WHAT IS DRY EYE?
Dry eye disease is a common condition that occurs when your tears aren't able to provide adequate lubrication for your eyes. Tears can be inadequate and unstable for many reasons. For example, dry eyes may occur if you don't produce enough tears or if you produce poor-quality tears. This tear instability leads to inflammation and damage of the eye's surface.
Dry eye disease is known to be multifactorial, with inflammation being a key contributing factor to the vicious dry eye cycle.
SIGNS AND SYMPTOMS
A stinging, burning or scratchy sensation in your eyes
Stringy mucus in or around your eyes
Sensitivity to light
Eye redness
A sensation of having something in your eyes
Difficulty wearing contact lenses
Difficulty with nighttime driving
Watery eyes, which is the body's response to the irritation of dry eyes
Blurred vision or eye fatigue
Difficulty wearing contact lenses
CONTRIBUTING RISK FACTORS
Systemic Factors
Autoimmune disease: Rheumatoid arthritis (RA), Lupus, and Sjogren's syndrome (SS).
Autoimmune Conditions and Collagen Vascular Disease
Diabetes
Thyroid-related disorders: Grave’s disease, Hashimoto’s thyroiditis
Sleep disorder: Obstructive sleep apnea
Allergies and asthma
Hormone changes
Graft vs Host Disease
Medication Factors
Diuretics
Antihistamine
Antidepressants
Anticholinergics
Hormone Therapy
Oral Contraceptives
Antianxiety
Certain pain, cough relievers & many others
Environmental/Anatomical Factors
Reduced/incomplete blink
Prolonged visual tasks
Incomplete lid closure while sleeping
Ceiling fans/air vents/wind exposure
Eyelid deformity/scar
History of ocular surgery or injury
Facial Nerve Palsy
Herpes Zoster/Simplex
Radiation therapy
History of chemical Burn
Extended wear of contact lenses
DIAGNOSIS
Dry eye is multifactorial and diagnosis is based on a combination of symptoms and ocular surface evaluation.
Testing includes evaluation of the following:
Staining-Highlights areas of damaged cells due to inflammation
Meibography- Infrared imaging of meibomian glands
Lacrimal Lake Height-quantity and volume of tears
Tear Osmolarity- quality and volume of tears
Lid wiper hygiene and gland expressibility
Tear physiology tests- analyzing natural blink patterns
Tear Breakup time-quality of tears
Inflammation markers- matrix metalloproteinase-9 or decreased lactoferrin
LAYERS OF TEAR FILM
When you blink, a film of tears spreads over the eye. This keeps the eye’s surface smooth and clear. The tear film is important for good vision.
Each layer of the tear film serves a purpose.
The oily layer is the outside of the tear film. It makes the tear surface smooth and keeps tears from drying up too quickly. This layer is made in the eye’s meibomian glands.
The watery layer is the middle of the tear film. It makes up most of what we see as tears. This layer cleans the eye, washing away particles that do not belong in the eye. This layer comes from the lacrimal glands in the eyelids.
The mucus layer is the inner layer of the tear film. This helps spread the watery layer over the eye’s surface, keeping it moist. Without mucus, tears would not stick to the eye. Mucus is made in the conjunctiva. This is the clear tissue covering the white of your eye and inside your eyelids.
What are the treatment options?
Treatment for dry eye usually depends on what’s causing your symptoms. Some of the treatment options include:
Over-the-counter eye. drops. Artificial tears in varying thicknesses can be used to supplement your natural tears.
Lid hygiene and supplements. Lid wipes and supplements can be added to help reduce inflammation.
Prescription medicines. These medications help your eyes make more tears and reduce inflammation. Some of those medications include cyclosporines (Restasis or Cequa) or lifitegrast (Xiidra).
Punctal Plugs. Increases the volume of tears in the tear film.
Gland Expression. Clogged glands cause an unstable tear film.
Blephadex. Procedure that cleans lids and lashes.
Biologic treatments. These therapies use your natural antibodies and growth factors to promote healing.
Surgery. If the thin layer of tissue on the white of your eye is loose, it can cause continuous irritation. Also, the eyelids themselves can be loose and no longer touching the front surface of your eye for protection and wiping fresh tears.
Lifestyle changes. Environmental factors can also play a role in dryness. Some of these modifications include:
Try to avoid smoke, wind, and air conditioning
Use a household humidifier
Limit screen time and take breaks from staring at screens
Wear wraparound sunglasses when you're outside
Drink plenty of water — try for 8 to 10 glasses every day
Get enough sleep — about 7 to 8 hours a night
