DRY EYES

What is Dry Eye?     

One of the more common causes of eye irritation is known as Dry Eye Syndrome.

The tear film lubricates the eye, smoothes irregularities for better vision, washes germs and other irritating substances from the eye surface and carries oxygen to the surface of the eye. Dry eye is a label for various disorders of the tear film which may be classified into two categories: (1) decreased tear production or (2) excessive tear evaporation. Dry eye may also develop as a result of disease in the oil-producing glands of the eyelid. Regardless of the mechanism, water is lost from the tear film, making it more “concentrated”. This draws water from the eye tissues, leading to further deterioration of the health of the eye surface. Eventually, dry, rough spots appear on the eye surface, which may reduce vision. Nowadays increased use of gadgets and computers is a leading cause of dry eyes.

SYMPTOMS

Patients with dry eye are typically symptomatic for at least six months, and complain of a collection of symptoms which worsen as the day goes on:

• sandy, gritty sensation
• eye redness
• burning or stinging
• dryness
• blurred vision
• foreign-body sensation
• contact lens intolerance

The dry eye becomes more common with increasing age and as body hormone changes develop. Most commonly affected are post-menopausal women. Medications taken by mouth are another common cause of dry eyes. In particular, several categories of drugs are more likely to cause dry eye, including:

• Blood pressure medications
• Antidepressants
• Certain medications which regulate heart rhythm irregularities
• Decongestants
• Antihistamines
• Medications for Parkinson’s Disease.

 

Tests and procedures that may be used to determine the cause of dry eyes include:

• A comprehensive eye exam.An eye exam that includes a complete history of overall health and eye health can help your doctor diagnose the cause of your dry eyes.
• Measuring the volume of your tears.Your doctor may measure your tear production using the Schirmer test. In this test, blotting strips of paper are placed under your lower eyelids. After five minutes your doctor measures the amount of strip soaked by your tears.
• Determining the quality of your tears.Other tests use special dyes in eyedrops to determine the surface condition of your eyes. Your doctor looks for staining patterns on the corneas and measures how long it takes before your tears evaporate.

 

How is Dry Eye Treated?

The approach to treating dry eye syndrome is the use of topical tear substitutes (drops, gels or ointments). Many varieties are available, including thin, watery tear substitutes and thicker, more viscous eye drops.

Besides lubricating your eyes, some artificial tears also promote healing of the eyes and others work to decrease tear evaporation. Artificial tears may also contain thickening agents, which keep the solution on the surface of your eyes longer.

There are two categories of artificial tears:

• Eyedrops with preservatives.This type often comes in multidose bottles and contains chemicals (preservatives) that discourage growth of bacteria once the bottle has been opened. The preservatives may irritate your eyes, especially if you have moderate or severe dry eyes.
• Preservative-free eyedrops.This type has fewer additives and is generally recommended if you apply artificial tears more than four times a day, or if you have moderate or severe dry eyes. Preservative-free eyedrops may come in single-dose vials.

Artificial tears are also available as nonprescription gels and gel inserts. These may cause temporary blurred vision.

If you still don’t have relief after trying various products, the next step might be to try one or more artificial tear ointments. These can temporarily cause blurred vision, so you might prefer to apply the ointment just before bedtime.

Other procedures

Other procedures that may be used to treat dry eyes include:

• Closing your tear ducts to reduce tear loss. Doctor may suggest this treatment to keep your tears from leaving your eye too quickly. This can be done by partially or completely closing your tear ducts, which normally serve to drain tears away.

Tear ducts can be plugged with tiny silicone plugs (punctal plugs). These are removable. Or tear ducts can be plugged with a procedure that uses heat. This is a more permanent solution called thermal cautery.

• Using special contact lenses.Ask your doctor about newer contact lenses designed to help people with dry eyes.

Some people with severe dry eyes may opt for special contact lenses that protect the surface of your eyes and trap moisture. These are called scleral lenses or bandage lenses.

• Unblocking oil glands.Warm compresses or eye masks used daily can help clear up blocked oil glands. A thermal pulsation device is another way to unclog the oil glands, but it is unclear whether this method provides any advantage over warm compresses.
• Using light therapy and eyelid massage.A technique called intense-pulsed light therapy followed by massage of the eyelids has proven to help people with severe dry eyes.

 

Strategies to increase the local humidity near the eyes may be very helpful for the more severe cases of dry eye. Plastic side shields attached to eyeglasses help prevent rapid evaporation of tears and may be very useful. In very severe cases, it may be necessary to suture the eyelids partially together at the corners to reduce the area exposed, also slowing loss of tears to evaporation.

Rule of 20 is very useful as a preventive measure while using computer or gadgets-

Using the 20–20–20 rule can help to prevent this problem. The rule says that for every 20 minutes spent looking at a screen, a person should look at something 20 feet away for 20 seconds. Following the rule is a great way to remember to take frequent breaks.

For Further Reading

1)https://www.mayoclinic.org/diseases-conditions/dry-eyes/symptoms-causes/syc-20371863

2)https://www.allaboutvision.com/en-in/conditions/dry-eye-syndrome/