Dry Eye Disease,Education

Woman with eye irritation from dry eye
Woman with eye irritation from dry eye

Dry eye syndrome is a common disease that affects people of all ages, genders, and races. It is a condition in which the eye either doesn’t produce enough tears, or where the quality of the tears is inadequate such that the tears don’t keep the eye healthy and moisturized. It can cause significant discomfort and can have a significant impact on quality of life.

Eye Associates Northwest is Proud to offer treatment and diagnoses of Dry Eye Disease with our Center For Eye Comfort.

Normal Tears – A Background

A normal functioning eye constantly produces tears that help keep the eye lubricated and the cornea surface healthy. This constant, steady production of tears helps keep the eye moist. The normal tear film consists of three layers:

  • An inner mucoid layer that is made by cells on the eye’s surface
    • The mucoid layer helps to spread the tears evenly over the surface of the eye to keep the whole eye lubricated
  • A middle watery layer that is produced by the eye’s tear glands
    • This layer helps to cleanse the eye and helps to wash away dust, allergens, and contaminants
  • An outer oily layer that is produced by the eyelid glands
    • This layer helps to maintain the smooth tear surface and help reduce the evaporation of tears.

An imbalance in any of these layers can cause abnormalities leading to incomplete coverage, an inadequate volume of tears, or evaporation that is too rapid. Any of these disruptions can lead to dry eye syndrome. Moreover, other conditions such as allergic conjunctivitis or blepharitis can compound this problem.

What is Dry Eye Syndrome?

Simply, dry eye is either inadequate production of these tears, or a poor quality of any one (or multiple of) these normal tear film layers. These abnormalities can cause dry spots which can lead to the symptoms listed below. Dry eye can be significantly disabling and rarely can even lead to permanent vision loss.

What are the Causes of Dry Eye Syndrome and Who is At Risk?

Dry eye syndrome can affect anyone. However, more typically these affect older people, especially women. It is thought that hormonal changes can be a main cause of dry eye syndrome, often associated with menopause, which is why women might be more affected.

There are many other causes of dry eye that can affect anyone.

  • Autoimmune or inflammatory diseases, such as lupus, rheumatoid arthritis, or Sjogren’s syndrome, can affect the lacrimal gland or its ducts, leading to decreased secretion of the middle layer (aqueous layer).
  • Other diseases, such as diabetes and herpes zoster, can decrease corneal sensation, which in turn results decreased stimulation and therefore inadequate tear production.
  • Extensive contact lens wear
  • Corneal eye surgeries, such as LASIK, can also lead to dry eye.
  • Finally, some medications, both over-the-counter (OTC) and prescription, can also be the cause of dry eye. These medications can include:
    • Anti-allergy medications such as anti-histamines
    • High blood pressure medications such as:
      • Diuretics
      • Beta-blockers
    • Sleeping pills
    • Pain medications
    • Anti-anxiety medications
    • Hormone replacement

Finally, environmental factors, such as outdoor or indoor humidity, fans, smoky air, air conditioning, etc. can increase evaporation and thereby dry out the eyes.

Did you know?

When we read or use the computer, our blink rate drops to half of our normal (basal) rate? This can contribute to dry eye and exacerbate symptoms of dry eye under certain conditions.

Dry eye symptoms may include:

  • Burning, stinging, or scratchy in the eyes.
  • A sensation like sand or grit is in the eye.
  • Redness and irritation, especially with wind or dust.
  • The eyes may produce stringy mucus.
  • Contact lenses may be difficult or impossible to wear.
  • Sometimes the eye will actually produce excessive tears that spill out and run down the cheek. *
  • Variable quality of vision (intermittent blurring).

**Though it sounds contradictory, sometimes the eye will actually produce excessive tears and these will overflow onto the cheek. The reason this makes sense, though, is that the rough spots causes the production of excess tears as a response to ocular discomfort. The eye becomes irritated by the lack of lubrication and these resultant dry spots, and this prompts the lacrimal gland (the gland that makes tears) to help and release a large volume of tears in order to try to sooth the discomfort. The eye senses these dry spots almost like dirt; this prompts the eye to try to wash out the dirt with tears, a normal reflex response.

Treatment of Dry Eye Syndrome:

Though there is no cure for dry eye, it is a chronic disease that is treatable. Treatments are tailored to improve symptoms by keeping the corneal surface smooth. Symptoms may wax and wane, and treatment may be needed in certain seasons or for different environments more than others.

Your eye doctor will talk to you about these treatments and will prescribe these in a step-wise approach depending on the severity, your lifestyle, and your preferences.
Some general therapies can include:

  • Drinking more water: Increasing water intake to eight, 8 oz glasses per day may improve symptoms.
  • Controlling one’s environment: Patients should avoid situations in which tears evaporate quickly; for example, by using a humidifier in a dry house, wearing wrap-around glasses in the wind, and not smoking.
  • Artificial tears: Mild to moderate cases of dry eye syndrome may be treated by applying artificial tear eye drops as little or as often as necessary. There are a wide range of products available without a prescription that the doctor can recommend.
  • Prescription medications: Sometimes your dry eye is significant enough that you need a more specific, prescription drop that you would take chronically. This can increase tear production for those with certain types of chronic dry eye. This drop helps by targeting inflammation in the eye.
  • Conserving tears: An effective way to make better use of the tears in the eye is a procedure to decrease the tear outflow by closing one or more of the tear drainage channels, thus preventing existing tears from leaving the eye as quickly. This may be done temporarily with punctal plugs (of which there are different types), or by more permanently cauterizing the tear ducts closed.
  • Improving the quality of the tear film with warm compresses and lid scrubs to treat blepharitis (see blepharitis page), a common concurrent syndrome.
  • Temporarily decreasing inflammation around the eye with drops when inflammation is a significant factor.

These are many other treatment options that your doctor will discuss with you at your visit.