Dry Eye 101

Is The Condition Affecting The Quality Of Your Life?

by Samantha K. McPherson, OD, FAAO // October - November - December 2017

Chronic dry eye affects an estimated 20.7 million people in the United States, occurring when the correct quantity or quality of tears are not produced. Anyone who has experienced getting an eyelash stuck in their eye knows that even the smallest amount of ocular discomfort can cause a significant amount of aggravation. Those with dry eye understand how a seemingly minor eye issue can become a daily nuisance and cause of frustration. Dry eye can be a progressive disease, and if left untreated, can lead to more serious problems, including impaired vision and an increased risk of eye infection. 

How do you know if you have dry eye? Symptoms vary from person to person and often change throughout the day. Symptoms may include itching, irritation, a gritty sensation, sensitivity to light, and fluctuating vision. A reduction in the length of comfortable contact lens wearing time is an early sign. Contrary to what you might think, dryness often causes your eyes to become watery. 

Dry eye has many causes, including computer use, hormonal changes, age, medications, environmental factors, medical conditions, contact lens wear, or a history of eye surgery. In this day and age, it is nearly impossible for most of us to survive without using a computer or some sort of digital device. Unfortunately, they are common culprits of your irritated eyes. Blinking is essential for activating the small oil producing glands in your eyelids and spreading those oils smoothly across the surface of your eye. When you use a computer or a digital device, your blink rate naturally drops. When your blink rate is chronically reduced, the oils can become thickened, causing the quality of your tears to degrade dramatically. Thickened oils can also cause your vision to fluctuate. More than half of all people with diabetes have dry eye, and it is highly associated with autoimmune conditions such as rheumatoid arthritis and thyroid disease. Some eye doctors offer lab testing to rule out some of the major autoimmune diseases as a cause of your dry eye.

Your eye doctor can check for signs of dry eye using several quick and painless tests. A colored eye drop is used to highlight problems on the ocular surface. The production, evaporation rate, and quality of the tear film will also be assessed. Evaluation of the nature of the oils in your tears will provide crucial information necessary for determining your best treatment options. Newer technologies are available in clinics that take a special interest in dry eye. An infrared camera is able to demonstrate the structure of the small oil producing glands in your eyelids, measure the thickness of the oil layer in your tears, and monitor how effectively you blink. A small device is able to capture a tiny amount of your tears and measure the osmolarity, or “how salty” your tears are. Increased osmolarity of your tears is a sure sign of dry eye. Photographs taken of your ocular surface can show you how dry eye is affecting the quality of your tears and possibly causing damage to your cornea, the front surface of your eye.

Treatment of dry eye is based on the disease severity and the cause of the dryness. For some people, simply changing their environment or medications can improve symptoms. Over-the-counter lubricating drops may be used for mild cases. If you are using over-the-counter lubricating drops daily or have persistent symptoms, you should see your eye doctor to determine if any additional treatments are needed. Anti-redness drops are not an effective dry eye treatment as they can cause more redness in the long term. Determining the cause of the redness is the best option. Prescription eye drops can help to reduce inflammation and increase the eyes’ natural ability to produce tears. They work differently than over-the-counter eye drops and have given many people the relief that they have been seeking. Tear duct plugs can be inserted into the small holes in the eyelids where the tears drain out. This painless, reversible procedure is quickly done in the office and is a great alternative for people who dislike or are unable to use eye drops or need treatments in addition to tears. Tear duct plugs help to keep the tears on the surface of the eyes for a longer period of time. LipiFlow is a revolutionary procedure that eliminates any obstructions present in the oil producing glands, bringing significant relief to those who have been suffering from dry eye symptoms. Omega 3 supplementation and eyelid warming are very effective at improving the function of the oil producing glands in the eyelids. Eyelid cleansing is an important aspect of dry eye management. Discuss with your eye doctor if any specific eyelid cleansing products would be of benefit to you. Traditional contact lenses can exacerbate dry eye symptoms. However, therapeutic contact lenses such as scleral lenses or bandage contact lenses may be able to improve dry eye by protecting the surface of the eye and providing continual moisture throughout the day. Blinking exercises sound silly, but they are an important component of managing dry eye, as many people with dry eye do not blink enough or effectively.

You do not have to merely accept dry eye symptoms as a normal part of aging or contact lens wear. While there is no cure for dry eye, many options are available to improve comfort. In general, early treatment for a chronic disease like dry eye is more likely to achieve a better outcome. Discuss your symptoms and concerns with your eye doctor who will be your best resource for determining the necessary steps toward a healthier ocular surface. 

Samantha K. McPherson, OD, FAAO

Founder of Dry Eye Center of NC, a subspecialty clinic of McPherson Family Eye Care.