky or red
• The adjacent image is a close-up photograph of a man’s eye who’s suffering from severe dry eye syndrome. Notice the extremely bloodshot eye. Don’t wait this long to seek medical treatment as he’s probably experiencing much pain as well.

If you experience one or more of the symptoms above, it’s a good idea to schedule an appointment with us at Good Eye Optometry located in the Brentwood neighborhood of Los Angeles. Our eye doctors have many years of experience successfully diagnosing and treating dry eyes. Our state-of-the-art equipment and the care and individual attention our optometrists give to every patient make us your perfect choice.

Age and gender
Age is the primary factor in having dry eyes. So, as we age, it’s more likely we’ll get dry eyes, especially for post-menopausal women.
Medications
Certain medications can decrease your ability to make tears, like antihistamines, tricyclic antidepressants, diuretics, beta-blockers, and selective serotonin reuptake inhibitors to name a few.

Other Diseases
People who have certain other diseases are at a higher risk for dry eyes, such as Sjögren’s syndrome, rheumatoid arthritis, collagen vascular diseases, hepatitis c, diabetes mellitus, inflamed eyelid glands and allergic eye disease. Sjögren’s disease is one of the most common causes of tear gland damage although it only affects about 1% of the US population. The mucous membranes, especially in the eye and mouth, get very dry as their function becomes compromised. These patients are more at risk of developing inner organ involvement, such as interstitial lung disease (hepatitis), nephritis or lymphoma.

Other Physical Problems
Problems that prevent your eyes from closing properly are also a risk factor for dry eye disease.
Environmental Factors
Certain weather conditions such as being outside on a high wind or low humidity day, elevated smog levels, and other particulates in the air, such as smoke, dust or pollen can cause dry eyes. Indoors, forced air heating or cooling that may create air movement and an environment with low humidity can cause problems as well.

Many consecutive hours staring at a computer screen and refractive surgery of cornea, such as LASIK or PRK also can cause dry eyes.

When tear production and drainage are not balanced, dry eyes may occur. Dry eyes can be caused by a lack of tears or poor-quality tears. Dry eye syndrome can be caused by many things. A comprehensive exam of the eyes is important to identify and treat them. A treatment plan that is appropriate for you can be created once the cause has been established. Understanding the layers of tear content and the tear film is essential before we can explain these causes.

The tear film is important for good vision and consists of three different layers, fatty oils, aqueous fluid, and mucus. These components are secreted by special glands located around the eye. The illustration nearby, titled, “Structures Involved in Tear Production” shows these tear layers and the parts of the eye responsible for their production. We’ve also provided a video short video (less than 30 seconds) produced by the Eyesmart Division of the American Academy of Ophthalmology for the visual learners.

The meibomian glands make the outside fatty oil layer, the lacrimal glands make the middle aqueous layer and the conjunctival goblet cells are the primary cells that make the innermost mucus layer. These layers work together to maintain a smooth, lubricated, and clear surface for your eyes. Dry eye syndrome can be caused by a lack of and/or an imbalance in these layers.

The main purpose of the outside fatty layer is to seal the tear film, which helps reduce evaporation of the middle layer of tear film and thus, keeps tears from drying up too quickly. In addition, it gives the tear a smooth surface for the eyelids to glide over.

Although most of the middle layer is water-based, it also includes electrolytes and proteins as well as vitamins, immunoglobulins, and peptide growth factor. It is the biggest volume of tear film and is what we think of when we see tears.

The middle layer is responsible for lubricating the eyes, washing away any particles and preventing infection. Film instability can result from problems with this layer. A thin water layer can cause oil and mucus layers to touch, leading to a stringy discharge, a classic sign of dry eye syndrome.

Mucin is the inner layer which allows water to be evenly distributed over the cornea and keeps it moist. The mucin layer provides nourishment to the cornea and allows the tears to stick to the eye’s surface.

Our eyes make tears constantly to keep them moist. Sometimes, the volume of tears is insufficient, or the tear film layers are disproportionate. Dry eyes can result in such cases.

The nearby illustration shows a cross section, cellular view of normal versus dry eyes. In the normal eye on the left, the tear film is intact, and the cornea is protected. However, due to tear insufficiency in the dry eye, the cornea is exposed to the elements and is easily irritated. Also, the cornea has many nerve endings, which when irritated is painful.

A film of teardrops forms in the eyes when you blink. The tear film keeps your eye’s surface clean and smooth. Blinking has the most significant benefit: it removes any dirt and cleans your eyes with new tears. By coating your eyes with tears, you can sharpen your vision and improve the quality of your retina’s image.

As a part of your comprehensive eye exam, we perform the Schirmer’s test, which is used to find out if you are producing enough tears. Assuming the tear quality is good, a low tear volume could be due to one of two problems or their combination. Either you are not producing enough tears, or the tears you are producing are draining too quickly.

Think of the bucket analogy shown in the nearby illustration, where the faucet represents the tears coming into the bucket (filled with the tears) and the hole near the bottom represents the eye drainage. Normal eyes are in homeostasis where the fluid in equals the fluid out and the tear volume remains constant. But if the faucet is turned down, while the hole remains the same, the bucket will lose volume (tears). In the opposite situation, when the faucet remains constant, but the drainage hole enlarges, the bucket volume will decrease. Both cases result in a low tear volume, but the causes are totally different.

To increase tear volume, we can either stimulate the tear glands to produce more tears or slow down the volume of tears draining out of the eye. Low tear volume due to insufficient tear production can be corrected using a class of drugs called cholinergics. Pilocarpine and cevimeline are examples of medications which act to increase tear production. These can be purchased as eye drops, gel or pills.

Tears drain into openings called puncta, which are located on the inside corners of your upper and lower eyelids. The tear ducts function like valves to drain tears out of the eye. Tears are refreshed when we blink as the new tears enter and the old tear fluid leaves via the puncta. This process continues with every eye blink.

By far, the major cause of dry eye syndrome is low quality tears, caused by an inadequate fatty oil tear layer. Recall this is the outermost layer of the tear film. The lipids are secreted by the meibomian glands and spread over the ocular surface through blinking to prevent tear evaporation. There are about 30–40 glands in the upper eyelid and 20–30 in the lower lid. This disease is called Meibomian Gland Dysfunction or MGD. In one study MGD was at least partially responsible for 86% of dry eye patients.

Eye allergies can cause dry eyes and are hereditary. So, if your family members suffer from allergies, you are also likely to have them. Many people are allergic to mold, dust, pollen, grass, and pet dander. It’s best to avoid or minimize situations that place you in contact with these items, if possible.

It stands to reason that eyelid problems could translate into dry eyes since a primary function of the eyelids is to distribute the tear film. Ectropion is where the eyelid opens outwards, while with entropion they open inwards. Dry eyes can also be caused by inflammation along the edges of the eyelids (blepharitis).

If you suspect you have dry eye disease, the first order of business is to make an appointment for a comprehensive eye exam with Good Eye Optometry. After obtaining your medical history, the exam begins. We’ll get an overall snapshot of your eye’s health and determine the cause of your dry eyes. More specifically, we’ll examine your eyelids, blinking, tear volume and tear film components. From these tests, we can determine the volume of tears, the rate of tear evaporation and the tear film composition.

Evidence suggests that taking omega-3 fatty acids as supplements or incorporating them into your diet can help to reduce dry eye symptoms. You should start to see a positive effect after a few months. These fatty acids are found in certain types of foods (oily fish, soybeans, walnuts), oils (canola, olive, flax, hemp), seeds (pumpkin, flax, hemp). There aren’t enough human studies to prove their effectiveness as a primary treatment.

Vitamins A, D and E are associated with healthy eyes and may help with chronic dry eye.

A humidifier can be used to improve the moisture level in your home and prevent dry conditions. You should limit the amount of time you wear contact lenses, as well as the time spent in front of the television or computer.

Making healthy lifestyle changes for better eye and overall health is a great idea by taking steps to eat healthier, exercise more and take time for your mental health..

Artificial tears are the most popular treatment for mild dry eyes. They come in a variety of forms, including drops, gels, and ointments. These eye drops can be purchased without the need for a prescription. You can also find over-the-counter moisturizers and creams that can help your eyes feel more comfortable. There is no one solution that works for all people. You might need to test several products before you find the right one. You should continue to use drops even if your eyes feel fine. You can also use an eye cream or ointment at night if your eyes become dry. It might be worth wearing goggles that are airtight when you sleep. These will create an airtight “moisture chamber”, which can be used to protect your eyes.

Eye drops without preservatives can be used as often as desired, but eye drops containing preservatives should only be used four times a day. When used too frequently, the preservative chemicals may start to irritate your eyes. Don’t use over-the-counter eye drops to treat redness in your eye. You should see a Doctor of Optometry, as the problem may be worse than you think. It’s a good idea to use eye drops just before doing activities that stress your eyes, like going outside on a windy day or spending hours looking at a computer screen. Ointments might be better for nighttime use as they last longer in your eye, even though they may blur your vision.

Artificial tear solutions and hot compresses with eyelid massage using ophthalmic ointments may be all the treatment necessary for mild cases of dry eye syndrome.

Your eye doctor might prescribe medication called cyclosporine, (Restasis), or lifitegrast, (Xiidra) if your dry eyes are more severe. These medications reduce the eye’s surface inflammation and increase the production of tears. If the patient has a history or eye infection, they should avoid this medication. Blepharitis patients may be required to wash the eye area with baby shampoo. A doctor might order prescription eye drops for the night or an ointment. An oral antibiotic may be prescribed, like tetracycline and doxycycline.

A lack of testosterone can cause dry eyes. A doctor may recommend a cream to treat dry eye which can make your oil glands more efficient.

Recently, in October 2021, the FDA approved a new nasal spray treatment for dry eyes. This novel approach acts as a neuro-activator to stimulate production of both the lacrimal and meibomian glands. Taken twice daily in each nostril, Tyrvaya (varenicline solution), will increase tear production of both the fatty-oil and aqueous layers of the tear film. Due to the newness of this treatment, long-term effects have yet to be determined. This spray should be a welcome relief for people that have trouble placing eye drops in their eyes.

To stop tears from draining too fast, punctal obstruction may be used. This involves inserting a plug in the puncta. Using the previously explained bucket scenario, this equates to using a cork to plug up the hole near the bottom of the bucket. This causes your natural tears to remain in your eyes longer, thus increasing your tear volume. Initially, using temporary plugs allows maximum flexibility as they can be removed and reinserted as necessary. This video shows our Good Eye Optometry optometrist, Dr. Ani Janszyan, performing the procedure on a patient. Anesthetic eyedrops make it painless and it’s a very simple procedure which only takes a few minutes.

Permanent plugs can be applied depending on the effectiveness of this procedure. Punctal occlusion with cautery is another permanent procedure. The doctor applies heat to the punctum to close the drain hole. This is the permanent closure. These techniques, taken together, increase the volume of tears by inhibiting their draining. You will notice a difference in your eyes and less need to use artificial tears.

Scleral contact lenses may be just the answer for certain people who have dry eye disease, especially when eyedrops and other treatments are ineffective. The scleral lenses, which are a hard contact lens with oxygen permeable properties, have a large diameter and rest on the sclera, or white portion of the eye.

These lenses rise above the cornea to trap liquid between the lenses and cornea, providing necessary hydration as well as visual clarity. The cornea, which has many nerve endings and can be very sensitive to pain, is normally where contact lenses sit. Scleral lenses, however, are more comfortable as they sit on the white part of the eye which has fewer nerve endings.

Scleral lenses can be worn as a supplement to eye drops as they are not mutually exclusive. The Dr. Eye Guy’s video titled, ”Scleral Lenses: How To Treat Dry Eye With Contacts!”, visually describes what they are and how they work to manage dry eyes.