Dry eyes

What are Dry Eyes?

Dry eyes, also known as dry eye syndrome or keratoconjunctivitis sicca, is a common condition characterized by insufficient lubrication and moisture on the surface of the eyes. Tears play a vital role in maintaining eye health by lubricating the ocular surface, reducing friction with blinking, and protecting against infection. When tear production or quality is compromised, individuals may experience symptoms of dryness, irritation, and discomfort in the eyes.

Causes of Dry Eyes

Dry eyes can be caused by various factors, including:

1. Decreased tear production: Age-related changes, hormonal fluctuations (such as menopause), certain medical conditions (such as Sjögren's syndrome), medications (such as antihistamines or decongestants), or laser eye surgery can lead to decreased tear production.

2. Increased tear evaporation: Environmental factors such as dry or windy conditions, exposure to air conditioning or heating, prolonged screen time (leading to decreased blink rate), or wearing contact lenses can increase tear evaporation and contribute to dry eyes.

3. Tear composition abnormalities: Imbalance in the composition of tears, including deficiencies in the lipid (oil) layer produced by the meibomian glands, can impair tear stability and lead to dry eye symptoms.

4. Eyelid problems: Conditions affecting the eyelids, such as blepharitis (inflammation of the eyelid margins) or meibomian gland dysfunction (MGD), can disrupt the production and secretion of oils that contribute to tear film integrity.

5. Systemic diseases: Certain systemic conditions such as diabetes, rheumatoid arthritis, thyroid disorders, or vitamin A deficiency can affect tear production, quality, or ocular surface health and contribute to dry eyes.

Symptoms of Dry Eyes

Symptoms of dry eyes may include:

• Dryness, itching, or grittiness in the eyes.
• Burning or stinging sensation.
• Redness or irritation of the eyes.
• Excessive tearing (reflex tearing) in response to dryness.
• Blurred vision, particularly during prolonged periods of visual tasks.
• Sensitivity to light (photophobia).
• Difficulty wearing contact lenses comfortably.
• Eye fatigue or discomfort after reading or using electronic devices.

Diagnosis of Dry Eyes

Diagnosing dry eyes typically involves a comprehensive eye examination and assessment of tear film dynamics by an eye care professional. Diagnostic tests may include:

1. Symptom assessment: Gathering information about the patient's symptoms, medical history, medications, and lifestyle factors that may contribute to dry eyes.

2. Visual acuity testing: Assessing visual acuity and refractive error to evaluate the impact of dry eyes on visual function and quality of life.

3. Tear film evaluation: Using techniques such as fluorescein or lissamine green staining, tear breakup time (TBUT) measurement, or tear osmolarity testing to assess tear film stability, integrity, and quality.

4. Meibomian gland assessment: Performing meibomian gland expression, infrared imaging, or meibography to evaluate meibomian gland function and structure in cases of suspected evaporative dry eye.

5. Schirmer's test: Measuring tear production by placing paper strips in the lower eyelid to assess basal and reflex tear secretion levels.

Treatment of Dry Eyes

Treatment for dry eyes aims to alleviate symptoms, improve tear film stability, and maintain ocular surface health. Treatment options may include:

1. Artificial tears: Using lubricating eye drops or ointments containing preservatives or non-preservatives to replenish moisture, soothe dryness, and provide symptomatic relief.

2. Prescription medications: Using prescription eye drops such as cyclosporine (Restasis), lifitegrast (Xiidra), or corticosteroids to reduce inflammation, increase tear production, or improve tear film stability in moderate to severe cases of dry eyes.

3. Meibomian gland therapy: Implementing treatments such as warm compresses, eyelid hygiene, meibomian gland expression, or in-office procedures such as intense pulsed light (IPL) therapy or meibomian gland probing to improve meibomian gland function and reduce evaporative dry eye symptoms.

4. Punctal occlusion: Inserting punctal plugs or performing punctal cautery to block tear drainage and increase tear retention on the ocular surface in cases of severe dry eyes refractory to other treatments.

5. Environmental modifications: Making lifestyle changes such as using humidifiers, avoiding exposure to dry or windy conditions, taking frequent breaks during prolonged visual tasks, or using computer glasses to reduce eye strain and dry eye symptoms.

Prevention of Dry Eyes

Preventive measures to reduce the risk of dry eyes include:

• Taking regular breaks during prolonged screen time or visual tasks to rest the eyes and blink more frequently.
• Maintaining adequate hydration by drinking plenty of water throughout the day.
• Using proper eye protection such as wrap-around sunglasses or goggles in windy or dusty environments.
• Avoiding smoking or exposure to secondhand smoke, which can exacerbate dry eye symptoms.
• Following a balanced diet rich in omega-3 fatty acids, antioxidants, and vitamin A to support ocular surface health and tear production.

When to Seek Medical Attention for Dry Eyes

Individuals experiencing persistent or severe dry eye symptoms, or those with underlying medical conditions that may contribute to dry eyes, should seek evaluation and treatment from an eye care professional. Early intervention can help alleviate symptoms, prevent complications, and improve quality of life for individuals affected by dry eyes.

In conclusion, dry eyes is a common condition characterized by insufficient tear production or quality, leading to symptoms of dryness, irritation, and discomfort in the eyes. With appropriate diagnosis, treatment, and preventive measures, individuals with dry eyes can achieve relief of symptoms and maintain ocular health and comfort.