Dry eyes

Dry eyes occur when the eyes do not produce enough tears with their lubrication component to maintain moistened eyes. Reduced tear production may result in damage to the ocular surface or infection. The condition stems from many causes.

You may experience eye pain or irritation when you spend long hours looking at a computer or mobile phone screen, watching television, riding a bike, staying in an air-conditioned room, or on an airplane.

Eye drops or lifestyle modifications can relieve the symptoms. The treatments must be ongoing without gaps for improved symptom outcomes.

Symptoms

• Red eyes and eye muscle fatigue
• Blurry vision 
• Watery eyes
• Burning sensation, irritation, or feeling of having something in your eyes
• Light sensitivity
• Stringy mucus in or around your eyes
• Problems with using contact lenses and night driving.

When to see a doctor

When the symptoms such as redness, irritation, eye fatigue, or pain in your eyes last for many days, you should see an ophthalmologist for proper medical care. 

Causes

Your tear consists of lipids, aqueous fluid, and mucus which help lubricate the surface of your eyes. When there are problems with any of these components, you can experience dry eyes. 

There are many causes for dry eyes, inadequate production, rapid evaporation, allergic eye disease, autoimmune diseases, meibomian gland dysfunction, or change in hormonal levels.

Your eyes do not produce enough tears because of:

• Older ages.
• Medications such as antidepressants, antihistamines, decongestants, hormone replacement therapy, acne medications, birth control pills, antihypertensive, and antiparkinsonian drugs 
• Medical conditions such as Vitamin A deficiency, allergic eye disease, graft vs. host disease, rheumatoid arthritis, sarcoidosis, Sjogren's syndrome, and thyroid diseases
• Corneal nerve de-sensitivity due to wearing contact lens, nerve damage, or after eye surgery can cause temporary dry eye 

Increased tear evaporation may be caused by:

• Allergic eye diseases or eye lid problems such as ectropion or entropion
• Dry air, wind, or smoke
• Preservatives in eye drops
• Deficiency of vitamin A
• Less blinking due to medical conditions such as Parkinson’s disease or activities such as looking at a computer screen, driving, or reading for prolonged period of time

Risk factors

• Ages over 50. The older you are, the lesser the tear production. 
• Female due to hormonal fluctuations during pregnancy, menopause, or when on birth control.  
• Use of contact lenses or refractive surgery. 
• Low vitamin A and omega-3 fatty acids intake from food.

Complications

• Increased risk of eye infections due to lack of tear to protect eye surface
• Ocular surface damage. Severe dry eyes can cause eye inflammation, abrasion of the corneal surface, corneal ulcers, and vision loss.
• Poor quality of life. You may have difficulty reading or carry out activities of daily living.

Prevention

Avoid situations that can cause dry eyes. For example:

• Avoid direct air from a hair dryer, air conditioners, or electric fans blowing into your eyes.
• Wear protective eyewear such as wraparound sunglasses to shield your eyes from dry wind or air.
• Close or blink your eyes often when peering at a computer screen, reading, or doing activities that need visual focus.
• Do not position your computer screen above eye level because it forces the eyes to open wider to view the screen and speeds up the tear evaporation. 
• Avoid smoke and smoking as it can worsen your symptoms.
• Regularly use eye drops to lubricate your eyes. If you have chronic dry eye syndrome, regularly use artificial tears even if you are asymptomatic.

Diagnosis

To identify the cause of dry eye syndrome, your doctor may order:

• An eye health screening exam to identify the cause of dry eye syndrome.
• A quantitative tear production Schirmer test by placing a blotting paper strip under your lower eyelids for 5 minutes to see how much tear is soaked up. 
• A tear quality test: Your doctor uses special dyes to check staining patterns on the corneas and check how fast your tears evaporate.  
• Tear osmolarity test to gauze its composition. Tears will have less aqueous fluid or water in dry eye patients.
• Test tear composition for evidence of dry eye diseases such as decreased lactoferrin and elevated matrix metalloproteinase-9.

Treatment

Apply eye drops or artificial tears for mild or temporary dry eye symptoms. 

Treatment depends on the cause of your symptoms in chronic or severe cases, which may include modifying your surroundings, improving the tear quality, or decreasing tear evaporation.

If your medications cause dry eyes, consult your doctor for alternatives.

If you have ectropion, an oculoplastic surgeon can do the corrective surgery.

Medications

• Antibiotics can help reduce blepharitis or eyelid inflammation which blocks oil from mixing into your tears. This type of medication is available as eye drops, ointments or pills.
• Immunosuppressants such as cyclosporine or corticosteroids can help control the inflammation of cornea. However, long-term use of corticosteroids can produce side effects.  
• Autologous blood serum drops made from your own blood by removing the red blood cells and mixing it with a balanced salt solution. It is a treatment option for severe cases that are not responsive to other treatments.

Other procedures

• Partial or completely close your eyelid tear ducts to prevent rapid tear drainage.
• Temporary punctual plugs to block your tear ducts with removable silicone plug or thermal cautery, which uses heat, to permanently close your tear ducts.
• Wear scleral lenses or bandage lenses to protect eye surface and lock in moisture.
• Apply a warm compress or eye mask to clear up blocked oil glands.
• Intense Pulsed Light (IPL) therapy followed by eyelid massage in severe cases of dry eye. 

Lifestyle and home remedies

Wash your eyelids often help to moisten your dry eyes, or use eye drops for lubrication. 

How to select eye drops

You can buy artificial tears from a drug store. However, discuss with your doctor which product is suitable for you. 

Artificial tears can relieve mild dry eye; however, how often you need to apply artificial tears depends on the severity of your symptoms. 

• Eye drops with preservatives have longer shelf life but can cause irritation and is limited to 4 times a day. Eye drops with no preservatives usually come in multiple single-use ampules. It is safe to use more than 4 times a day.
• Artificial tears do not interfere with your vision, so you can use them all day, whereas ointments can cloud your vision. Before bed time, you may opt for eye ointments because they provide long relief. 
• Avoid using eye drops for pink eyes as long-term use can cause irritation.

Washing your eyelids often can relieve the eyelid infection

• Put a warm washcloth onto your eyelid for 5 minutes. Gently clean your eyelids to remove any debris. 
• Further clean your eyelids with mild soap, gently massage your closed eyes and rinse thoroughly.

Preparing for your appointment

What you can do
You can take note of the following:

• When it first happens and the symptoms you experienced, including others which may or may not be related to dry eyes.
• Significant events or changes in your life.
• All medications and supplements you are taking.
• Questions you would like to ask your doctor.

Sample of questions you may want to ask your doctor

• What is the cause of my symptoms?
• Do I need to undergo any tests?
• Can the symptoms resolve by themselves?
• What treatments are available? Are there any side effects?
• I have a medical condition. How should I treat both dry eyes and preexisting health problems?
• Are there any restrictions I should follow?
• Is a follow-up visit necessary?
• Where can I find more information about dry eye?

Sample of questions your doctor may ask

• When did dry eyes first occur? 
• What are your symptoms? Do they occur daily or intermittently?
• Does anyone in your family have dry eyes?
• Have you used eye drops to relieve your symptoms?
• What makes symptoms better or worse?
• Are you taking any medications?
• Do you have headaches or neck pain?

What you can do while waiting for your appointment
You can use artificial tears to keep your eyes moistened. Do not use eye drops for pink eyes as they can cause eye irritation.