What Is Dry Eyes Syndrome?
Having chronic dry eyes is a form of ocular surface disease, where there is an abnormality in tears and on the ocular surface. It is also called dry eyes syndrome, dysfunctional tear syndrome, keratoconjunctivitis sicca, and/or keratitis sicca. This is a complex disease that has two main types: aqueous tear deficiency, and evaporative dry eye disease.
In this article, we will discuss the main causes of dry eyes syndrome, how to get diagnosed, and different prevention methods you can practice.
Most Common Complaints
There are many signs and symptoms of dry eyes syndrome that you can look for. Usually, someone will experience one or more of the following:
- Feeling of having sandpaper in their eyes
- Dryness and grittiness of the eyes
- The appearance of blood on eyes
- Red, bloodshot eyes
- Presence of mucoid eye discharge
- Excessive production of tears
- Photophobia or sensitivity to light
- Fluctuating or blurry vision
If you are experiencing any of these, make an appointment with a medical professional.
Types of Dry Eyes Syndrome
As mentioned above, there are two main types of dry eyes syndrome. While both of them result in dry eyes, there are different causes.
Evaporative state is the most common form of dry eye disease. The tears in this condition are easily evaporating because they lack the right amount of oil in their composition.
Causes of evaporative loss include the following:
- Meibomian gland disease
- Low blink rate (occurs when an individual is concentrated while performing something, such as using a computer)
- Eyelid disorder
- Vitamin A deficiency
- Topical drugs and preservatives that cause eye surface damage
- Contact lens wear
Aqueous deficiency state is the second type, and occurs when your glands are not producing enough tears to keep them moist.
Some of the causes of deficient aqueous production include the following:
- Congenital lacrimal gland disorder
- Sjogren syndrome-associated dry eye disease
- Lacrimal gland duct obstruction
- Systemic drugs, such as antihistamines, beta-blockers, oral contraceptives, and diuretics
Diagnostic Tools for Dry Eyes Syndrome
There are multiple ways of identifying the possibility of having dry eye disease.
The doctor uses a microscope to look at the eyelids, cornea, and conjunctiva to check how healthy they are.
Tear Breakup Time Test
A yellow fluorescein dye is put into the eye while the patient holds their eyes open. During this time, the tear film is observed under a blue filter over a white light source. If the tear film breaks up quickly, it is a sign that there is a dry eye.
This is a synthetically produced organic dye that allows doctors to detect early dry eyes syndrome. Sometimes, a patient's cornea may look normal, but when this dye is picked up by the conjunctiva, it could mean there is a problem. This is because lissamine green only stains dead and degenerate cells in the eye.
This objective measurement of dry eye identifies if your tear glands are functioning well. For this test, one end of a non-toxic filter paper will be placed against your lower eyelid. Your eyes must be closed for five minutes to let the filter paper absorb the volume of tears produced.
MMP-9 is a substance secreted by epithelial cells if there is a presence of inflammation. This has been a reliable marker to detect early ocular surface disease and dry eyes. An inexpensive device is used in clinics to quickly touch the cornea and gather a tiny sample that is on the surface of the cornea. This procedure requires no anesthesia.
A study has found an association between lipid layer thickness and dry eye symptoms. This lipid layer is the target area of the LipiView device, which measures the layer’s thickness in between blinks and the oil content on tears.
Range of Therapies
Dry eye disease is a chronic condition that requires chronic treatment. Patients have to exert intensive labor to lessen or completely remove the uncomfortable symptoms that come with dry eyes.
Initially, doctors will recommend warm compresses for the eye, modification of the environment, and usage of preservative-free tear products in the market.
They may offer the use of tear substitutes in some cases. Depending on the level of severity, you may need to instill eye drops four times a day, or as many as 12 times a day. Tear ointments may be prescribed as well, but they should be used during nighttime as it can cause poor vision after application.
If the patient's symptoms fail to improve using moderate therapy, pharmacological therapy will be initiated. It can be in the form of anti-inflammatory agents, such as topical cyclosporine or topical corticosteroid. Other agents used to treat dry eyes syndrome are topical or systemic omega-3 fatty acids, and topical or systemic tetracyclines.
When treatments mentioned are inadequate, surgical options might be considered such as salivary gland transplantation and surgical punctal occlusion.
Prevention Is Key
By looking at the causes, you will be able to identify steps on how to prevent getting a dry eye.
Inflammation of the meibomian glands in the eyelids is the most common cause of dry eye. By keeping your eyelids clean and completely removing eye makeup before bedtime will prevent you from having inflamed oil glands.
Eating Vitamin A rich foods like kale, carrot, sweet potato, and spinach can be beneficial to your eyes and your overall health.
When using contact lenses, make sure you don't sleep while wearing them. You should always remove your contacts at the end of the day, and care for them properly.
In some cases, prolonged use of contact lenses may induce dry eyes. To avoid this, switch to wearing your glasses from time to time.
There may be some causes of dry eyes that you cannot prevent from happening, such as age-related issues or having an autoimmune disease called Sjogren Syndrome. However, with all of the available treatments, you may be able to find an option that works for you.
The possibility of multiple applications of topical medications a day may be exhausting. On the bright side, it is worthwhile as you will still be able to maintain your vision and have healthy eyes.
- Review of Cornea & Contact Lenses (Vital Stains: What You Really Need to Know)
- Johns Hopkins Medicine (Schirmer’s Test)
- Review of Ophthalmology (Inflammation Check: A New Test for Dry Eye)
- Review of Ophthalmology (Dry-Eye Disease by the Numbers)
- Medscape (Dry Eye Disease (Keratoconjunctivitis Sicca) Treatment & Management)