Cause, Symptoms & Treatments
You are not alone! Dry eyes sometimes called “dry eye disease” or “dry eye syndrome” is a very common problem affecting tens of millions of adults in the United States alone. Yet, only 30 million Americans go to their doctor for a possible solution.
Dry eye is a multifactorial disease of the ocular surface
There are two types of dry eye:
Aqueous dry eye: this condition occurs when the surface of the eyes is not sufficiently hydrated because tears are not being produced sufficiently
Evaporative dry eye: occurs when tears are drying out too quickly. Evaporative Dry Eye (EDE) is far more prevalent.
The 2 subtypes are not mutually exclusive, rather on a spectrum.
Dry eyes are bothersome and have a way of making everyday tasks that much harder; from causing difficulty focusing when you’re reading, working, or just watching TV, to raising sensitivity to light, wind, or airborne irritants, and even disturbing rest.
Dry Eye is also referred to as Keratitis sicca, Keratoconjunctivitis sicca, and Dysfunctional tear syndrome.
Dryness Sensation
Scratchy, Gritty Feeling
Stinging or Burning
Itchiness & Redness
Stringy Mucus in/around the Eye
Eye Pain & Soreness
Watery Eyes
Foreign Object Feeling
Contact Lenses Discomfort
Difficult Nighttime Driving
Sensitivity to Light
Blurred Vision
Normally, your eyes are kept moist and clean by the continuous production of tears from your lacrimal glands which secrete the salty fluid from behind your upper eyelids. As you blink, these tears are wiped down across your eyes where they keep the moisture and electrolyte levels on the delicate surfaces of your eyes in balance and wash away any debris that might be on them. This moisture is prevented from evaporating or spilling over by a special layer of lipids produced by the meibomian glands along the edges of your eyelids.
In the case of dry eyes, an inflammatory process is either preventing enough tears from being made or is disrupting the secretion of the protective lipid layer, causing moisture to evaporate too quickly. When not enough water content is produced by your lacrimal glands or when it evaporates away, the salt content in your eyes becomes concentrated. And as suggested by the expression “pouring salt in a wound,” excess salt is painful to sensitive tissue, causing the burning and itching you feel in your eyes.
Finally, the condition is also affected by our immune system and involves:
Inflammation of the lacrimal glands and the ocular surface
Nerve dysfunction causing irritation and leading to immune activation
Pathological cellular changes on the ocular surface
Dry Eye is really a disorder of the tear film. It is important to understand the components of tears and their functions in the normal, healthy tear film.
Normal, healthy tears contain, in addition to water, a complex mixture of proteins, mucins, and electrolytes. The most abundant proteins have antimicrobial and protective functions. They are critical for the viscosity of the tear film and to ensure correct osmolarity. (ref: Stern ME, Beuerman RW, Pflugfelder SP. The normal tear film and ocular surface.)
Altered tears failed to support ocular surface cell growth and function. This results in:
Compromised lubrication due to poor viscosity
Increased osmolarity
Imbalanced growth factors fail to promote normal epithelial growth
Ultimately, it could lead to corneal (ocular surface) damage. (ref: Pflugfelder SC. Antiinflammatory therapy for dry eye. Am J Ophthalmol)
Dry eye disease, characterized by lacrimal and ocular surface inflammation, can be initiated by a number of environmental factors, health conditions, and diseases that can all lead to insufficient tear production or can cause them to evaporate too quickly.
These conditions produce drying environments, causing chronic ocular surface irritation and inflammation.
Sjögren’s syndrome: This autoimmune disease, characterized by altered lacrimal and salivary function, causes tissue inflammation.
Rheumatoid arthritis: A chronic inflammatory disorder affecting the quality and quantity of tears.
Lupus: Systemic autoimmune disease causing inflammation leading to dry eye disease.
Graft vs host disease (GVHD): Results in inflammation of the ocular surface.
Blepharitis/Meibomian Gland Disease (evaporative and non-evaporative):
Results in a poor lipid layer of the tear film, allowing excessive evaporation and tear deficiency. Blepharitis is swelling or inflammation of the eyelids, usually where the eyelash hair follicles are located, caused by Demodex mites, bacteria, and excessive oil.
Postmenopause: Decreased androgen levels in postmenopausal women can cause tear deficiency and altered tear composition that can result in ocular surface irritation and inflammation..
Age & Gender: Drop in hormone levels for people above 50 and women could lead to the loss of the protective anti-inflammatory environment of the lacrimal glands.
What do all of these have in common? They can lead to stress and inflammation in your eyes and eyelids, which can cause swelling that hinders tear and lipid production and can contribute to your eyes’ discomfort.
Because Dry Eye is a multifactor disease, there are many treatment options available. Effective therapy should address one or more of the pathophysiologic factors involved and work to break the cycle of pro-inflammatory effects. Ask your doctor was would be the best for you.
Because most cases of dry eye (to be verified) are Blepharitis and MGD, here are the best solutions to prevent and manage mild-to-moderate dry eye.
Keep your eyes clean.
Using gentle cleansers or wipes on your eyes as part of your daily routine can keep your glands and ducts open and working properly, and can help remove irritants like dust, pollen, and viruses. Traditionally, warm water with diluted baby shampoo has been recommended for cleaning eyelids to unclog glands and clear irritants, but natural products such as cleansers containing tea tree oil have been found to be effective recently. Cliradex Light cleanser contains 4-terpineol, the primary active ingredient in tea tree oil, and is gentler to use than other products containing complete tea tree essential oils.
Clear any infections or infestations if they are the cause of inflammation or blockages. Your eye doctor may prescribe antibiotic eye drops if a bacterial infection is the source of your dry eye. Similar to Cliradex Light, Cliradex towelettes contain a higher concentration of 4-terpineol, which has antibiotic, antifungal, anti-inflammatory, and mite-killing properties to alleviate a range of underlying infections. Demodex mite infestations are notoriously difficult to eliminate as traditional cleansers typically do not clean deeply enough or are not gentle enough to be used for the length of time required; this can be resolved by using Cliradex towelettes which are specifically formulated to kill demodex mites while still being gentle enough to use long-term.
If you have an idea what the source is, reduce your exposure to irritants. Limit your time outdoors during allergy season and on high pollution days, and remember to take regular breaks when working in front of a screen. You might also need to reconsider wearing contact lenses.
Lubricating eye drops can provide relief from dry eye symptoms in the short-term.
If your eyes still feel irritated after using lubricating eye drops or symptoms do not go away on their own, talk to your doctor or optician who can help you determine your cause of dry eyes and choose an appropriate treatment.
Introduce graphic with 1 sentence The treatment and modifications in step 1 should be done by ALL dry eye syndrome sufferers. This is the basis to treatment for all disease. Remember that a disease is your body’s way of telling you that something YOU are doing is wrong! Certain therapies are reserved for more severe dysfunctional tear syndrome.
Demodex mites: Their activity leads to inflammation which then leads to the development of tear film instability.
Blepharitis: This is an inflammation of the eyelids caused by bacteria (Staphylococcus) and scalp dandruff.
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