Definition & Overview

A dry eye syndrome is a condition wherein the supply of tears is not adequate to provide constant lubrication in the eyes. Since moisture in the eyes is important to maintain a person’s comfort and good vision, inadequate lubrication can lead to several uncomfortable symptoms.

The tears, made up of water, oil, mucus, antibodies, and special proteins, play an important role in the eyes. While the water and oil provide moisture and lubrication, the mucus, antibodies, and proteins help prevent infection. All of these originate from special glands surrounding the eyes. However, some factors may cause an imbalance in the tear system, causing an inadequate supply of tears.

Cause of Condition

Dry eyes or the lack of sufficient moisture or normal composition of tears, can be caused by several factors that lead the tear film to become dry. These factors include:

  • Dry air due to air conditioning
  • Excessive heat
  • Aging
  • Menopause
  • Side effects of medications such as antihistamines, blood pressure medications, anti-depressants, tranquilizers, or medications for Parkinson’s disease
  • Side effects of oral contraceptives
  • Sjogren’s syndrome
  • Rheumatoid arthritis
  • Collagen vascular disease
  • Inflamed eye surface
  • Inflamed lacrimal or meibomian glands
  • Thyroid disease affecting the surface of the eye
  • Cosmetic surgery causing the eyelids to open too wide
  • Structural eye problems
  • Allergic reactions

These causes can lead to two different types of dry eye, namely:

  • Aqueous tear-deficient dry eye – This disorder sets in when the lacrimal glands are unable to produce the adequate supply of the water-based component of tears to keep the eye surface healthy.

  • Evaporative dry eye – This stems from the inflammation of the meibomian glands that produce the lipid or oil-based component of tears. Since the oily component is responsible for limiting the evaporation of tears, low levels may cause tears to evaporate more quickly than normal, causing dryness in the eyes.

Based on the abovementioned causes of dry eyes, some people face a higher risk of developing this condition. Those with a higher tendency of having dry eyes include:

  • People taking some medications or those who have underlying conditions that require continuous use of dry eye-causing medications
  • Those with skin disease near the eyes
  • Those undergoing hormone replacement therapy
  • Those who have undergone LASIK refractive surgery
  • Those who have experienced chemical or thermal burns
  • Those working or staring at the computer for extended periods of time, with minimal blinking
  • Those who wear contact lenses
  • People older than 50 years of age

Key Symptoms

The main symptoms that arise when the eyes do not receive enough lubrication include:

  • Pain
  • Sensitivity to light
  • Feeling of having a foreign object or sand in the eye
  • Itching
  • Redness
  • Stinging or burning feeling
  • Alternating periods of dryness and excessive tearing
  • Stringy eye discharge
  • Heavy eyelids
  • Inability to release tears when stressed
  • Decreased tolerance for extended eye usage
  • General eye fatigue
  • Blurry vision
  • An uncomfortable sensation in the eyes

A dry eye may also cause some misleading symptoms such as tears running uncontrollably down the cheeks, which occurs when the eye transmits signals to the nervous system requiring more lubrication and the nervous system, in turn, responds by flooding the eyes with tears as compensation for the dry sensation. Unfortunately, this does not resolve dry eyes because the tears released in such situations are made up mostly of water instead of the complete composition required for lubricating the eyes.

In some cases, dry eyes occur temporarily, in which case it may not require treatment and may revert to normal and healthy eye condition once the causative factors have disappeared. However, if symptoms persist, it is best to seek professional help to relieve the above symptoms and to prevent further damaging the eyes.

Who to See & Types of Treatments Available

If you are experiencing dry eyes, you can see an ophthalmologist to seek advice on how to make your eyes more comfortable. The condition is not curable, but there are many ways to lessen its symptoms, such as:

  • Eye drops – Eye drops provide artificial lubrication and are used as the primary means of treating dry eyes. These are widely available over the counter and come in many brands and variants. Not all drops will affect different people the same way, so you may need to try different types to find the right product that effectively works for you. Your ophthalmologist may also prescribe specific types, especially if your condition is considered chronic, if the symptoms are excessive, or if the eyes dry out even when you are sleeping.

  • Temporary punctual occlusion – In some cases, ophthalmologists prescribe closing the ducts that release tears from the eyes using a dissolving plug inserted into the lower eyelid, where the tear drain is located. Sometimes, a temporary occlusion is used to evaluate whether a permanent occlusion is necessary.

  • Permanent occlusion – In case permanent occlusion is deemed necessary, non-dissolving punctal plugs will be used.

  • Cauterization – The tear drain can also be permanently plugged through cauterization, a procedure that is also called surgical occlusion.

  • Lipiflow – This refers to a medical device that unclogs blocked glands surrounding the eyes to improve tear production using both pressure and heat. This method also prevents the evaporation of tears.

  • Restasis – This is a special FDA-approved prescription eye drop that can effectively treat chronic dry eyes. With continued use, patients can expect an increase in tear production.

  • Steroid eyedrops – There are some steroid-based eyedrops that can be used for a set period of time to help relieve periods of dryness. These are most effective in more severe cases of eye dryness, but they should only be used for the short term.

  • Prescription medication – Aside from eye drops, there is an oral medication used for the treatment of dry eyes; it is called cyclosporine, which is an anti-inflammatory drug that protects the cornea from damage and increases tear production, keeping it at a stable level.

  • Nutritional supplements – Some studies show that increased intake of fish oil and omega-3 can help relieve the discomfort caused by dry eyes.
    References:

  • Gayton J. (2009). “Etiology, prevalence, and treatment of dry eye disease.” Clinical Ophthalmology Volume 3.

  • Tsubota K, Goto E, Fujita H, Ono M, Inoue H, Saito I, Shimmura S. (1999). “Treatment of dry eye by autologous serum application in Sjogren’s syndrome.” British Journal of Ophthalmology.
  • Bhargava R, Kumar P, Kumar M, Mehra N, Mishra A. (2013). “A randomized controlled trial of omega-3 fatty acids in dry eye syndrome.” International Journal of Ophthalmology.
  • Nelson D. (1997). “Dry Eye.” British Journal of Ophthalmology.
  • Afshari N. (2002). “Dry Eye Syndrome.” Digital Journal of Ophthalmology.
  • Phadatare S, Momin M, et al. (2015). “A Comprehensive Review on Dry Eye Disease: Diagnosis, Medical Management, Recent Developments, and Future Challenges.” Advances in Pharmaceutics.
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