Dry eyes: Symptoms, Causes, and Treatments

We tend to take our eyes for granted. They enable us to see well, sometimes with the help of glasses, and when they feel good, we don’t think about them. Then comes the day when our eyes feel uncomfortable. It’s hard to think of anything else. What is causing this discomfort, and what will make it go away? This article will discuss the details of the frustrating condition called dry eyes, including its symptoms, causes, and treatments.

Symptoms

Dry eyes bring on a burning, stinging, scratchy sensation. Counterintuitively, dry eyes may water excessively as a compensatory response. They may look red and irritated and be sensitive to light. Blurry vision can accompany dry eyes as well. Some people experience a constant haze, while others experience an intermittent blur that clears with every blink.

Causes

Dry eye disease is a common condition, affecting an estimated 75% of people over 40. Women are affected more often than men, and the condition is multifactorial. It results from a lack of balance in the tear film.

The tear film has three layers: an oily layer, a watery layer, and a mucus layer. All three layers play a crucial role in maintaining the balance of the tear film. The oily layer is made by the meibomian glands of the eyelids. The watery layer is secreted by the lacrimal gland. Conjunctival cells on the eye secrete the mucus later. The anatomy of the eyelids is important since the eyelids help to spread the tear film over the eyes with every blink.

The following factors can all contribute to dry eyes:

  • Aging: This is likely due to hormonal changes. Certain conditions can also make you more prone to dry eye disease, such as rheumatoid arthritis.
  • Medications, including antihistamines and antidepressants.
  • Environment: The lack of humidity in heavily air-conditioned or heated environments, windy conditions, smoke, and the use of fans can also aggravate dryness.
  • Digital devices: Looking at a screen slows down the blink rate, causing the eyes to dry out further.
  • Anatomical factors: Some people’s eyelids don’t close completely, for example, and therefore their eyes dry out during the night.

Treatments

Start by taking an inventory of your environment. Avoid fans or forced air blowing directly towards your eyes. Take breaks when using digital devices. Ask your eye doctor if any of your medications could be contributing to the problem. Remember to drink plenty of water and consider using a humidifier if you live in a dry climate.

The most common initial treatment for dry eyes is artificial tears. These are over-the-counter lubricating eye drops used to supplement the natural tear film. There are many different brands out there, and most are suitable. Be sure, however, to avoid anything that has a “redness reliever” in it or is designed for allergies.

Some measures can help replenish the oily layer of the tear film. Hot compresses with gentle lid massage can help get the meibomian glands moving. There are also heat packs that you can purchase specifically for this purpose. Use caution not to burn the delicate skin on the eyelids when using heat on them.

Your eye doctor may recommend prescription eye drops to stimulate tear production. There is a nasal spray now available by prescription as well. Your doctor may also advocate for in-office procedures such as punctal plugs. This process involves the placement of tiny plugs in the tear ducts to prevent drainage and retain more moisture in the eyes. There are also in-office procedures to treat the meibomian glands, such as thermal pulsation or intense pulsed light.

Nutritional supplements are sometimes of benefit as well. Talk to your doctor about the use of omega-3 supplementation.

Key take-aways

  • While dry eyes can occasionally be a short-term problem, this is not the norm. In most cases, dry eye disease is a chronic condition.
  • While there are treatments available to manage the condition, you must use them in the long term to keep symptoms under control.
  • The good news is that there are many tools to help with dry eyes, both at home and at the eye doctor’s office. New therapies are on the horizon as well, as it is such a common condition.
  • With the right set of treatments, you can keep dry eyes under control so they’re not such a disturbance to your everyday life.

References:

American Optometric Association. Dry eye.

Shimazak,i J. Definition and diagnostic criteria of dry eye disease: Historical overview and future directions. Invest Ophthalmol Vis Sci.

Stapleton F., Alves M., Bunya V.Y., et al. TFOS DEWS II Epidemiology Report. Ocul Surf.

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