Dry eye syndrome (DES) is a chronic condition that develops when your eyes do not produce and maintain enough tears to keep the eye’s surface lubricated resulting in multiple symptoms that range from person to person.
This can be due to a reduction in tear production or increased tear evaporation from a lack of lipid in the tears that stem from oil glands in the eyelids. The effects can range from minor dryness and discomfort to pain, blurred vision and frequent infections.
Symptoms of Dry Eye Disease
Symptoms of dry eye syndrome can vary depending on the severity of the condition but can include:
- Dry, itchy eyes
- Burning or stinging
- Irritation
- Watery eyes
- Blurred vision
- Pain
- Foreign body sensation
The main function of tears is to maintain the health of the cornea of your eye by washing away foreign matter and ensuring that the surface of your eye remains moist, smooth and clear. Tears also rinse away dust particles from your eyes and contain enzymes that protect your eyes from bacteria that can cause infections.
Dry eyes is a condition that develops when the amount of tears produced is not sufficient to maintain the moisture balance in your eye. This can result in that scratchy sensation, a continuous feeling of dryness, stinging and a sensation of a foreign body in your eye. Ironically in an effort to fight off the condition, dry eyes can cause you to produce excessive tears, which is why some people experience watery eyes.
Causes of Dry Eye Disease
Dry eyes can occur naturally as a result of aging or hormonal changes, typically in women who are pregnant, taking oral contraceptives or going through menopause. In fact, women over 50 have a 50% greater risk of dry eye disease than men do of the same age.
It can also result from taking certain medications that reduce tear production such as antihistamines, blood pressure medications and antidepressants. Environmental factors can also play a role in drying out the eyes and DED is common in areas where the climate is dry, dusty and windy.
Home air conditioners or heating systems and excessive time spent staring at a computer or television screen can also dry out eyes and exacerbate symptoms due to the lack of blinking while staring at our screens.
Individuals that suffer from certain medical conditions such as diabetes, blepharitis, lupus, arthritis and thyroid problems are more vulnerable to developing DED. Other causes can be due to eye surgery including LASIK, certain conditions in which the eyelids don’t close properly or extended contact lens use.
A person may have MGD - meibomian gland dysfunction, where the meibomian glands are not secreting enough oil into their tears. This causes the tears to evaporate too quickly and a person to be left with dry eyes.
Diagnosis of Dry Eye Disease
Typically, dry eye disease can be diagnosed through a comprehensive eye exam and a description of your symptoms. On some occasions the eye doctor might decide to do a test that measures how quickly your tears evaporate from the surface of your eye.
By instilling a simple dye called fluorescein (much like food coloring) the doctor is able to watch and count how long it takes the tears to start to break up after they’ve asked you to hold your eyes open after a blink. This is called TBUT or a Tear Break Up Time test.
A low TBUT generally indicates a lipid (aka oil) deficiency in the tears resulting from oil glands in the eyelids not functioning properly. In another type of test, called a Schirmer test, a strip of filter paper is placed under the lid of the eye and you will be asked to close your eye for five minutes. Following the test the amount of moisture on the strip will be measured. Schirmer tests are performed less frequently than a TBUT test.
InflammaDry
InflammaDry is the first and only, rapid result, in-office test that detects elevated levels of MMP-9, an inflammatory marker that is consistently elevated in the tears of patients with dry eye disease. All other dry eye tests measure tear production and stability. Using a simple 4-step process, InflammaDry recognizes elevated levels of MMP-9, to identify patients that may otherwise be missed with other dry eye testing methods.
Using direct sampling microfiltration technology, InflammaDry accurately identifies elevated levels of MMP-9 protein in tear fluid samples taken from the inside lining of the lower eyelid, the palpebral conjunctiva.
InflammaDry provides highly accurate results: 85% sensitivity, 94% specificity
InflammaDry is a disposable, low-cost test, that requires no additional equipment to administer or interpret results. Using four simple steps, InflammaDry test results are achieved in just 10 minutes, aiding in the diagnosis of dry eye before the patient leaves the office.
Preventing Dry Eyes
If the cause of your dry eyes is something external or environmental, eliminating that cause may solve the problem and resolve the symptoms. Avoid dry environments, hairdryers, heaters and fans, (particularly directed toward the eyes) and smoky environments and wear eye protection such as wraparound glasses or goggles when in dusty or windy areas.
Use a humidifier to add moisture to dry indoor air. If working on the computer or watching television, make sure to blink purposefully as our natural tendency is to reduce our blink rate when staring at a screen. Also, avoid rubbing your eyes as this can further irritate them. Staying hydrated by drinking at least 8 to 10 glasses of water per day can also help.
Dry eye disease won't have a permanent effect on your vision, but there is no reason to endure dry, itchy and uncomfortable eyes, especially since there are so many treatment options to increase moisture and comfort. It’s also important to realize that this is a chronic disease that needs consistent treatment. Your doctor will work with you to create a long-term strategy to keep your eyes as comfortable as possible.
Meibomian Gland Dysfunction
This is a picture of meibomian glands in the eyelids being expressed in office and showing the thick, stagnant meibum that is stuck in the glands. The meibum, or oil, should be clear and fluid like olive oil. These oils form an important layer of our tear film that keeps our tears from evaporating. With meibomian gland dysfunction, the oils become thick more like coconut oil and don't release into the tear film effectively and we lose the important barrier on our tears. This can lead to dry eyes and inflammation and styes. Having the glands expressed in office as well as supportive treatment at home helps to manage this disease.
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