Dry Eye Disease is a chronic inflammatory condition that is best managed with early diagnosis and treatment. This common condition arises when your tears fail to provide sufficient lubrication for your eyes. Tear instability can result from various factors, such as insufficient tear production or poor-quality tears. This instability often leads to inflammation and damage to the surface of the eye.
Dry eyes can be uncomfortable and may cause symptoms like stinging or burning. Certain environments or activities, such as being on an airplane, in an air-conditioned space, riding a bike, or staring at a computer screen for extended periods, can exacerbate the condition.
Common Symptoms of Dry Eye Disease
- A burning sensation, grittiness, or the feeling of a foreign object in the eye
- Redness, itching, or an urge to frequently rub the eyes
- Excessive tearing, with tears spilling onto the cheeks
- A strong desire to close the eyes for relief
- Difficulty or discomfort while wearing contact lenses
- Stinging, burning, or scratchy sensations in the eyes
- Stringy mucus in or around the eyes
- Sensitivity to light
- Eye redness
- A sensation of something in the eyes
- Difficulty wearing contact lenses or driving at night
- Watery eyes as a reaction to irritation
- Blurred vision or eye fatigue
Proper diagnosis and management can help alleviate these symptoms and prevent further damage to the eyes.
Causes of Dry Eye Disease
Your tear film and blinking mechanisms are essential for maintaining eye health by lubricating and protecting the ocular surface. The tear film is a complex structure made of mucus, water, electrolytes, and a thin oily layer that prevents evaporation. Disruptions in any of these components, often due to inflammation, can result in dry eye disease.
Aqueous Deficiency
Caused by inadequate production of the watery part of tears. Common in conditions like Sjögren’s Syndrome and after LASIK or other surgeries.
Meibomian Gland Dysfunction (MGD)
Caused by poor oil secretion, leading to rapid tear evaporation.
Chronic Inflammation
Persistent inflammation can damage ocular tissues, resulting in scarring and impaired blinking.
Medications
Certain medications, including antidepressants, antihistamines, and birth control, can interfere with tear production, leading to dryness.
Eyelid Mites
Microscopic mites (Demodex folliculorum) living in eyelash follicles may harbor bacteria that trigger inflammation, contributing to dry eye.
Lifestyle Factors
Habits such as consuming alcohol, excessive caffeine, insufficient water, and poor dietary choices can intensify dry eye symptoms.
Eyelid Conditions
Issues like Meibomian Gland Dysfunction (MGD) hinder the production of the oily layer in tears, destabilizing the tear film. Treating these underlying conditions is often essential for relief.
Reduced Blinking and Tear Evaporation
Blink rates drop significantly during activities such as computer use, decreasing from an average of 12–15 blinks per minute to just 3–4. This reduction accelerates tear evaporation, worsening dryness.
Additional Causes of Dry Eye Disease
Aging: Tear production naturally decreases with age.
Environmental Factors: Dry, windy, or smoky environments increase tear evaporation. Eye Allergies also share similar symptoms as dry eye such as redness itchiness, tearing, and a gritty or burning sensation. Eye Allergies are Caused by the body’s reaction to allergens such as pet dander, dust, pollen, smoke, perfumes, or certain foods. To combat allergens, the body produces histamine, leading to red, swollen, itchy eyelids, and at times, excessive tearing and burning. If you have been using over-the-counter Allergy treatments without seeing improvement, book an appointment with us to assess if its dry eye.
Screen Time: Prolonged use of digital devices reduces blink frequency, contributing to dryness.
Hormonal Changes: Pregnancy, menopause, or hormonal therapies may lead to changes in tear production.
Medical Procedures: Eye surgeries or radiation therapy can sometimes disrupt tear production.Many individuals with refractive errors like nearsightedness choose LASIK (laser-assisted in situ keratomileusis) surgery to correct their vision due to its safety and effectiveness. But dry eyes are a remarkably common after-effect of LASIK surgery, affecting up to 95% of patients who’ve undergone this procedure. In fact, dry eye symptoms are the primary reason for patient dissatisfaction after LASIK. Although symptoms of dry eye syndrome (DES) most commonly occur in the immediate postoperative phase and are generally only temporary in nature, some individuals develop chronic and severe DES that can negatively impact their quality of life.
Contact Lenses: Prolonged wear can irritate the eye surface and worsen dryness.
Irritants: Exposure to smoke, dust, or chemicals can trigger symptoms.
Eye Trauma: Injuries or burns to the eye can reduce tear stability.
Vitamin A Deficiency: This nutrient is crucial for maintaining healthy tear production and eye function.
Sjögren’s Syndrome: This autoimmune condition targets tear and saliva glands, causing chronic dryness.
Understanding the underlying causes of dry eye is crucial for identifying the most effective treatments. If symptoms persist, seek a comprehensive evaluation from an eye care professional.
Testing for Dry Eye Disease
Dry eye disease is a multifaceted condition requiring a comprehensive diagnostic approach to pinpoint its root causes. Using advanced technologies and specialized tests, we create personalized treatment plans for lasting symptom relief.
Comprehensive Eye Exam
The diagnostic process includes the following evaluations:
Tear Production Tests
- Schirmer’s Test: Measures tear production using a small strip of paper placed under the lower eyelid for five minutes.
- Phenol Red Thread Test: Assesses tear volume with a thread treated with a pH-sensitive dye.
- SM Tube Test: Quantifies tear production to evaluate sufficiency.
Tear Quality Tests
- Tear Film Breakup Time: Measures the time it takes for the tear film to destabilize after blinking, using dyes.
- Meibography: Uses infrared imaging to assess the structure and function of the Meibomian glands, which produce the oily layer of the tear film.
- Fluorescein Dye Test: Highlights corneal damage and microabrasions using an orange dye and blue light.
- Tear Osmolarity Test: Evaluates the balance of water and solutes in tears to identify instability.
- Interferometry: Analyzes the tear film’s stability and evaporation rate.
Specialized Tests
- Biomicroscopy: Magnifies the eye’s surface to detect chronic inflammation, structural abnormalities, mites, clogged glands, and signs of rosacea.
- Functional Visual Acuity (FVA): Assesses visual clarity during prolonged eye-opening without blinking.
- Blood Tests: May be used to rule out systemic or autoimmune conditions that could contribute to dryness.
Personalized Diagnosis and Treatment
During the evaluation, your eye care professional will review your medical history, medications, and lifestyle factors to identify contributing elements. These diagnostic results inform a tailored treatment plan that targets your specific condition.
By addressing the underlying causes of dry eye disease, effective and lasting relief can be achieved. If your symptoms persist, consult an eye care specialist for a detailed evaluation and treatment options.
Treatment Options
Medicines to reduce eyelid inflammation: Inflammation along the edge of your eyelids can keep oil glands from secreting oil into your tears. Your eye care specialist may recommend antibiotics to reduce inflammation. Antibiotics for dry eyes are usually taken by mouth, though some are used as eye drops or ointments.
Eye drops to control cornea inflammation: Inflammation on the surface of your eyes (cornea) may be controlled with prescription eye drops that contain the immune-suppressing medicine cyclosporine (Restasis, Xiidra, Cequa) or corticosteroids. Corticosteroids are not ideal for long-term use due to possible side effects.
Eye inserts that work like artificial tears: If you have moderate to severe dry eye symptoms and artificial tears don't help, another option may be a tiny eye insert that looks like a clear grain of rice. Once a day, you place the hydroxypropyl cellulose (Lacrisert) insert between your lower eyelid and your eyeball. The insert dissolves slowly, releasing a substance that's used in eye drops to lubricate your eye.
Tear-stimulating medicines: Medicines called cholinergics (pilocarpine, cevimeline) help increase tear production. These medicines are available as pills, gels or eye drops. Possible side effects include sweating.
Eye drops made from your own blood: These are called autologous blood serum drops. They may be an option if you have severe dry eye symptoms that don't respond to any other treatment. To make these eye drops, a sample of your blood is processed to remove the red blood cells and then mixed with a salt solution.
A nasal spray to increase tear production: The Food and Drug Administration (FDA) recently approved varenicline (Tyrvaya) to treat dry eyes. This medicine is delivered via a nasal spray. Varenicline is to be sprayed once into each nostril, twice a day.
Closing your tear ducts to reduce tear loss: Your eye care specialist 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 eye care specialist 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 the 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.
Omega-3 Supplements: High-quality omega-3 supplements to support tear production and reduce inflammation.
In-Office Treatments
Clinically validated procedures targeting inflammation and other underlying issues associated with dry eye disease:
ZocuKit Treatment for Dry Eye: ZocuKit is an effective in-office treatment for dry eye, blepharitis, and inflammation. This gentle, convenient system offers immediate relief, complemented by at-home maintenance with Zocular products.
BlephEx: is a procedure that employs a rapidly rotating exfoliating head to remove demodex mites, bacteria, and hardened tissue from the eyelid margin. This removal of “biofilm” reduces a major source of inflammation and opens the oil producing glands essential for good quality tears. It also promotes healing of the mucus membrane needed for a smooth and comfortable blink.
Radio Frequency for Dry Eye: Radio Frequency (RF) technology regenerates collagen and reduces skin imperfections like wrinkles.
Intense Pulsed Light Therapy (IPL): IPL is a groundbreaking in-office treatment that uses light to reduce inflammation and improve oil production in the meibomian glands. The heat from IPL pulses liquefies and releases clogged oils, helping restore normal tear production and reduce dry eye symptoms.
Lidpro: LidPro is an in-office procedure that can help treat dry eye and blepharitis. It uses a medical-grade silicone disc to exfoliate the eyelids and remove infected debris
Lipiflow: Lipiflow is a medical device that treats dry eye caused by Meibomian gland dysfunction (MGD). It uses Shell-shaped applicators that are placed over the eyelids. A computer delivers heat to the applicators, warming the oil glands to 42°C . The applicators gently squeeze the glands to remove any trapped oil
Mibo Thermoflo: Mibo Thermoflow Is a treatment that uses heat and massage to treat dry eye caused by meibomian gland dysfunction (MGD). The treatment device emits heat to the eyelids, which helps to liquefy oils in the meibomian glands. The device also massages the eyelids to help unblock the glands and improve tear quality
Scleral lenses: are large diameter rigid gas permeable contact lenses that provide a moisture barrier on the cornea, protecting it from dehydration. Scleral lenses bathe the eye in moisture all day long and are used when other therapies fail or if contact lenses are desired for vision correction in the presence of dry eye disease.