Dry Eye

Dry eye, medically known as keratoconjunctivitis sicca, is a prevalent eye condition that affects millions of people worldwide. It occurs when the eyes fail to produce sufficient tears or when the tears produced are of poor quality, resulting in inadequate lubrication and moisture on the eye's surface. This can lead to discomfort, irritation, and potential vision problems if left untreated.

What is Dry Eye?

Dry eye, also referred to as dry eye syndrome (DES), dry eye disease (DED), or keratoconjunctivitis sicca, is a condition characterised by insufficient tear production or rapid tear evaporation. Tears play a crucial role in maintaining the health and comfort of the eyes by providing lubrication, nourishment, and protection against infections. When the balance of tear production and evaporation is disrupted, it can lead to the development of dry eyes.

There are two main types of dry eye:

1. Aqueous Tear-deficient Keratoconjunctivitis Sicca: This type of dry eye occurs when the lacrimal glands fail to produce enough of the watery component of tears. It can be associated with systemic autoimmune conditions like Sjögren's syndrome, diseases or inflammation of the lacrimal gland, and the use of certain medications such as decongestants, antihistamines, and diuretics.

2. Evaporative Keratoconjunctivitis Sicca: In this type of dry eye, the quantity of tears produced is normal, but the quality of the tears is compromised, leading to rapid evaporation. The most common cause of evaporative dry eye is meibomian gland dysfunction, which affects the lipid layer of the tear film.

The symptoms of dry eye can vary in severity and may fluctuate throughout the day. Common symptoms include:

• Scratchy or gritty feeling in the eyes

• Stinging or burning sensation

• Redness of the eyes

• Sensitivity to light

• Blurred vision

• Watery eyes (as a compensatory mechanism)

These symptoms can make everyday activities, such as reading, watching television, or driving, uncomfortable and challenging. If left untreated, dry eye can lead to complications like corneal damage. It is essential to seek medical attention if symptoms persist or worsen over time to prevent potential complications and maintain optimal eye health.

Dry eye can be caused by a decrease in tear production or an increase in tear evaporation. Several factors contribute to these conditions, such as:

• Autoimmune or inflammatory systemic conditions: Diseases like Sjögren's syndrome, sarcoidosis, lupus, or rheumatoid arthritis can damage the tear glands, leading to decreased tear production.

• Meibomian gland dysfunction: Meibomian gland dysfunction due to conditions like rosacea, Demodex mites, graft versus host disease, and other skin disorders can increase tear evaporation, leading to dry eyes.

• Environmental factors: Exposure to windy, smoky, or dry environments, prolonged screen time, and certain medications, such as antihistamines, decongestants, and some antidepressants, can also exacerbate dry eye symptoms.

• Hormonal changes: Changes in hormones, particularly in women during pregnancy, menopause, or while using birth control pills, can lead to reduced tear production.

Several factors can increase the risk of developing dry eye syndrome. These include age, sex, certain health conditions, and dietary deficiencies.

Who's at Risk?

• Age 50 or older, as tear production decreases with age

• Women, due to hormonal changes during pregnancy, menopause, or while using birth control pills

• Contact lens users, as long-term wear can reduce corneal sensation

• Individuals with certain health conditions, such as diabetes, thyroid problems, autoimmune disorders like lupus or Sjögren's syndrome, and those who have undergone laser eye surgery

• Dietary deficiencies, particularly lack of vitamin A and omega-3 fatty acids

Identifying these risk factors can help in dry eye prevention, allowing for timely management and treatment.

If left untreated or poorly managed, dry eye can lead to several complications that may impact vision and overall eye health.

• Vision Loss: Chronic dry eye can cause lasting damage to the corneal surface, resulting in a gradual decline in vision.

• Corneal Ulcers: In severe cases, dry eye can lead to corneal ulcers or infections, compromising eye health.

• Poor Quality of Life: Individuals with dry eyes may experience blurred vision and sensitivity to light, which can significantly impact daily activities and quality of life.

• Sjögren's Syndrome: Dry eye is a common symptom of Sjögren's syndrome, an autoimmune disorder that attacks the glands, producing tears and saliva, leading to dry eye, dry mouth, and other systemic complications.

Regular eye check-ups, proper dry eye diagnosis, and appropriate dry eye medication or treatment can help prevent these complications and maintain optimal eye health.

Preventing dry eye syndrome involves a combination of lifestyle changes, environmental adjustments, and good eye care habits.

• One key strategy is to blink regularly, especially when working on a computer or reading for extended periods. The 20-20-20 rule can be helpful: every 20 minutes, take a 20-second break and focus on something 20 feet away.

• Maintaining humidity in your environment by using a humidifier can also help prevent dry eyes, particularly in air-conditioned spaces.

• Staying hydrated by drinking plenty of water (8 to 10 glasses a day) supports overall eye health and maintains tear production.

• When outdoors, protect your eyes from wind and smoke by wearing wraparound sunglasses, and avoid environments with high pollution levels.

• Optimising your workspace ergonomics by positioning your computer screen at eye level and adjusting lighting to reduce glare can help alleviate eye strain and reduce the risk of developing dry eye symptoms.

Diagnosing keratoconjunctivitis sicca typically involves a comprehensive eye examination conducted by an ophthalmologist or optometrist.

• Medical History: The process begins with a thorough review of your medical history, including any symptoms you've been experiencing, existing medical conditions, and medications you are currently taking. Certain health issues like Sjögren's syndrome, lupus, and diabetes can increase the risk of dry eye.

• Eye Examination: During the eye examination, the doctor will visually inspect your eyes for signs of dryness, such as redness, irritation, and abnormalities in the tear film. Special dyes like fluorescein may be used to observe the tear film and corneal surface closely.

• Diagnostic Tests: Two common diagnostic tests for dry eye are the tear break-up time (TBUT) test, which measures how long it takes for tears to break up on the eye's surface, and the Schirmer's test, which assesses the quantity of tears produced by the eyes.

The management of dry eye syndrome often involves a multi-faceted approach tailored to the individual patient's needs and the underlying causes of their condition.

• Over-the-counter eye drops: Artificial tears are usually the first line of treatment, providing lubrication and relief from dry eye symptoms. They help replace or supplement the natural tear film. These over-the-counter eye drops come in various formulations, including preservative-free options for those with sensitive eyes.

• Prescription medicines: For more severe cases of dry eye, prescription medications like cyclosporine or lifitegrast may be recommended to reduce inflammation and stimulate tear production.

• Medical devices or inserts: Punctal plugs and tiny silicone/collagen inserts placed in the tear ducts can also help retain tears on the eye surface for longer periods.

• Scleral contact lenses: For those with severe, unresponsive dry eye, autologous serum eye drops or scleral contact lenses may provide relief by protecting the cornea and maintaining a layer of moisture on the eye surface.

Medications for Dry Eye

• Artificial tears are the most common treatment for dry eye syndrome. Some artificial tears have a hypotonic and electrolyte-balanced formula that replicates healthy tears, containing ingredients such as sodium carboxymethylcellulose, borate buffers, calcium chloride, magnesium chloride, potassium chloride, sodium bicarbonate, sodium chloride, and sodium phosphate.

• For inflammation, medications like cyclosporine can be prescribed.

• Corticosteroid eye drops can also control corneal inflammation but are not ideal for long-term use due to potential side effects.

• Blepharitis, an inflammation of the oil glands along the eyelid, may require antibiotics like doxycycline orally or antibiotic eye drops and ointments, along with warm compresses and eyelid scrubs to unblock oil glands.

• Tear-stimulating medicines like pilocarpine and cevimeline (cholinergics) can help increase tear production, available as pills, gels, or eye drops.

• Autologous blood serum drops can be used for severe cases that do not respond to other treatments. These drops are made from the patient's blood, processed to remove red blood cells, and mixed with a salt solution.

• Varenicline, a nasal spray, is another option to increase tear production.

If symptoms persist or worsen despite treatment, it is crucial to consult an eye care professional for further evaluation and management.

It is important to know when to see a doctor for dry eyes. Some of the conditions that make visiting a doctor a necessity are as follows:

• If you experience persistent symptoms of dry eye, such as burning, stinging, or gritty sensations in the eyes, blurred vision, or eye fatigue, it is important to consult an eye care professional. While mild cases of dry eye may be managed with over-the-counter artificial tears, more severe cases may require prescription medications or other interventions.

• You should also see a doctor if you notice any changes in your vision, experience eye pain or have any signs of infection, such as redness, swelling, or discharge from the eyes.

• If you have an underlying medical condition that may be contributing to your dry eye symptoms, such as an autoimmune disorder or thyroid disease, it is important to work with both your eye care professional and your primary care physician to manage your condition effectively.

• Regular eye exams are also important for detecting and monitoring dry eye syndrome, as well as other eye health issues. Your eye care professional can perform tests to evaluate the quantity and quality of your tears, assess the health of your cornea and other eye structures, and recommend the most appropriate treatment options for your individual needs.

• Dry eye syndrome is a common condition characterised by insufficient or poor-quality tear production, leading to eye discomfort and vision problems.

• Common symptoms of dry eye include burning, stinging, or gritty sensations in the eyes, blurred vision, and eye fatigue.

• Risk factors for dry eye include age, gender (more common in women), certain medications, medical conditions (e.g. autoimmune disorders, thyroid disease), and environmental factors (e.g. dry or windy conditions, prolonged screen time).

• Diagnosis of dry eye involves a comprehensive eye exam, including tests to evaluate tear quantity and quality, corneal health, and other eye structures.

• Treatment options for dry eye include artificial tears, anti-inflammatory medications, antibiotics, tear-stimulating medicines, and autologous blood serum drops, depending on the severity and underlying cause of the condition.

• Lifestyle modifications, such as taking frequent breaks during prolonged screen time, using a humidifier, and consuming a balanced diet rich in omega-3 fatty acids, can help manage dry eye symptoms.

• If symptoms persist or worsen despite treatment, or if you experience changes in vision, eye pain, or signs of infection, it is important to consult an eye care professional for further evaluation and management.