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Dry Eye

Dry eye is a very common pathology that can affect up to one in two people1. It is a complex condition where multiple factors disrupt the thin fluid layer covering the ocular surface called the tear film.

This disruption causes discomfort, visual issues, and potential eye damage. It's not just about dryness; it's a tear film imbalance due to factors like age, medications, environment, or gland dysfunction. Excessive saltiness in tears can lead to ocular inflammation. Treatment ranges from artificial tears to more advanced interventions. Consultation with an eye professional is advised for persistent symptoms to ensure proper care and management.

Firstly, Dry Eye isn’t just about having dry-feeling eyes. Dry Eye is a multifactorial disease. This means it involves multiple factors affecting the tears and the ocular (eye) surface. These factors result in symptoms like discomfort and visual disturbances, and they can potentially damage the eye’s surface. This condition is accompanied by increased osmolarity (saltiness) of the tear film and inflammation of the ocular surface.2

Now, let’s break this down. Your eyes are covered by a thin fluid layer called the tear film that’s vital for keeping them comfortable and healthy. When this film is disrupted, either due to a lack of tears or excessive evaporation of tears, it leads to Dry Eye. This disruption can harm the surface of your eyes and cause that familiar feeling of discomfort.3

But here’s something interesting: the core issue in Dry Eye is tear hyperosmolarity. This means the tears become too salty, leading to damage on the ocular surface and kickstarting inflammation. Factors like eye surgeries can also increase the risk of developing Dry Eye3,4.

Managing Dry Eye can be as simple as using artificial tears to more specialized treatments, depending on its severity and cause. But remember, if you’re experiencing persistent eye discomfort or changes in your vision, it’s best to consult an eye care professional. They can provide a tailored approach to managing your symptoms.

So next time you feel that uncomfortable dryness in your eyes, remember it’s more than just needing to blink a few extra times. It’s a sign that your eyes need a little extra attention to maintain their health and comfort.

causes

What can cause dry eyes?

Dry Eye arises from Aqueous Dry Eye (ADDE), with reduced tear production, or Evaporative Dry Eye (EDE), where tear quality is compromised due to high evaporation. Conditions like Meibomian Gland Dysfunction, systemic diseases, eye surgeries, environmental factors, and certain medications can all trigger Dry Eye by disrupting the tear film’s balance. It’s a complex interplay of various factors, not merely a sensation of dryness.

Women with painful eye

First off, Dry Eye can be due to two main types of issues: Aqueous Dry Eye (ADDE) and Evaporative Dry Eye (EDE). In ADDE, there’s a problem with the quantity of tears produced, whereas in EDE, the quality of tears is affected, often due to excessive evaporation. Both types disrupt the natural balance of your tear film​​. 3,4

Now, what exactly triggers these issues? For starters, certain medical conditions can play a role. For example, Meibomian Gland Dysfunction (MGD), where the glands that produce the oily layer of your tear film are affected, can lead to EDE. Also, systemic diseases like Lupus and Scleroderma can contribute to Dry Eye.3,4

Surprisingly, even eye surgeries can be a culprit. These procedures can damage important nerves and cells in the eye, leading to decreased tear production and increased tear evaporation – all contributing to Dry Eye.3,4

Moreover, environmental factors play a big role. In EDE, conditions like high wind speed, low humidity, or even allergy and preservative use can cause your tears to evaporate too quickly, leading to tear film instability and Dry Eye.4

Lastly, certain medications can also contribute to Dry Eye. Medications like antihistamines, beta-blockers, and some psychotropic drugs can reduce tear secretion, disrupting the balance of your tear film and leading to ADDE.4

In conclusion, Dry Eye is a multifaceted condition with various potential causes. It’s not just about ‘dry’ eyes but a complex interplay of medical, environmental, and physiological factors.

symptoms

What are the symptoms of dry eye?

Dry Eye symptoms include redness, a stinging or burning sensation, blurred vision, light sensitivity, excessive tearing, a feeling of grit in the eyes and itchiness. These signs indicate your eyes may require more care, such as lifestyle adjustments, eye drops, or professional consultation. It’s a condition signaling the need for attention to eye health, not just a temporary discomfort.

Dry Eye symptoms can vary from person to person, but there are some common signs you can look out for. The typical symptoms include:

  • Foreign Body Sensation: This is like feeling there’s a speck of dust in your eye that you can’t get rid of.
  • Redness: Your eyes might look more red than usual.
  • Stinging or Burning Sensation: It can feel like there’s something irritating your eyes.
  • Blurred Vision: Your vision might not be as sharp, and you might have trouble focusing.
  • Sensitivity to Light: Bright lights might feel more uncomfortable than they used to.
  • Excessive Tearing: Ironically, Dry Eye can cause your eyes to produce more tears.
  • Itchiness: Your eyes might feel itchy.
  • Dryness Sensation: dry, burning and gritty sensation in the eyes

These symptoms are quite common and are often associated with Dry Eye​​.5

Remember, Dry Eye is more than just an occasional inconvenience. It’s a signal from your body that your eyes need a bit more care, whether that’s through lifestyle changes, eye drops, or professional advice.

diagnostic

How to diagnose a dry eye problem?

Diagnosing Dry Eye blends patient symptoms with clinical observations. Doctors may use clinical questionnaires to assess symptom severity. Clinical tests, including tear film break-up time and tear osmolarity, check for dryness and damage. Advanced methods like Tear Film Interferometry and in vivo Confocal microscopy offer deeper insights. Regular visits to an eye care professional are essential for accurate diagnosis and effective treatment guidance.

Diagnostic of Dry Eye

Diagnosing Dry Eye involves a combination of patient-reported symptoms and clinical signs. It’s not just about what you feel but also what your eye doctor can observe and measure.

Firstly, your eye doctor might use questionnaires like the Ocular Surface Disease Index (OSDI) or the Dry Eye Questionnaire (DEQ-5). These are tools to help gauge the severity of your symptoms and understand how they affect your daily life. They ask about things like how often you feel eye discomfort, whether you have trouble with your vision, and how your eyes respond in different environments3,4.

Next, there are clinical tests to assess the health of your eyes. One of the key tests is measuring the tear film break-up time. This test looks at how long it takes for dry spots to appear on your eye’s surface after a blink. Other tests include checking the osmolarity of your tears (how salty they are) and examining your eyes for any signs of damage or inflammation, like redness or staining on the cornea or conjunctiva​​6.

Advanced diagnostic methods are also available. Tear Film Interferometry measures the thickness of the lipid (oil) layer in your tears and how quickly it breaks up. In vivo Confocal microscopy is another high-tech tool that helps to see detailed cellular changes in your eyes. These methods provide a more in-depth understanding of your eye’s health and can be particularly useful for complex cases7.

Diagnosing Dry Eye can be a bit like detective work. It involves looking at a range of factors to get a complete picture of what’s going on with your eyes. If you’re experiencing persistent eye discomfort or changes in your vision, it’s a good idea to visit an eye care professional. They have the tools and expertise to accurately diagnose the problem and guide you toward the best treatment.

treatment

What treatments are available for dry eyes8?

Treatment for Dry Eye begins with artificial tears and osmoprotectants to supplement the tear film. If ineffective, punctal plugs may be used to retain tears and enhance moisture. Topical anti-inflammatories like cyclosporine or hydrocortisone can address inflammation. Further strategies vary by severity and include moisture chambers, tear-stimulating secretagogues, therapeutic lenses, and advanced options like amniotic grafts and systemic anti-inflammatories, each targeting different Dry Eye facets.

One of the first lines of treatment for Dry Eye is the use of artificial tears and osmoprotectants. These help to supplement your natural tear film, especially in cases where your eyes are sensitive, like after eye surgeries. They’re like giving your eyes a much-needed drink of water​​.

If artificial tears aren’t quite cutting it, your eye doctor might consider something like punctal plugs. These tiny devices are inserted into the tear ducts to help keep your natural tears in your eyes longer, improving moisture and comfort. They’re particularly helpful in more severe cases of Dry Eye.

For inflammation-related symptoms, local anti-inflammatory drugs and mild steroids like can be used. These treatments help reduce the inflammation that often accompanies Dry Eye, thereby relieving some of the discomfort and redness.

There is also a range of other therapeutic strategies, for extremely severe Dry Eye symptoms. These include moisture chamber devices, topical secretagogues (which stimulate tear production), therapeutic contact lenses, and even more advanced treatments like amniotic membrane grafts and systemic anti-inflammatory agents. Each of these options targets different aspects of Dry Eye, from increasing tear production to reducing inflammation.

Dry eye, often referred to as "Dry Eye Syndrome," is a condition where the eyes don't produce enough tears or the right quality of tears. The tear film, a protective layer on our eyes, is made up of water, salt, proteins, and lipids. This film is essential for hydration, lubrication, and protection. When there's an imbalance, either due to reduced tear production or a change in its composition, dry eye occurs. This can lead to discomfort, inflammation, and other symptoms, impacting overall eye health.
Symptoms of dry eye can range from mild to severe. Common signs include a gritty sensation, redness, excessive tearing, burning, itching, blurred vision, and sensitivity to light. These symptoms can make daily tasks like reading, driving, or using a computer challenging. Over time, if left untreated, dry eye can lead to complications, including damage to the eye's surface. Recognizing these symptoms early and seeking appropriate treatment is crucial to manage the condition and maintain a good quality of life.
Dry eye treatment aims to restore the natural balance of the tear film, alleviating symptoms and preventing complications. Common treatments include artificial tears, which provide immediate relief by mimicking natural tears. Eyelid hygiene, ensuring the eyelids are clean and free from blockages, is also crucial. Nutritional supplements, especially those rich in Omega-3 and Omega-6, can enhance tear production. In more severe cases, medications or surgical interventions might be recommended. Regular check-ups with an ophthalmologist ensure the treatment remains effective.
Several factors can lead to dry eyes. Aging, hormonal changes, medications, and underlying diseases are some internal causes. However, environmental factors play a significant role too. Extended computer use, exposure to blue light, air conditioning, drafts, and pollutants can exacerbate dry eye symptoms. Prolonged screen time can reduce blink rate, leading to faster tear evaporation. Moreover, dry or polluted environments can disrupt the tear film's balance. Being aware of these factors and making necessary adjustments can help manage and prevent dry eye symptoms.
To limit the appearance of dry eye, it's important to make lifestyle adjustments and adopt preventive measures. Ensure a balanced diet rich in omega-3 fatty acids, stay hydrated, and get adequate sleep. Regularly exercise and avoid smoking. When using screens, follow the 20-20-20 rule: every 20 minutes, look at something 20 feet away for at least 20 seconds to reduce eye strain. Remember to blink your eyes regularly and be mindful of air quality indoors; use a humidifier if the air is dry. Lastly, consult with an eye care professional for personalized advice.

In general, don’t hesitate to ask your pharmacist for advice if you have any eye symptoms.

On the other hand, if you experience one or more of these symptoms, you should see an eye specialist as a matter of urgency; -Moderate,-Severe pain, -Intense sensitivity to light, -Decreased vision, -Flashes of light, -Dark spots, -Sensation of a foreign object in the eye, -Trauma (injury, contusion, acid burn etc.), -Persisting or worsening symptoms despite appropriate treatment.

  1. TFOS-DEWS-II-Epidemiology-Report_2017_The Ocular Surface.
  2. Lemp MA. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007 Apr;5(2):84.
  3. Craig JP, Nelson JD, Azar DT, Belmonte C, Bron AJ, Chauhan SK, de Paiva CS, Gomes JAP, Hammitt KM, Jones L, Nichols JJ, Nichols KK, Novack GD, Stapleton FJ, Willcox MDP, Wolffsohn JS, Sullivan DA. TFOS DEWS II Report Executive Summary. Ocul Surf. 2017 Oct;15(4):802-812. 
  4. Bron AJ, de Paiva CS, Chauhan SK, Bonini S, Gabison EE, Jain S, Knop E, Markoulli M, Ogawa Y, Perez V, Uchino Y, Yokoi N, Zoukhri D, Sullivan DA. TFOS DEWS II pathophysiology report. Ocul Surf. 2017 Jul;15(3):438-510. Erratum in: Ocul Surf. 2019 Oct;17(4):842.
  5. Tavares Fde P, Fernandes RS, Bernardes TF, Bonfioli AA, Soares EJ. Dry eye disease. Semin Ophthalmol. 2010 May;25(3):84-93. 
  6. Zeev MS, Miller DD, Latkany R. Diagnosis of dry eye disease and emerging technologies. Clin Ophthalmol. 2014 Mar 20;8:581-90. 
  7. Bernardes TF, Bonfioli AA. Blepharitis. Semin Ophthalmol. 2010 May;25(3):79-83.
  8. Jones L, Downie LE, Korb D, Benitez-Del-Castillo JM, Dana R, Deng SX, Dong PN, Geerling G, Hida RY, Liu Y, Seo KY, Tauber J, Wakamatsu TH, Xu J, Wolffsohn JS, Craig JP. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017 Jul;15(3):575-628. 

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