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.
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.
What Causes Dry Eyes?
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, 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.
Dry eye syndrome is more common in women, possibly due to hormone fluctuations. 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.
Treatment for Dry Eye in St. Louis MO
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.
Your south St. Louis optometrist may recommend artificial tears, which are lubricating eye drops that may alleviate the dry, scratchy feeling and foreign body sensation of dry eye. 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.
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.
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.
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 your dry eye is caused by meibomian gland dysfunction (MGD), your doctor may recommend warm compresses and suggest an in-office procedure to clear the blocked glands and restore normal function.
Doctors sometimes also recommend special nutritional supplements containing certain essential fatty acids to decrease dry eye symptoms. Drinking more water may also offer some relief.
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.
Treating any underlying eyelid disease, such as blepharitis, helps as well. This may call for antibiotic or steroid drops, plus frequent eyelid scrubs with an antibacterial shampoo.
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.
Frequently Asked Questions About Dry Eye
Q: Why do we get dry eyes?
A: Dry Eye sufferers have at least one, if not all four, of these problems:
- Tear film instability or hyperosmolarity.
- Biofilm formation
- Obstruction of meibomian glands.
The Meibomian glands are found in our eyelids and secrete thin oil into the tear film which floats to the top of the tears and keeps them from evaporating. It is thought that meibomian gland dysfunction may be responsible for as much as 90% of dry eye problems. For this reason, doctors are starting to refer to Dry Eye Syndrome as Eyelid Inflammation, or Blepharitis. Sometimes it is called Meibomian Gland Disease or MGD. When our meibomian glands are not working properly, instead of secreting thin oil, they become plugged with a thicker paste-like substance, which can lead to the glands dying altogether.
Q: What causes meibomian glands to malfunction?
A: One reason has been linked to our modern diet which contains an especially high ratio of Omega-6 fatty acids to Omega-3 fatty acids. Another reason goes to how we use our eyes today, specifically because of all the time we spend looking at computers, tablets, and smart phones.
When we concentrate, whether using these devices or just reading, we don’t blink as much. Blinking causes meibomian glands to release some of their oil. Other causes include systemic conditions and inflammations such as arthritis, diabetes, rosacea and thyroid disease as well as medications we take such as antihistamines, antidepressants, and estrogens.
Q: How do I know if I have dry eyes, eyelid disease, or how bad it is?
A: If you are having any of the symptoms listed above: dryness, burning, grittiness, or other irritation, you should schedule an appointment with us or with your eye doctor. You should also schedule an appointment if you or someone else notices that your eyes or eyelids look red or have debris in your eyelashes. If you use any artificial tears, but find that you need to use them more than 2-3 times per day, this would also be a reason to schedule an appointment.
There are several tests that we use to determine how to treat your dry eye. These include:
- A standardized questionnaire like the Standard Patient Evaluation of Eye Dryness (SPEED) survey or the Ocular Surface Disease Index (OSDI)
- Tear sampling to determine salt concentration
- Tear sampling to determine the presence of inflammatory markers
- Microscopic examination to look at the general appearance of the eyes and eyelids
- Dyes to look for damaged and missing corneal and conjunctival cells
- Tear film break-up time following a blink
- Meibomian gland expression
Q: My doctor said i have Tear Film Instability/Hyperosmolarity. What can you do to help me?
- Blink exercises – Blinking helps to release tears into the eye and spreads the tears over the cornea. While blinking is seen as an involuntary action, blinking differs from one person to the next. Poor blinking habits are often acquired, especially among contact lens wearers. If poor habits do exist, it is possible to train them by means of special exercises. See the attached sheet at the end of this paper. Also, there is an app for that – for iPhone or Android. Look for Korb Blinking Exercises.
- Life Style and Environmental Changes – Air conditioners, ceiling fans, coffee, smoking and other common items can have an effect on dry eyes.
- Newer, often Non-preserved, Artificial Tears – Oasis Tears and other artificial tear products such as Retaine MGD, Soothe XP, Refresh Optive Advance or Gel, Systane Balance better interact with our own tears to last longer and work more naturally.
- Punctal Plugs – The puncta are the tiny holes in each eyelid where tears drain. Sometimes, it is beneficial to block the drainage of our tears so they will last longer.
Q: What do you prescribe to control or reduce inflammation?
- High quality Fish Oil Supplements – We often recommend PRN Omega 3 Dry Eye This product supplies the more bio-available triglyceride form of Omega 3s in the correct amounts. This helps our Meibomian glands produce the proper secretion and lubrication for our tear film.
- Prescription Eyedrops like Restasis, Xiidra, Azasite and Lotemax – These products help to fight inflammation in the eyes and in some cases, actually increase our own tear production.
- Systemic Medications Like Azithromycin or Doxycycline – These oral antibiotics are known for their anti-inflammatory properties and help to control excessive eyelid bacteria and inflammation.
- Amniotic Tissue Bandages – These are used for more severe corneal dryness or damage. Amniotic tissue taken from the placenta after a live birth has tremendous healing abilities and represents a new, high-tech treatment.
Q: What do you prescribe to remove Biofilm that forms on the eyelids?
- Eyelid cleansers like Avenova and Cliradex – Avenova is a prescription product that contains purified hypochlorous acid. It helps with Dry Eye, MGD, and blepharitis. Cliradex is a preservative-free pad containing the active ingredient found in Tea Tree Oil. It is useful for blepharitis, dry eye and rosacea.
- BlephEx – BlephEx is an in office cleaning treatment. We use a small spinning sponge to clean away the debris and bio-film that collects on the lids and lashes. It is a great head start on many of the other treatments and products listed here.
Q: What treatments do you have to keep my meibomian glands unobstructed?
- Heat Masks – Heat helps to melt and liquefy the blockages to our meibomian glands.
- LipiFlow – Lipiflow is a new procedure that uses heat to melt and express the meibomian glands. It is very effective at relieving symptoms. We do not offer this in our office but we can refer you to another office for the procedure. You can expect to pay around $1000 per eye. It is not covered by insurance.