Dry Eye Syndrome: Symptoms, causes, diagnosis and treatment.

Dry eye syndrome, also called dry keratitis , keratoconjunctivitis sicca, or xerophthalmia, is a recurring or persistent sensation of dry eyes. The condition is uncomfortable and can affect your quality of life. You may have problems with your eyes open or you may not be able to work or drive a car due to severe dryness of your eyes. Dry eye disease can range from mild to very severe. Treating dry eyes can go a long way in alleviating discomfort.

Symptoms

As the name suggests, this condition causes dry, scratchy, and gritty sensations in the eyes. You may experience these symptoms constantly or intermittently. They tend to get worse after a long day and are usually less noticeable immediately after waking up.

Common symptoms of dry eye syndrome can include :

  • Irritated eyes
  • Tingling sensation in the eyes
  • Itchy eyes
  • Sore eyes
  • Sensitivity to light
  • Redness of the eyes
  • Blurry vision
  • The feeling that there is a grain of dirt in the eyes.

Reflex tears

Dry eyes can cause watery eyes. Tears are like tears that occur when something enters your eye. They are called reflex tears.

Reflex tears do not have the lubricating properties of tears that normally protect the eyes, so they do not prevent dry eyes.

Complications

Most people with dry eyes experience mild irritation with no long-term effects. But if the disease is left untreated or worsens, eye damage and even vision loss can occur. Serious dry eye problems can cause:

  • Inflammation of the eyes
  • Corneal abrasion (scratch on the surface of the eye)
  • Corneal erosion (thinning of the surface of the eye)
  • Corneal infection
  • Scars in the eyes
  • Loss of sight
Illustration by Brianna Gilmartin, Verwell

Causes

Tears serve as a protective layer, keeping eyes moist, providing essential nutrients, and removing dust and other particles. The tear film is made up of water, oil, and mucus, which are important for maintaining good eye health.

The cornea, which covers the front of the eye, must be constantly watered with tears to protect it from infection. Dry eyes develop when the eyes do not produce enough tears or the quality of tears.

There are several common factors that lead to dry eye syndrome.

Environmental factors

Environmental conditions can cause dry eyes. This can be especially frustrating if you find yourself in these conditions frequently.

  • Wind
  • Hot
  • Dust
  • Air conditioning
  • Cigarette smoke

Some people are more likely to develop dry eyes in response to environmental conditions, and this may be due to the presence of other risk factors for dry eyes, such as contact lenses or an autoimmune disease.

Aging

Aging is one of the most common causes of dry eyes because tearing decreases with age.

Not blinking enough

Another common cause is insufficient blinking, which occurs during activities such as watching television and using the computer. Every time he blinks, his eyes fill with tears. It usually blinks every 12 seconds. People who play computer games can only blink once or twice in three minutes .

Also, anything that causes blink reflex problems can interfere with blinking. Features include:

  • Eyelid disease
  • Lagophthalmos
  • Ectropion
  • Entropy
  • Foppy cap
  • Parkinson's disease
  • Progressive supranuclear palsy (PNP)
  • Certain types of thyroid conditions can make blinking difficult.

Contact lenses

About half of all contact lens wearers complain of dry eyes. Soft contact lenses that float on the tear film that covers the cornea absorb tears in the eyes.

Laser vision correction and other procedures.

Dry eye syndrome can start or worsen after LASIK and other refractive surgeries, in which the corneal nerves are cut during the creation of a corneal flap. The corneal nerves stimulate the secretion of tears. If you've had dry eyes and are considering refractive surgery, this possible side effect is worth considering.

Medicines

Dry eyes can also be caused by certain medications, including:

Eye diseases

Some conditions that affect the eyes can also cause dry eyes. Blepharitis, an inflammation of the eyelids, can affect the oil glands in the eyes. Meibomian gland dysfunction is a condition in which the glands in the eyes become inflamed and do not produce tears properly. Evaporative dry eye is a condition in which tears form but do not last long due to evaporation.

Autoimmune diseases

Some autoimmune diseases can affect the tear glands. Autoimmune conditions that can cause dry eyes include :

Diagnostics

Diagnosing dry eye often involves ruling out other eye diseases and conditions.

The effects of dry eyes can be similar to allergies, viral conjunctivitis (viral conjunctivitis), corneal abrasions, migraines, and Bell's palsy (when facial weakness prevents the eyelid from closing).

If you have other problems, such as eye discharge, crusty eyes, sneezing, nasal congestion, headaches, vision changes, or tingling in the face, this may indicate a cause other than dry eyes.

Your healthcare provider may examine your eye or refer you to an optometrist who will perform special tests to determine the cause of your symptoms. You may need to have an eye exam because people with undiagnosed vision problems may squint or experience eye discomfort that can be mistaken for dry eyes.

Specialized tests can include:

  • Schirmer test : a strip of special paper is placed on the edge of the lower eyelid. It measures how much moisture or tears accumulates in the eye over time and is a useful test to determine the severity of a problem.
  • Fluorescein or Rose Bengal : During this test, a dye is applied to the eye to color the surface. This can show how much dryness has affected the surface of the eye.
  • Tear Break Time (TBUT) : This test measures the time it takes for tears to flow from the eyes. A dye, such as fluorescein, is placed in the eye and the tears are viewed under a special light to estimate how long it will take for them to fall apart.

In addition to determining if you have dry eyes, your healthcare professional will also work with you to determine the cause. If you are concerned that you may have a medical condition that is causing dry eyes, you may need blood tests to look for signs of a systemic disease that may be causing it.

Watch out

Prevention is key to fighting dry eyes. If environmental factors are the cause, goggles or a humidifier can help. If you wear contact lenses, it is important that you pay close attention to replacing them as needed.

There are several treatment approaches that can help dry your eyes, including over-the-counter artificial tears, prescription drugs, and interventional treatments.

Artificial tears

The first line of treatment for dry eye is usually over-the-counter eye drops, also known as artificial tears. Artificial tears temporarily lubricate the eyes and relieve symptoms. Always read the instructions, but you can generally use these products as often as you like throughout the day.

These products typically include hydroxypropylmethylcellulose, found in Bion Tears and GenTeal, and carboxymethylcellulose, found in Refresh Plus and Thera Tears.

Your healthcare professional can help you choose the right one for you. Some people use red eye drops, but they can make your eyes even more dry. Red eyes can be caused by many factors, from allergies to eye infections, so a correct diagnosis is important.

If you wear contact lenses, use moisturizing drops specifically for contact lenses. Other types of drops may contain ingredients that damage lenses.

Prescription drugs

Various prescription medications can be used to treat dry eyes. Oral (by mouth) or topical (applied to the eyes) gels, ointments, and steroids can relieve dryness.

Restasis (cyclosporine ophthalmic emulsion) and Xyidra (lifitegrast ophthalmic solution) are approved for the treatment of dry eye. Restasis helps the eyes produce tears, while Xydra reduces inflammation that can reduce tear production.

Keep in mind that prescription drugs can cause side effects and are not necessarily suitable for everyone.

Point plugs

Each eye has four points, which are small holes through which tears drain into the tear ducts. Plugs can be inserted at the point to block the flow of tears and keep tears in the eyes .

The risk of blockage of the tear openings is minimal, but there is a risk of eye irritation, excessive tearing and, rarely, infection.

You may still need to use artificial tears after the tear plug is installed.

Get the word of drug information

If you think you may have dry eyes, it is important to discuss this with your healthcare provider. This is not only inconvenient, it can also cause complications. A correct diagnosis is the first step in finding an effective dry eye treatment .

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