Dry eye happens when your eyes don’t make enough tears to stay wet, or when your tears don’t work correctly. This can make your eyes feel uncomfortable, and in some cases it can also cause vision problems. If Dry Eye is not treated, it can damage the surface of the eye.
Dry eye is common — it affects millions of Americans every year. The good news is that if you have dry eye, there are lots of things you can do to keep your eyes healthy and stay comfortable.
The Tear Film
The surface of the eye is covered by a tear film that keep the eye moist, smooth and washes away dust and debris. It also helps protect the eye from infection. The tear film is composed of three layers:
- An outer, oily, lipid layer produced by the meibomian glands in the eyelid
- A middle, watery layer produced by the lacrimal glands
- An inner, mucous layer produced by goblet cells in the surface layer of the eye
- In addition, there are proteins (growth factor), electrolytes and vitamins that help maintain the health of the eye surface
Types of Dry Eyes
Aqueous Deficiency Dry Eyes
Aqueous tear-deficient dry eye is a disorder in which the lacrimal glands fail to produce enough of the watery component of tears to maintain a healthy eye surface.
Evaporative Dry Eyes
Evaporative dry eye occurs when the tear film evaporates too quickly. This may be caused by meibomian gland dysfunction, blepharitis, autoimmune diseases, or exposure.
Symptoms of Dry Eyes
- A scratchy feeling, like there’s something in your eye
- Stinging, burning, itching
- Red eyes
- Sensitivity to light
- Blurry vision
- Stringy discharge
- Excessive tearing
- Fatigue, especially when performing close tasks (computer, reading)
- Inability to dry when emotionally stressed
- Contact lens intolerance
- If symptoms of dry eye persist, see your Eye Doctor to avoid permanent damage
Risks Factors for Dry Eyes
Anyone can get dry eyes, but you might be more likely to have dry eye if you:
- Are age 50 or older
- Are female
- Wear contact lenses
- Don’t get enough vitamin A (found in foods like carrots, broccoli, and liver) or omega-3 fatty acids (found in fish, walnuts, and vegetable oils)
- Have certain autoimmune conditions, like lupus or Sjögren syndrome
Diagnosing Dry Eyes
Your doctor can check for dry eye as part of a comprehensive dilated eye exam. Be sure to tell your doctor if you think you might have dry eye.
To find out if you have dry eye, your doctor might check:
Dry Eye Questionnaire – This series of questions can indicate patients likely to have dry eyes
Review of Medications – Some medications can increase make your eyes drier.
External Eye Exam – Evaluate for proper position and functioning of the eyelids, proper position of the tear ducts, blink rate, appearance of the Meibomian glands and lid margins
Schirmer Test – Determines the amount of tears your eyes make
Tear Break-Up Time – How long it takes for your tears to dry up
Fluorescein and Vital Staining – Highlights areas of the ocular surface that may be dry or damaged
TearLab – Tests the concentration (osmolarity) of your tears
Inflammadry – Tests your tears for an inflammatory protein (MMP-9)
Ocular Allergy Testing – Can determine allergy to 63 common environmental allergens
Sjö Test – The unique markers in this blood test can detect Sjögren’s Syndrome earlier than standard testing.
Treating Dry Eyes
Treatment for dry eye usually depends on what’s causing your symptoms. There are a few different types of treatment that can ease your symptoms and help keep your eyes healthy.
Use a humidifier, especially in your bedroom
Avoid wind, dust, and smoke
Redirect fans, vents and hairdryers
Wear wrap-around sunglasses
Take breaks from computer and phone use
Get enough sleep
Warm Compresses – Warming the eyelids with a damp compress can loosen accumulated debris and make it easier to remove
Lid Cleaning – Cleaning the lids with diluted baby shampoo, OcuSoft Plus, Avenova can reduce the bacteria on the lid and lashes. Optase Tea Tree Oil wipes can also remove the demodex mite.
Over-The-Counter Eye Drops
The most common treatment for mild dry eye is a type of eye drops called artificial tears. You can get these eye drops without a prescription. There are also over-the-counter moisturizing gels and ointments that may help your eyes feel better.
Omega 3 Fatty Acid Supplements – Omega 3 supplements with DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid) can improve the oily secretion from the meibomian glands
Cyclosporine (Restasis, Cequa) or lifitegrast (Xiidra) – These medicines are eye drops that can help your eye produce more tears
Lacrisert – The is a lubricant insert that sits behind the eye and slowly dissolves, lubricating the eye
Autologous serum drops – These eye drops, made from the patient’s own blood, contain immunoglobulins, vitamin A, fibronectin, and growth factors that promote healing of the ocular surface
Steroid drops – Steroid can be used to reduce severe inflammation.
Doxycycline or Azithromycin – These antibiotics can reduce inflammation and inactivate lipases and Matrix Matalloproteinase-9 that can harm the ocular surface
Antibiotic Ointments – These can reduce the bacterial load on the eyelid margins.
Immunosuppressive Creams (Tacrolimus) – These can be helpful for atopic dermatitis of the lids
N-Acetylcysteine Drops – This medication has anti-inflammatory properties and mucolytic properties. This makes it helpful in Filamentary Keratopathy.
TrueTear – This FDA-approved device stimulates the production of your own natural tears
Tear Duct Occlusion
Punctal Plugs – These tiny plugs are placed in the opening (punctum) of the duct that drains tears from your eyes
Canalicular Plugs – These plugs are placed inside the duct that drains tears
Punctal Cautery – Cauterization of the opening of the duct can be a more permanent solution
iLUX – FDA-approved device used to warm the meibomian gland secretions and then empty the glands
Meibomian Gland Probing – Probing the glands can release scarring which is preventing flow of secretions
Microblepharoexfoliation – This device is used to clean and remove debris bacteria, biofilm, bacterial toxins from the eyelid margins
Amniotic Membrane Grafting
Prokera or Visidisc – Amniotic membrane grafts can be placed on the eye to aid in healing of a damaged ocular surface
Eyelid Surgery – Sometimes, the eyelids are too loose due to aging or Floppy Eyelid Syndrome. Thyroid Eye Disease can expose more of the eye as the eyes move forward in the eye socket. Occasionally, the eyelids can be too tight following cosmetic surgery. Surgical repair of the lids can reduce exposure.
Conjunctivoplasty – Sometimes the outer layer of the eye (conjunctiva) is loose and redundant. Removing this excess conjunctiva can improve comfort and improve the flow of tears across the ocular surface.
TearLab Osmolarity Test