Dry Eye (Ocular Surface Disease)

What is dry eye?

The surface of the eye is coated with a layer of tears. Dry eye occurs when the eyes don’t produce enough tears or produce tears without the proper chemical composition.¹ 

What causes dry eye?

Many factors can contribute to dry eye, including aging, hormonal changes, UV exposure, environmental conditions (e.g., exposure to air pollution, wind, low humidity, etc.), or problems with normal blinking.  Dry eye can also be symptomatic of problems with general health (e.g. rheumatoid arthritis, thyroid disease, Parkinson’s disease), and medications (e.g. oral contraceptives, antidepressants, antihistamines etc.).^1,3,4 Genetics and family history may also play a role in dry eyes.⁴ 

What are signs/symptoms of dry eye?

Common signs and symptoms of dry eye may include redness, stinging, burning, grittiness, scratchiness, or a feeling of something foreign in the eye.² Some people may also experience excessive tearing as a result of dry eye.² This is a natural reflex of the eyes to compensate for symptoms of Ocular Surface Disease by creating more tears to comfort the eye in response to dryness.

How is dry eye diagnosed?

During an eye examination, an optometrist will ask you questions about your general health, medications, and home/work environments to determine whether these are factors that may be causing dry eyes. This information will help an optometrist decide whether to perform additional dry eye testing. An optometrist may use a high-powered microscope known as a slit lamp, in conjunction with specialized dyes, to evaluate the quality, quantity and distribution of tears on the eye to detect signs of dry eyes. Additional assessments, from questionnaires to taking images of the glands in the eye may also be used to assist the diagnosis of dry eyes.⁵ 

Can dry eye be cured?

In most cases, dry eye is a chronic condition and requires maintenance. However, dry eye symptoms can be alleviated, and the health of the eye can improve through treatment interventions. Depending on the type and severity of the dry eyes, different treatment options are recommended. 

Lubricating eye drops and warm compress are a first step,⁶ with gels and ointments providing additional lubrication before going to sleep.⁶ Prescription medications for dry eyes can help reduce inflammation in the eyes and improve the body’s natural ability to produce tears.⁶ In some cases, small plugs may be inserted in the corner of the eyelids to slow the drainage and loss of tears.⁶ Lifestyle changes such as avoiding windy conditions, using a humidifier, taking breaks from prolonged screen use, staying hydrated, and getting enough sleep can help to reduce dry eye symptoms.⁶ Treatment of any underlying systemic disease, change of medication, or addition of omega 3 supplements may alleviate symptoms overtime.⁶ New treatment options using devices that apply heat or light to target the glands in the eye are available to promote a healthy tear film.⁶

Will dry eye harm my eyes?

If left untreated, dry eyes can affect the individual’s quality of life and can even be harmful to the eye. Excessive and chronic dry eyes can damage and possibly scar the sensitive corneal tissues of the eye leading to impaired vision.⁷ Dry eye can make contact lens wear more difficult due to increased irritation and greater chance of eye infection6. The best treatment is to follow an optometrist’s instructions carefully. If you have increased dryness or redness that is not relieved by the prescribed treatment, contact your optometrist as soon as possible.

References

1. Craig JP et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15(3):276-283.
2. Belmonte C et al. TFOS DEWS II pain and sensation report. Ocul Surf. 2017;15(3):404-437.
3. Stapleton F et al. TFOS DEWS II epidemiology report. Ocul Surf. 2017;15(3):334-365.
4. Bron AJ et al. TFOS DEWS II pathophysiology report. Ocul Surf. 2017;15(3):438-510.
5. Wolffsohn JS et al. TFOS DEWS II diagnostic methodology report. Ocul Surf. 2017;15(3):539-574.
6. Jones et al. TFOS DEWS II Management and therapy report. Ocul Surf. 2017;15(3):575-628.
7. Şimşek C et al. Current Management and Treatment of Dry Eye Disease. Turk J Ophthalmol. 2018;48(6):309-13.