Written by Dr. Abby Taffe
Dry eye is a condition that occurs when the quantity and/or quality of tears fails to keep the surface of the eye adequately lubricated. Studies have shown that dry eye affects millions of adults in the United States. The risk of developing dry eye increases with advancing age and has a higher prevalence in women.
Symptoms of dry eye include a scratchy, gritty feeling or the sensation that something is in the eye. Other symptoms include: stinging or burning, watery eyes, redness, and occasionally a white stringy discharge. Some people with dry eye may also experience blurry or hazy vision that often times improves with blinking.
Tears have many important roles for the eyes including: providing lubrication, reducing the risk of eye infection, washing away foreign matter from the eye, and keeping the surface smooth and clear. In a healthy eye, lubricating tears (called basal tears) continuously bathe the cornea and are replenished constantly with every blink. As the basal tears flow across the cornea, they nourish its cells and provide a layer of protection from the environment. When the lacrimal glands fail to produce enough tears, or if the composition of the tears change, the health of the eye can be compromised. Vision may also be affected because tears play a very important role in focusing light in order to provide clear, quality vision.
In order to fully understand dry eye, we must first understand the components of the tear film and how they interact. The tears themselves are composed of three different layers: an outer oil layer, a middle water layer, and an inner mucus layer. Each layer has an essential role in providing a good quality tear film.
- Oil layer – produced by the meibomian glands located in the upper and lower eyelids. The oil keeps tears from evaporating too quickly and helps tears remain on the eye
- Water layer – produced by the lacrimal gland and accessory lacrimal glands. This layer consists of many proteins and other nutrients that help to nourish the cornea and conjunctiva
- Mucus layer – produced by goblet cells. This layer binds with the water layer to help keep the tear film attached to the cornea and keep the eye lubricated
Dry eye occurs when basal tear production decreases, tear evaporation increases, or the composition of the tears is imbalanced. Some of the most common factors that can contribute to dry eye include:
- Age: Advancing age is a risk factor for a decline in tear production. Dry eye commonly affects people aged 50 and older
- Gender: Women are more likely to develop dry eye due to hormonal changes with pregnancy, the use of oral contraceptives, and menopause.
- Medications: some of the most common contributors include antihistamines, decongestants, antidepressants, birth control pills, hormone replacement therapy, and medications for anxiety and high blood pressure
- Medical conditions:
- Rosacea and blepharitis can disrupt the function of the meibomian glands, which in turn affect the oil layer of the tear film. This often causes tears to evaporate too quickly.
- Autoimmune conditions such a lupus, Sjogren’s syndrome, scleroderma, and rheumatoid arthritis can affect the production of tears.
- Other systemic conditions including diabetes, thyroid disorders, and Vitamin A deficiency can affect tear production as well
- Environmental factors: Windy, smoky, or dry environments. Prolonged periods of screen time (computers, tablets, cellphones, etc.) cause insufficient blinking
- Other factors: History of laser eye surgery or long term contact lens wear
Thankfully, there are several treatment options that can help relieve dry eye. It’s important to understand which component of the tear film is causing the problem, in order the correctly treat dry eye. Some of the most common dry eye treatment options include:
- Artificial Tears: Used up to 4 times per day in both eyes
- Artificial tears are often used to supplement natural tear production
- Artificial Tear Ointment: Instill 1/8 inch of ointment before bedtime in both eyes
- Using an ointment before bed can help lubricate the eyes throughout the night. The ointment is thicker than most artificial tears so it will make your vision blurry, which is why it is used before bed. In the morning, you may remove any leftover ointment on your eyelids and lashes with a warm washcloth.
- Warm Compresses: Used 1-2 times a day over both eyes for 10 minutes.
- Warm compresses help to open the meibomian glands that produce the oil part of the tear film. Better flowing oil allows for production of better quality tears.
- Lid Hygiene: Do this 1-2 times per day on both eyelids
- Wrap a warm washcloth around your finger and wash right along the lid margin at the base of your lashes (with eyelids shut). Diluted baby shampoo or over-the-counter lid scrubs (ex. OcuSoft Lid Scrubs) can be used to help clean the eyelids.
- Prescription Medications:
- Xiidra, Restasis or short term steroid drops
- These help to decrease inflammation in the eye and stimulate tear production in the lacrimal glands
- Omega-3 Supplements: Take 2000 milligrams per day with food
- Omega-3 supplements have been proven to significantly improve dry eye symptoms by helping with the oil layer of the tear film
- Blink Exercises:
- Close your eyes, gently squeeze eyelids closed for 2-3 seconds, and open. Repeat same steps for designated number of repetitions.
- Blink exercises train your eyelids to blink more completely in hopes to help improve dry eye symptoms.
- Punctal Plugs:
- Punctal plugs are inserted in office in the punctum (tear duct) in the upper and/or lower lids to block drainage to help keep the tears on the eyes for a longer period of time
- Environmental and lifestyle changes
- Cutting back on screen time and taking more frequent breaks.
- Sunglasses that wrap around the face or with side shields that block wind and dry air
- Smoking cessation and limiting exposure to secondhand smoke
- Increasing water intake
- Using a humidifier in your home and turning off ceiling fans
If you are having problems with dry eye, please schedule an appointment with one of our optometrists. We would be happy to work with you to help with your dry eye symptoms!
Dry eye. American Optometric Association. 2015. https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/dry-eye
Dry eye disease. The Mayo Clinic. 2018. https://www.mayoclinic.org/diseases-conditions/dry-eyes/diagnosis-treatment/drc-20371869
Facts about dry eye. The National Eye Institute. 2017. https://nei.nih.gov/health/dryeye/dryeye