An Overview of Dry Eye Syndrome

Dry eye syndrome, also called keratitis sicca, keratoconjunctivitis sicca, or xerophthalmia is a recurrent or persistent sensation of dryness of the eyes. The condition is uncomfortable and it can interfere with your quality of life. You may have trouble keeping your eyes open or you may not be able to work or drive due to severe dryness of your eyes. Dry eye disease can vary from mild to extremely severe. Getting treatment for your dry eyes can make a big difference in easing your discomfort.

Symptoms

Just as the name suggests, this condition makes the eyes feel dry, scratchy, and gritty. You may experience these symptoms all the time or intermittently. They tend to worsen after a long day, and they are generally less noticeable right when you wake up.

Common symptoms of dry eye syndrome may include:

• Burning eyes
• A stinging sensation of the eyes
• Itchy eyes
• Painful eyes
• Sensitivity to light
• Redness of the eyes
• Blurry vision
• A feeling that there is a speck of dirt in the eyes

Reflex Tears

Dry eyes can actually cause your eyes to water. The tears are similar to the tear production that is triggered when something gets in your eye. They are called reflex tears.

Reflex tears don't have the same lubricating qualities as the tears that normally protect your eyes, so they do not prevent dry eyes.

Complications

Most people who have dry eyes experience mild irritation with no long-term effects. But if the condition is left untreated or becomes severe, eye damage and even vision loss can occur.

Severe problems with dry eyes can cause:

• Eye inflammation
• Corneal abrasion (a scratch on the surface of the eye)
• Corneal erosion (thinning of the surface of the eye)
• Corneal infection
• Scarring of the eyes
• Vision loss

Causes

Tears serve as a protective coating, keeping the eyes moist, providing essential nutrients, and washing away dust and other particles. The tear film is made of water, oil, and mucus, all of which are important for maintaining good eye health.

The cornea, which covers the front of the eye, needs to be continuously bathed in tears, which protect it against infection. Dry eyes develop when the eyes don't produce enough tears or don't produce the right quality of tears.

There are several common factors that lead to dry eye syndrome.

Environmental Factors

Environmental conditions can lead to dry eyes. This can be especially bothersome if you are frequently exposed to these conditions.

• Wind
• Heat
• Dust
• Air conditioning
• Cigarette smoke

Aging

Aging is one of the most common causes of dry eyes because tear production decreases as we get older, and the lids are unable to spread out the tears like they used to.

Not Blinking Enough

Another common culprit is not blinking enough, which happens during activities such as watching TV and computer use. Each time you blink, it coats the eye with tears. You normally blink about every 12 seconds. People who play computer games may only blink once or twice during a three-minute time span.

Additionally, anything that causes an issue with the blink reflex can interfere with blinking.

Possibilities include:

• Lid disease
• Lagophthalmos
• Ectropion
• Entropion
• Foppy lid
• Parkinson's disease
• Progressive supra nuclear palsy (PCP)
• Certain types of thyroid disease can interfere with blinking.

Contact Lenses

About half of all people who wear contact lenses complain of dry eyes. Soft contact lenses, which float on the tear film that covers the cornea, absorb the tears in the eyes, contributing to eye dryness.

Laser Vision Correction and Other Procedures

Dry eye syndrome may begin or worsen after LASIK and other refractive surgeries, in which the corneal nerves are cut during the creation of a corneal flap. The corneal nerves stimulate tear secretion.

If you've had dry eyes and are thinking about refractive surgery, this potential side effect is something to consider because it will make your dry eyes worse.

Medications

Dry eyes also can be caused by certain medications, including:

• Antihistamines
• Antidepressants
• Birth control pills
• Nasal decongestants
• The prescription acne drug Accutane

Eye Conditions

Several conditions that affect the eyes can also cause dry eyes.

A few of these include:

• Blepharitis, an inflammation of the eyelids, can interfere with the oil glands in the eyes.
• Meibomian gland dysfunction is a condition in which the glands in the eyes become inflamed and do not produce the oil component for the tears.
• Evaporative dry eye is a condition in which the tears are produced, but do not last due to evaporation.

Autoimmune Diseases

Some autoimmune diseases can affect the tear glands.

Autoimmune conditions that can cause dry eyes include:

• Lupus, an autoimmune disease that can affect many parts of the body
• Rheumatoid arthritis, an inflammatory disease that causes joint pain, swelling, and stiffness, as well as systemic (whole-body) effects
• Sjogren's syndrome, an autoimmune disease in which the immune system targets moisture-producing glands, causing dryness in the mouth and eyes

Diagnosis

Diagnosis of dry eyes often involves ruling out other eye conditions and medical conditions.

Some of the effects of dry eyes can be similar to the effects of allergies, viral conjunctivitis (pink eye), corneal abrasion, migraines, and Bell's palsy (when facial weakness prevents you from closing your eyelid).

Your healthcare provider may examine your eye or refer you to an eye doctor, who can perform specialized tests to determine the cause of your symptoms.

People who have undiagnosed vision problems may squint or feel a type of eye discomfort that can be confused with dry eyes, so you might have a vision test.

Specialized tests may include:

• The Schirmer test: A strip of special paper is placed on the edge of the lower eyelid. This measures how much moisture or tears are produced in the eye over time and is a useful test to determine the severity of the problem.
• Fluorescein or rose bengal: When you have this test, a dye is placed on your eye to stain the surface. This can show how much the surface of your eye has been affected by dryness.
• Tear break-up time (TBUT): This test measures the time it takes for tears to break up in the eye. Dye, such as fluorescein, is placed into your eye, and your tears are observed under a special light to assess how long it takes them to break up.

In addition to determining whether you have dry eyes, your healthcare providers will also work with you to determine the cause. If there is a concern that you could have a medical condition causing your dry eyes, you may need blood tests to assess for signs of systemic diseases.

Treatment

Prevention is a key factor in managing dry eyes, If environmental factors are the cause, protective eyewear or using a humidifier can be helpful. If you wear contact lenses, paying close attention to changing them when necessary is important.

There are several treatment approaches that can help with dry eyes, including over-the-counter (OTC) artificial tears, prescription medications, and interventional procedures.

Artificial Tears

The first line of treatment for dry eyes is usually OTC demulcent drops, also known as artificial tears. Artificial tears temporarily lubricate the eye and ease symptoms. Always read the directions, but these products can generally be used as often as needed throughout the day.

Commonly found ingredients in these products include hydroxypropyl methylcellulose, the ingredient in Bion Tears and GenTeal, and carboxymethylcellulose, contained in Refresh Plus and Thera Tears.

Your healthcare provider can guide you in choosing the right one for you. Some people use drops for red eyes, but that can make the eyes even drier. Red eyes could be caused by numerous factors, from allergies to an eye infection, which is why a proper diagnosis is important.

Prescription Medications

A number of prescription medications can be used for the treatment of dry eyes. Gels, ointments, and oral (by mouth) or topical (placed on the eye) steroids may reduce dryness.

Miebo (perfluorohexyloctane), Restasis (cyclosporine ophthalmic emulsion), and Xiidra (lifitegrast ophthalmic solution) are approved for the treatment of dry eyes. Restasis helps the eye produce tears, while Xiidra reduces the inflammation that may cause decreased tear production.

Keep in mind that prescription medications can cause side effects and they are not necessarily right for everyone.

Punctal Plugs

In each eye, there are four puncta, which are small openings that drain tears into the tear ducts. Punctal plugs can be inserted into the puncta to block tear drainage, preserving your tears in your eyes.

The risks of punctal plugs are fairly minimal, but there is a risk of eye irritation, excessive tearing, and, in rare cases, infection.

A Word From Verywell

If you think that you may have dry eyes, it is important that you discuss it with your healthcare provider. Not only is it uncomfortable, but it can also cause complications. Getting the right diagnosis is the first step in making sure that you can find an effective treatment for your dry eyes.