1. What is dry eye?
Dry eye disease (also known as dry eye syndrome) or commonly referred to as just dry eye is a common condition that occurs when your tears aren’t able to provide sufficient lubrication for your eyes or when the tears evaporate too quickly.
If you have dry eye, it feels uncomfortable, and your eyes may itch or sting. Your eyes may get red and have a feeling of a foreign body or sand, or even have excess tears running down the cheek.
Dry eye may be more likely to happen in certain situations, such as being in an air-conditioned room, extended mask-wearing, or screen use for an extended period.
2. What causes dry eye?
Dry eye may be caused by a number of reasons that disrupt the healthy tear film. In general, the potential causes of dry eye are decreased tear production or increased tear evaporation.
Some common causes of decreased tear production include:
- Health conditions: allergic eye disease, thyroid disorder, rheumatoid arthritis…
- Medications: antihistamines, decongestants, antidepressants, high blood pressure…
- Corneal nerve de-sensitivity due to contact lens wearing
- Post-eye surgery, i.e., LASIK or intravitreal injections
Some common causes of increased tear evaporation or drying out of the tear film include:
- Health conditions: ocular rosacea or meibomian gland dysfunction, Parkinson's disease, vitamin A deficiency …
- No or not enough oil film produced
- Not blinking enough while reading, driving, or working at a computer
- Eyelid problem – turning outward or inward
- Eye allergies
- Preservatives in eye drops
- Wind, smoke, dry air, or other environmental conditions
- Extended mask wearing – air blown into the eyes
Some patients may have multiple causes at the same time.
3. What are the risk factors of dry eye?
You may develop dry eye for many reasons. They include:
- Age. Dry eye is more common starting from 50 to 65. They are a part of the natural aging process - tear production tends to diminish.
- Gender. Women are more likely to develop dry eye, especially when they experience hormonal changes. These include pregnancy, using birth control pills, or menopause.
- Medications. Certain medicines, such as antihistamines, decongestants, antidepressants, high blood pressure, and atropine, can reduce tear production.
- Diet. A diet that is low in vitamin A may lead to dry eye.
- Contact lenses. Long-term use of contact lenses is a common risk factor. About half of contact lens wearers develop contact lens-related dry eye.
- Eye surgery. LASIK or intravitreal injections can lead to decreased tear production.
- Environment or winter season. Exposure to smoke, wind, dry air, and winter heating can increase tear evaporation.
- Extended screen use. If you are staring at a screen and not blinking regularly, such as when using a computer or watching TV, your eyes’ tear film can dry out.
4. How do you treat dry eye?
The treatment for dry eye depends on the underlying cause of the condition, which can range from environmental factors to medical conditions. Here are some tips to help you manage your dry eye symptoms:
- Home remedies and changes to your environment: Your healthcare provider may recommend starting with home remedies, especially if your symptoms are mild. Avoiding environmental triggers, such as cigarette smoke, air vents blowing toward your face, wind, and allergens, may help. You can also use a humidifier in your bedroom, place a warm compress over your eyes, take frequent breaks when reading or using a computer, and take omega-3 fatty acid supplements. Remember to blink often to help your tear production.
- Eye drops: Artificial tears can provide temporary relief by lubricating and soothing your eyes. However, it's important to check with your provider before trying them, especially if you have other medical conditions or take medications that may interact with them. Some versions of artificial tears contain lipids, which can help prevent tear evaporation. Ointments are another option for those who experience dry eyes while sleeping. Topical cyclosporine A eye drops (Restasis®) and lifitegrast (Xildra®) eye drops can help treat inflammation in your tear glands, leading to better quality tears. These drops are typically used twice daily in each eye, and most people see improvements in their symptoms after several months.
- Other medications: Varenicline (Tyrvaya®) nasal spray is a medication that can increase tear production by stimulating your trigeminal nerve. And, in severe cases, your provider may recommend autologous serum drops, which are custom artificial tears made from your own serum. While effective, this treatment is expensive and may not be covered by insurance.
- In-office procedures: Your provider can perform in-office procedures to help your dry eye, such as thermal pulsation therapy (Lipiflow®), intense pulsed light (IPL) therapy, and therapeutic contact lenses. Thermal pulsation therapy can help people with an unstable tear film due to meibomian gland dysfunction. IPL therapy involves using pulses of light to melt the thick substances that block your meibomian glands. Therapeutic contact lenses can help protect and lubricate the surface of your eye.
- Therapeutic contact lenses: Dry eye disease can make the simple act of blinking very painful. That’s because your eyelid rubs against the dry, irritated surface of your eye. Therapeutic contact lenses can help by protecting and lubricating the surface of your eye. These lenses come in several forms, including soft bandage lenses, which protect your eyes and help heal any damage to your cornea, and rigid scleral lenses, which are larger and come into contact with your sclera (the white part of your eye) rather than your cornea.
- Punctal occlusion: If your eyes do not produce enough tears, punctal occlusion may be a helpful option for you. This surgical procedure involves inserting a plug into the tear drain (punctum) in your lower eyelid. The plug allows more tears to stay in your eyes, reducing symptoms of dryness.