Dry eye syndrome (DES or dry eye) is a chronic lack of sufficient lubrication and moisture on the surface of the eye. Its consequences range from minor irritation to the inability to wear contact lenses and an increased risk of corneal inflammation and eye infections.
What are the signs and symptoms of Dry Eye?
Persistent dryness, scratchiness and a burning sensation on your eyes are common symptoms of dry eye syndrome. These symptoms alone may be enough for your eye doctor to diagnose dry eye syndrome. Sometimes, he or she may want to measure the amount of tears in your eyes. A thin strip of filter paper placed at the edge of the eye, called a Schirmer test, is one way of measuring this.
Some people with dry eyes also experience a "foreign body sensation” – the feeling that something is in the eye. And it may seem odd, but sometimes dry eye syndrome can cause watery eyes, because the excessive dryness works to overstimulate production of the watery component of your eye's tears.
Other symptoms might include itching, fluctuating or blurry vision, mucous discharge, irritation from wind or smoke, redness, tired eyes, light sensitivity, contact lens discomfort, contact lens solution sensitivity, eyelid infections/styes, and eyelids stuck together at awakening.
What causes dry eyes? Are there lifestyle factors or genetic factors that affect it?
In dry eye syndrome, the tear glands that moisturize the eye don't produce enough tears, or the tears have a chemical composition that causes them to evaporate too quickly.
Dry eye syndrome has several causes. It occurs:
- As a part of the natural aging process, especially among women over age 40.
- As a side effect of many medications, such as antihistamines, antidepressants, certain blood pressure medicines, Parkinson's medications and birth control pills.
- Because you live in a dry, dusty or windy climate with low humidity.
If your home or office has air conditioning or a dry heating system, that too can dry out your eyes. Another cause is insufficient blinking (low blink rates), such as when you're staring at a computer screen all day.
Dry eyes are also associated with certain systemic diseases such as lupus, rheumatoid arthritis, rosacea or Sjogren's Syndrome (a triad of dry eyes, dry mouth, and rheumatoid arthritis or lupus).
Long-term contact lens wear, incomplete closure of the eyelids, eyelid disease and a deficiency of the tear-producing glands are other causes.
Genetics affect skin types, which sometimes influences dry eyes. Dry eye syndrome is more common in women, possibly due to hormone fluctuations.
Lifestyle factors include the environment the patient lives or works in. Working outside in the wind, or inside where there is a lot of recycled forced air would naturally contribute to dry eye symptoms. Allergens and pollens will affect it.
Recent research suggests that smoking, too, can increase your risk of dry eye syndrome. Dry eye has also been associated with incomplete lid closure following blepharoplasty – a popular cosmetic surgery to eliminate droopy eyelids.
How is Dry Eye diagnosed? What tools or techniques do you use?
Dry eyes are usually diagnosed in the exam room when the doctor listens to the patient’s symptoms and examines their eyes in the slit lamp bio-microscope. The doctor can stain the tears yellow and shine a blue light on them that makes them glow green. This allows the doctor to count how long it takes before the tears begin to evaporate. This test is called “tear break up time” and a normal score is 10 seconds. The doctor will also evaluate the eyelid margins since eyelid health is critical for proper tear film (see below in the section about blepharitis).
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What treatment options do you offer at Ballantyne Vision Care? What are they and how and why do they work? Can lifestyle changes help?
Dry eye syndrome is an ongoing condition that treatments may be unable to cure. But the symptoms of dry eye – including dryness, scratchiness and burning – can usually be successfully managed.
Artificial tears can help heal a dry cornea, but having to rely on them full time is not much fun. Our doctors seek to find other ways to help the patient develop a healthier natural tear film, thus decreasing your dependency on artificial tears. Tear stimulation drops are sometimes prescribed, and eyelid hygiene instructions are usually given (detailed below in the section about blepharitis). Prescription eye drops for dry eye go one step further: they help increase your tear production. In some cases, your doctor may also prescribe a steroid for more immediate short-term relief.
Another option for dry eye treatment involves a tiny insert filled with a lubricating ingredient. The insert is placed just inside the lower eyelid, where it continuously releases lubrication throughout the day.
For more significant cases of dry eye, your eye doctor may recommend punctal plugs. These tiny devices are inserted in ducts in your lids to slow the drainage of tears away from your eyes, thereby keeping your eyes more moist.
If you wear contact lenses, be aware that many artificial tears cannot be used during contact lens wear. You may need to remove your lenses before using the drops. Wait 15 minutes or longer (check the label) before reinserting them. For mild dry eye, contact lens rewetting drops may be sufficient to make your eyes feel better, but the effect is usually only temporary. Switching to another lens brand could also help.
Check the label, but better yet, check with your doctor before buying any over-the-counter eye drops. Your eye doctor will know which formulas are effective and long-lasting and which are not, as well as which eye drops will work with your contact lenses.
How do the different treatment options compare in terms of cost and effectiveness?
Treatment options range from no cost to hundreds of dollars. Our doctors have developed a system that is affordable and effective.
I have heard that fish oil is helpful. Is that true? How and why?
There is anecdotal evidence that 2000mg per day of fish oil (or another omega 3 source) taken by mouth helps to develop a healthier tear film because it helps your oil glands in your eyelids secrete better quality oil onto the surface of your tears, which then increases your tear break up time. Our doctors routinely recommend this. Fish oil is known to have many other health benefits as well. However, you need to be careful about fish oil if you are pregnant or if you are taking blood thinners—when in doubt, ask your primary care provider before you start a fish oil regimen.
What is blepharitis? How is it treated?
Blepharitis (often referred to as meibomian gland dysfunction or MGD) is a condition caused by eyelid inflammation. Each of our eyelids contains several small oil glands, called meibomian glands, which secrete oil or meibum onto the surface of our tears so that our tears will stay on the eyes and resist evaporation. Most people have some degree of blepharitis, so this is a logical thing that our doctors usually seek to treat first. If left untreated it can lead to painful and unsightly styes and/or severe dry eye. Treatment involves hot compresses on the closed eyelids to melt down the oil, followed by lid massage to express the oil out of the glands. This can be done with a hot washcloth, but it is much more convenient to use a microwaveable heat mask called the Bruder mask (available in our office). We also recommend Ocusoft lid scrub foam to be used in the shower and/or to clean off makeup. This is a special eye soap that is gentle and very good at cleansing the eyelids which prevents inflammation. We also have a product called Hypochlor that is sprayed on and left on all day which we use in more difficult cases.
What is MGD and how is it different than blepharitis? Is it treated differently?
Meibomian Gland Dysfunction (MGD) is very similar to blepharitis and the treatments are the same. In our office we tend to use the terms interchangeably.
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Is there anything else I need to know about treating Dry Eye?
To reduce the effects of sun, wind and dust on dry eyes, wear sunglasses when outdoors. Wraparound styles offer the best protection.
Indoors, an air cleaner can filter out dust and other particles from the air, while a humidifier adds moisture to air that’s too dry because of air conditioning or heating.
If medications are the cause of dry eyes, discontinuing the drug generally resolves the problem. But in this case, the benefits of the drug must be weighed against the side effect of dry eyes. Sometimes switching to a different type of medication alleviates the dry eye symptoms while keeping the needed treatment. In any case, never switch or discontinue your medications without consulting with your doctor first.
If you are considering LASIK, be aware that dry eyes may disqualify you for the surgery, at least until your dry eye condition is successfully treated. Dry eyes increase your risk for poor healing after LASIK, so most surgeons will want to treat the dry eyes first, to ensure a good LASIK outcome. This goes for other types of vision correction surgery, as well.