What Is Dry Eye Disease And What To Do If I Have It

Here in my ophthalmology practice at Westchester Health, I often have patients come to me complaining about dry eyes, a common and often chronic problem, particularly in older adults. Dry eye disease (also called keratoconjunctivitis sicca) is a condition in which a person doesn’t have enough natural tears to lubricate and nourish the eye. 

Tears are necessary for maintaining the health of the front surface of the eye and providing clear vision.

William B. Dieck, MD, FAAO

Every time you blink, tears spread across the surface of your eye, known as the cornea. Tears provide lubrication, reduce the risk of eye infection, wash away foreign matter in the eye, and keep the surface of the eyes smooth and clear. Excess tears in the eyes flow into small drainage ducts in the inner corners of the eyelids, which drain into the back of the nose. It’s when this tear production and drainage is not in balance that dry eyes can occur. If dry eyes are not treated and the condition becomes advanced, this can damage the front surface of the eye and impair vision.

People with dry eyes may experience:

  • irritated, gritty, scratchy or burning eyes
  • a feeling that something is in their eyes
  • excess watering
  • blurred vision

 What causes dry eyes?

People with dry eyes either do not produce enough tears or their tears are of poor quality. Tears are produced by several glands in and around the eyelids. Typically, tear production tends to diminish with age, as a result of various medical conditions or as a side effect of certain medicines.

Environmental conditions, such as wind and dry climates, can also decrease tear volume due to increased tear evaporation. When the normal amount of tear production decreases or tears evaporate too quickly from the eyes, symptoms of dry eye can develop.

Tears are made up of three layers: oil, water and mucus. Each component protects and nourishes the front surface of the eye. A smooth oil layer helps prevent evaporation of the water layer, while the mucin layer spreads the tears evenly over the surface of the eye. Subsequently, if the tears evaporate too quickly or do not spread evenly over the cornea due to deficiencies with any of the three tear layers, dry eye symptoms can develop.

Dry eyes can develop for many reasons, including:

  • Dry eyes are a part of the natural aging process. The majority of people over age 65 experience some symptoms of dry eyes.
  • Women are more likely to develop dry eyes due to hormonal changes caused by pregnancy, the use of oral contraceptives and menopause.
  • Certain medicines, including antihistamines, decongestants, blood pressure medications and antidepressants can reduce tear production.
  • Medical conditions. People with rheumatoid arthritis, diabetes and thyroid problems are more likely to have symptoms of dry eyes. Also, problems with inflammation of the eyelids (blepharitis), inflammation of the surfaces of the eye or the inward or outward turning of eyelids can cause dry eyes to develop.
  • Environmental conditions. Exposure to smoke, wind and dry climates can increase tear evaporation, resulting in dry eye symptoms. Failure to blink regularly, such as when staring at a computer screen for long periods of time, can also contribute to drying of the eyes.
  • Other factors. Long-term use of contact lenses can be a factor in the development of dry eyes. Refractive eye surgeries, such as LASIK, can decrease tear production and contribute to dry eyes.

How are dry eyes diagnosed?

Dry eyes can be diagnosed through a comprehensive eye examination by a qualified ophthalmologist. Tests, with emphasis on the evaluation of the quantity and quality of tears produced by the eyes, may include:

  • An evaluation of your health history to determine your symptoms and to identify any general health problems, medications or environmental factors that may be contributing to your dry eye problem.
  • External examination of the eye, including lid structure and blink dynamics.
  • Evaluation of the eyelids and cornea using bright light and magnification.
  • Measuring the quantity and quality of tears for any abnormalities. Special dyes may be put in the eyes to better observe tear flow and to highlight any changes to the outer surface of the eye caused by insufficient tears.

What’s the treatment for dry eyes?

Dry eyes can be a chronic condition, but there are several treatments that can keep your eyes healthy and comfortable and prevent your vision from being affected.

  1. Adding tears. Mild cases of dry eyes can often be managed using over-the-counter artificial tear solutions to supplement natural tear production. Preservative-free options are recommended because they contain fewer additives which can further irritate the eyes.
  2. Conserving tears. Keeping natural tears in the eyes longer can reduce the symptoms of dry eyes. This can be done by blocking the tear ducts through which the tears normally drain, with tiny silicone or gel-like plugs. Alternatively, a surgical procedure can permanently close the tear ducts. In either case, the goal is to keep the available tears in the eye longer.
  3. Increasing tear production. Prescription-strength eye drops can increase tear production, as well as omega-3 fatty acid nutritional supplements.
  4. Treating the contributing eyelid or ocular surface inflammation. Prescription eye drops or ointments, warm compresses, lid massage or eyelid cleaners all can help decrease inflammation around the surface of the eyes.

5 things you can do at home to help dry eyes

  1. Blink regularly when reading or staring at a computer screen for long periods of time.
  2. Increase the humidity in the air at work and at home.
  3. Wear sunglasses outdoors, with wraparound frames if possible, especially when it’s very dry and/or windy.
  4. Nutritional supplements containing essential fatty acids may help decrease your dry eye symptoms.
  5. Avoid becoming dehydrated by drinking plenty of water (8-10 glasses) a day.

Do you think you have dry eyes? Come see us.

If your eyes are bothering you and you think you may have dry eye disease, please make an appointment to come in and see one of our Westchester Health ophthalmologists. He/she will examine you, perform any needed tests, answer all your questions, and together with you, determine the best course of action to help relieve your dry eyes so you can feel better and be more comfortable, as soon as possible. Whenever, wherever you need us, we’re here for you.
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By William B. Dieck, MD, FAAO, Vice President, Westchester Health, member of Northwell Health Physician Partners; Director, Ophthalmology Division 

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