Dry eye is a condition that affects the tear film, which covers and protects the cornea. When disrupted, it can lead to discomfort and changes in vision. Left untreated, it can cause painful ulcers and scarring of the cornea.
Mild cases of dry eye resulting from situational causes can be treated with regular use of lubricating drops. Your doctor may also prescribe a special type of contact lens called a scleral lens. Click the Eye Dry Baltimore, MD to learn more.
Each time you blink, a teary film spreads over the eye, lubricating it and washing away debris. If this natural process is disrupted, you may experience symptoms of dry eye syndrome, including an irritated sensation that feels like something is in your eye or a gritty, sandy feeling.
The condition can also cause itchy eyes, blurred vision, or watery eyes. It can also interfere with one’s ability to focus and read, drive, or work on a computer. Yale Medicine experts can identify the underlying causes of one’s symptoms and recommend the best treatment to restore one’s quality of life.
Most patients with mild cases of dry eye are treated with lubricating drops, gels, or ointments. These ointments are available over the counter (OTC) without a prescription and come in various ingredients and viscosities.
More serious cases of dry eye are caused by a variety of medical conditions that reduce the body’s production or alter the composition of tears. These include rheumatoid arthritis, diabetes, thyroid abnormalities, and the use of certain medications such as antihistamines, decongestants, oral contraceptives, diuretics, narcotic pain relievers, or blood pressure medications. Vitamin A deficiency can also reduce tear secretion. In addition, the condition can be associated with blepharitis, ocular herpes, Demodex mites, or graft versus-host disease.
Environmental factors can also affect your tear film. Exposure to sunlight, wind, smoke, or air pollution can increase tear evaporation. Prolonged focus on a task such as reading or driving can decrease your blink rate and further deplete the tears. Other factors that can contribute to dry eye include aging, the use of contact lenses, and hormonal changes associated with pregnancy, menopause, or hormone therapy.
Your doctor can diagnose dry eye syndrome by asking about your symptoms and examining the front of your eyes. They may also perform a simple test called the Schirmer test, which measures tear thickness. This can be done in the office or at home. They can also recommend over-the-counter or prescription eye drops, ointments, oral medications and essential fatty acid supplements to help increase your tear production.
Diagnosis
Many patients experience dry eye symptoms as a side effect of certain medications or because of environmental factors. If left untreated, symptoms can become severe and may even damage the front surface of the eye. Identifying the root cause of a patient’s symptoms is a crucial part of the evaluation process. A detailed patient history and a comprehensive eye exam can help us determine the underlying causes of dry eyes.
Some of the most common causes of dry eye include overly windy or cold climates, contact lens wear and the natural aging process. Some underlying medical conditions, such as autoimmune disorders, can also increase your risk of developing dry eye. In addition, some surgeries, such as LASIK, can decrease tear production and contribute to dry eye symptoms.
During the examination, we will ask you about your symptoms and examine the front of your eye to assess your vision. We will also ask about your general health and any medications you are taking. Many drugs, such as antihistamines, decongestants, diuretics and birth control pills, can worsen dry eye symptoms. We can work with your primary care doctor or specialists to find a replacement medication that will not exacerbate the condition.
We can diagnose dry eye through a number of tests, such as the Schirmer test or TearLab. The Schirmer test is a painless procedure that involves placing a strip of medical paper underneath your lower lids and then examining how far the water in your tears travel down the paper. A reading of less than 15mm indicates that you have a low water content in your tears. TearLab evaluates the osmolarity, or saltiness, of your tears and indicates how much moisture is in your eyes.
Symptoms of dry eye are often relieved by using over-the-counter artificial tears. We can also recommend prescription eye drops that will increase your tear production and decrease inflammation. Oral supplements of essential fatty acids can also help to reduce dry eye symptoms. In some cases, surgical treatment, such as ocular punctal plugs or amniotic membrane grafting, may be recommended.
Treatment
With each blink, tears spread across the front of the eye’s surface (the cornea), providing lubrication and reducing your risk of infection and other health problems. Tears also wash away debris from the eye’s surface and keep your eyes clean. When the tear film is disrupted, it can cause dry eye.
Depending on the cause of your symptoms, there are many treatment options available to you. Your eye care professional will start with a comprehensive eye exam to evaluate your symptoms and take into account your complete medical history.
Your eye care professional may prescribe preservative-free artificial tears and ointments to help with your discomfort. If your symptoms persist, your provider might recommend the immune-suppressing medication cyclosporine (Restasis) or corticosteroids to reduce inflammation in the eyes.
For severe cases of dry eye, your provider might recommend autologous serum drops. These are custom drops made with your own blood serum, which is spun down to remove the red blood cells and then mixed with a salt solution. This treatment can be expensive, so your insurance may not cover it.
Another option is punctal occlusion (temporary or permanent). Through a painless procedure, your provider inserts a plug into the tear drain (punctum) in the lower eyelid, to keep more tears in your eyes.
If you have evaporative dry eye, your provider may recommend a thicker ointment at night (like a bedtime ointment). This can help prevent tears from evaporating while you sleep.
There are several lifestyle changes you can make to help manage your symptoms of dry eye, including staying hydrated and blinking more frequently to spread tears evenly across the eye’s surface. Your provider may also recommend wearing contact lenses that are designed to stay moist all day.
If you are suffering from discomfort or blurry vision, it’s important to see a specialist for dry eye. We will develop a treatment plan for you that will minimize your symptoms and improve your quality of life. Our goal is to get you back to your normal activities as quickly as possible. Call us today to schedule an appointment.
Prevention
In many cases, doctors can prevent dry eye symptoms by treating the underlying cause. In addition to the standard treatments listed above, they may recommend lubricating drops or ointments, warm compresses, lid massage and dietary supplements such as Omega-3 or essential fatty acids. They may also use a special microscope to test for meibomian gland dysfunction, which often causes dry eyes, especially in women during menopause and those older than 50.
The condition develops when the eyes do not make enough tears to clear the surface of the cornea, or when those tears evaporate too quickly from the eye. Tear production can decrease with age or due to medical conditions such as glaucoma or rheumatoid arthritis, or due to certain medicines such as anti-depressants, blood pressure medications, diuretics, antihistamines and retinoids. Other medications including benzylpenicillin, antifungals and narcotics increase the risk of dry eye symptoms as well.
Environmental and lifestyle factors can also contribute to dry eye. Smoking can irritate the eyes, and constant exposure to wind, smoke, sunlight or fluorescent lighting can deplete tear volume. Those who wear contact lenses are more likely to have dry eyes, as can those who spend long hours at the computer or staring at TV screens. Increasing the humidity of the home, especially in the winter, can help. Taking breaks to blink regularly or wearing sunglasses that block ultraviolet rays will help, as can washing the eyelids with a gentle cleanser before bed.
For a temporary solution, some doctors recommend blocking the tear ducts with tiny silicone or gel-like plugs. The procedure is quick, painless and effective. A more permanent option involves surgery to close the lacrimal glands. Doctors treat any underlying condition that is contributing to the dry eye, such as blepharitis or a thyroid disorder, and change the medications being used if they are increasing the patient’s risk for dry eyes, such as anti-depressants, steroids or anticholinergics. They may also prescribe artificial tears or ointments to restore the natural amount of tears in the eyes and help reduce symptoms. They may advise patients to wear goggles while using a personal care device such as a hair dryer or vacuum cleaner, and they encourage them to avoid direct contact with hot or windy surfaces.