Dry Eyes

What is dry eye syndrome?

Dry eye syndrome (also known as kerato-conjunctivitis sicca, or simply dry eyes) occurs when there is a problem with the tear film that normally keeps the eye moist and lubricated. .

What is the tear film?

The tear film is made up of three layers -a thin outer layer, the main middle watery layer, and the thin inner mucus layer. The tears come from the lacrimal gland, which is located just above, and to the outer side, of each eye. When you blink, the eyelid spreads the tears over the front of the eye and into the tear ducts.

The tears then drain down small channels (canaliculi) on the inner side of the eye into a tear sac. From here they flow down a channel called the tear duct (nasolacrimal duct) into the nose.

Who gets dry eye syndrome and what causes it?

Dry eye syndrome can affect anyone, however it becomes more prominent as an individual ages. Dry eyes affect about 15 to 33% of people. Women are affected much more often than men.

The causes include:

  • Aging. You tend to make fewer tears as you get older. In particular, some women notice dry eyes developing after the menopause.
  • Medication. Some medicines have a side-effects that can cause dry eyes, or make dry eyes worse. These medications include:
    o ‘Water’ tablets (diuretics).

    • ‘Water’ tablets (diuretics).
    • Some antidepressants.
    • Antihistamines.
    • Some treatments for anxiety and other psychological problems.
    • Beta-blockers such as propranolol, atenolol.
    • Some treatments for acne, etc.
  • Illness. Some people develop dry eyes as a symptom of a more general disease. For example, dry eyes may be associated with rheumatoid arthritis, systemic lupus erythematosus (SLE) and Sjögren’s syndrome. In these situations you would normally have other symptoms in other parts of the body such as joint pains.
  • Increased evaporation of tears. This may be due to:
    • Low humidity – for example, from central heating or air conditioning.
    • Low blink rate, often combined with opening your eyes wider than normal. For example, spending a long time looking at a computer, TV or microscope. Also people with Parkinson’s disease can blink less.
    • Wearing contact lenses.
    • Windy conditions when you are outside.
    • Not being able to cover the eyes completely when closing the eyelids.
  • Damage to the outer part of the eyes, eyelids, etc, from disease, injury or surgery.
  • Skin rashes such as seborrhoeic dermatitis or rosacea.
  • Unknown. Some younger people have no apparent cause. They simply produce less than the normal amount of tears.

What are the symptoms of dry eyes?

Both eyes are usually affected. Symptoms include:

  • Irritation in the eyes. The eyes may feel gritty or burning. However, the eyes do not go red. If they do, another eye problem or a complication is usually present.
  • Slight blurring of vision from time to time. However, dry eyes do not usually cause permanent damage to vision.
  • Discomfort in your eyes when looking at bright lights.
  • If you wear contact lenses, you may find they become uncomfortable.

What are the possible complications of dry eyes?

Complications are uncommon. Inflammation of the conjunctiva (conjunctivitis) or the cornea at the front of the eye (keratitis) sometimes occurs. In severe cases, small ulcers may develop on the cornea. Rarely, the corneal may puncture (perforate).

See a doctor if your eye becomes red or if vision becomes affected (more than slight temporary blurring). Also, if eye pain develops other than the feeling of grittiness or irritation please see a doctor. These are not normal symptoms of dry eyes and may indicate other eye conditions or a complications

How are dry eyes diagnosed?

A doctor can usually diagnose dry eyes from the symptoms. However, as dry eyes can be a symptom of an underlying disease (such as Sjögren’s syndrome), don’t be surprised if your doctor asks about all sorts of other symptoms.

Sometimes a test is done to confirm the diagnosis of dry eyes. This is called Schirmer’s Tear Test. This measures the amount of tears that you form. Special filter paper is placed under the lower lid of your eye and left for five minutes. The amount of tears that you make can be assessed by how wet the filter paper becomes after five minutes. Further examination with an instrument called a slit lamp is sometimes needed. Sometimes eye drops containing special dyes are used to show up dry areas or ulcers in the eye. If these tests are needed, your doctor will usually recommend that you visit an optician. If your dry eyes are more complicated and associated with another disease, your doctor may refer you to an ophthalmologist for tests and treatment.

What is the treatment for dry eyes?

Artificial tears

These come as eye drops and gels, and are usually good at relieving symptoms. You can buy them at pharmacies or get them on prescription. At first, you may need to use them every hour or more to improve symptoms. Once symptoms improve, you may then only need to use them three or four times a day. You may need to use them regularly to keep symptoms away.

There are several types of artificial tear drops and gels with different ingredients. Occasionally, some people find one type may irritate. A change to a different preparation may help if the first does not suit.

Note: some types of artificial tears contain preservatives such as benzalkonium hexachloride. If you use drops that contain benzalkonium hexachloride for long periods, they may damage the front of the eye (the cornea). Therefore, if you use artificial tears more than four times per day long-term, it is best to use a preservative-free brand which does not contain benzalkonium chloride. Or, if the artificial tears you are using cause irritation in your eyes, try changing to a type which is preservative-free.

Eye ointment

It may also help to use a soothing and lubricating ointment at bedtime for overnight. You can buy this too at pharmacies, or get it on prescription. You should not use ointment during the day as it may make the artificial tear drops less effective, and can blur vision. (Also, do not use eye ointment if you use other eye drops for other conditions such as raised pressure in the eye (glaucoma). The other eye drops may not work so well on top of an ointment.)

Other treatments

Artificial tears and soothing ointments work well in most cases. Other treatments may be advised by a specialist in severe cases not helped by the above.

Examples of other treatment options sometimes used for severe cases include:

  • Anti-inflammatory eye drops or tablets (for example, steroid eye drops or tetracycline tablets).
  • Medicines to boost tear production by the tear gland (for example pilocarpine).
  • Surgery to stop the tears from draining away.
  • Plugs inserted in your lacrimal ducts to form a temporary block to the tears draining away.
  • The fluid contained in your own blood can be used to make special tear drops which are not artificial. These are called autologous serum tears.
  • Special lenses or goggles are used to try to keep the moisture in your eyes.

Also, some people may need other treatments if they have an underlying cause for their dry eyes.

It appears that fats from fish oils (omega-3) in the diet, or as supplements, can improve dry eyes. More studies are needed to work out the exact combination and dose. However, meanwhile, including oily fish in your diet once or twice a week may be beneficial. Some groups of people should be careful about the amount of oily fish in their diet, or omega-3 supplements (eg, pregnant women) so check with your doctor or pharmacist.

Contact lens wearers

You should not wear contact lenses whilst using many types of eye drops or ointments. Check with your doctor or pharmacist. It is often the preservative in the drops that may cause problems. Some types of drops are available without preservative, which are suitable for contact lens wearers.

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