Dry Eye Management

Dry Eye? Causes and Treatment Options

Does your eye feel itchy and painful? Dry eye syndrome is caused by a lack of lubrication and moisture on the eye’s surface that occurs over the years. 

Dry eye is a chronic condition (occurs over the years) when the eye’s surface does not have enough lubrication. The causes can be many, but all result in changes in the quantity and quality of tears.

Tears are the system that cleans the impurities that reach our eyes. The tear is a crystalline, transparent liquid produced by the lacrimal glands that come out every time we blink.

The sensation of itching, grittiness, ocular dryness, conjunctival redness, and a hard time opening the eyes in the morning is discomfort that, although they are not specific to dry eye, could indicate this condition. Given this range of complaints, at XXXX, we have professional ophthalmologists and optometrists to treat dry eye depending on your symptoms and needs.

Many of the patients who suffer from this and sometimes labelled as “allergic” are people with deficient ocular lubrication and are often misdiagnosed in other care facilities.

You must know that the tear film is composed of three layers. The innermost is the mucous layer produced by the goblet cells. The middle is the watery layer created by the lacrimal glands, and the oily layer, the outermost, is produced by the Meibomian glands. The last one prevents tear evaporation by holding the necessary moisture on the ocular surface.

The dry eye causes are many, but can be classified into two according to the eye’s damage:

Dry eye syndrome due to deficiency in water production:

  • Both primary and secondary Sjögren’s syndrome

Dry eye syndrome due to evaporative losses (tantalic eye). The frequent causes are: 

  • Meibomian gland disease: alteration in the tear lipid layer, also occurs in psoriasis, rosacea, and seborrhea dermatitis
  • Alterations in blinking or eye exposure
  • Use of contact lenses

There are also other causes of dry eye such as medications, nutritional deficiencies (vitamin A deficiencies), alcoholism, and ageing or ocular or eyelid infections.

Risk factors also exist. They increase the probability of suffering from dry eyes, such as cigarette smoking, hormonal imbalances such as adolescence or menopause, elderly, chemo or radiotherapy, or air conditioning, heating, dry or polluted environments.

Symptoms

We have talked about the symptoms throughout the article, but we haven’t explained them yet well. You must pay attention to your eyes appearance to be able to detect dry eye timely.

The main symptom is a foreign body sensation and dry eyes, especially when you wake up in the morning, with trouble opening the eyes.

Other symptoms include:

  • Itching
  • A sensation of dirt or grit in the eyes
  • Slight visión blurring
  • Light sensibility sometimes

Diagnosis

When you arrive at the ophthalmologist’s office, the first thing the specialist does is ask you about your symptoms to take a proper medical history. 

After this, ophthalmologists run a series of tests with special devices to see and evaluate your eye correctly. Among these tests is the application of fluorescein.

Fluorescein first alleviates discomfort, and secondly, it allows for ruling out or confirm ocular problems such as uveitis, keratitis or glaucoma. These problems are not necessarily related to dry eye, but they could be found in people who feel eye discomfort.  

If the fluorescein test is successful, the specialist proceeds with more specific tests, such as Schirmer’s test, tests that study the tear film, or tests that show previous ocular lesions.

Schirmer’s test consists of placing a thin strip of paper on the eye to check the person’s tear production capacity. 

Treatment. How Can We Help You?

The most common treatment for dry eye is tearing replacement with artificial tears. 

Know that the treatment of dry eye depends on the underlying cause and the discomfort you are experiencing. Thus, if the dry eye is very severe, the treatment will be more intense, while if other diseases cause the dry eye, the goal is to treat the causal condition.

Some of the treatment options for dry eye include:

  • Eye drops prescription for dry eyes such as Restasis or Xiidra
  • Heat therapy to promote normal meibomian gland function
  • Eyelid scrubs and foaming eyelid cleanser to reduce bacteria overproduction
  • Bleph-Ex treatment to remove eyelid biofilm and Meibomian gland blockages

Some symptoms are due to sleeping with the eyes slightly open. Lubricating ointments applied at night before going to sleep are very effective for this. 

Once you and your doctor have chosen the best treatment, you must follow these recommendations to prevent and improve your eyes health:

  • Avoid air conditioners, fans, place loaded with fumes or air currents.
  • Avoid excessive heaters
  • Avoid contaminated environments 

These circumstances contribute to worsening dry eye.

  • Use a humidifier
  • Reduce allergy and cold medications (they reduce tear production)
  • Blink on purpose often. Rest your eyes from time to time
  • Clean eyelashes regularly and apply warm pads

Outlook (Prognosis)

Most people with dry eye syndrome have only discomfort but no vision loss. Dry eye is likely to be challenging to cure, but treatment is simple and almost always effective in all people.

If you think you have dry eyes, don’t hesitate to assist a professional. Many people who treat their dry eye early experience only mild eye discomfort throughout their lives.

References:

  1. Lurati A. R. (2019). Menopause and Dry Eye Syndrome. Nursing for women’s health23(1), 71–78. https://doi.org/10.1016/j.nwh.2018.11.001
  2. Laura M. Periman, Victor L. Perez, Daniel R. Saban, Meng C. Lin, and Piergiorgio Neri.Journal of Ocular Pharmacology and Therapeutics.Apr 2020.137-146.http://doi.org/10.1089/jop.2019.0060
  3. Rouen, P. A., & White, M. L. (2018). Dry Eye Disease: Prevalence, Assessment, and Management. Home healthcare now36(2), 74–83. https://doi.org/10.1097/NHH.0000000000000652
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