A steady flow of tears covers the clear front surface of the eye (cornea). Tears provide lubrication, reduce risk of infection, wash away foreign material and help maintain consistent vision.
Adding foods to your diet that are rich in omega-3 fatty acids (walnuts and salmon) may decrease dry eye symptoms. Cholinergic medicines (pilocarpine, cevimeline) can also increase tear production. Contact Dry Eye Baltimore, MD now!
Many people experience temporary dry eye symptoms on occasion, such as when they’re in a windy environment or after spending too much time looking at screens. But chronic dry eye, which is also called dysfunctional tear syndrome or keratoconjunctivitis sicca, can cause discomfort, red eyes, watery eyes, blurred vision and the feeling that something is in your eye.
If you think you have DED, the first step is to make an appointment with your family health care provider or an ophthalmologist. They’ll ask about your symptoms and perform a comprehensive exam of the eyes and the surrounding area, including an assessment of the tears. A Schirmer test is often used to measure the amount of tears produced; it involves placing a strip of paper under the lower lid and then measuring how much the strip is soaked up after five minutes.
Your doctor may recommend that you try different types of artificial tears or prescription eye drops, which can help reduce inflammation and improve the quality of the tear film. They might also prescribe a medicated ointment or tear duct plugs. Your doctor might also suggest changes to your lifestyle or environment, such as using a humidifier in your home and office and eliminating forced air conditioning or heating, which can irritate the eyes.
In some cases, patients have very little evidence of low tear volume but still suffer from the pain and other symptoms of DED because their brains amplify the nerve impulses caused by the disease. These patients are said to have neuropathic DED.
Other conditions besides DED can evoke similar symptoms, such as an allergic reaction (allergy) or toxic conjunctivitis (a condition that causes scarring of the cornea). It’s important to determine which primary problem you have — and treat it accordingly — before trying to relieve your DED symptoms. A good way to do this is to add foods such as walnuts and fish, which are rich in omega-3 fatty acids, to your diet. These nutrients can help keep the tear layer thicker and prevent evaporation. You can also find a wide range of natural treatments for dry eye and allergy relief online.
Diagnosis
For an accurate diagnosis, the ophthalmologist will ask about the symptoms and duration of the condition. They will also check the health of the tear film, the three layers that cover the cornea, for signs of inflammation or other issues.
Eye drops may be prescribed to help increase tear production or decrease inflammation. In addition, prescription eye ointments and artificial tears can be used to provide immediate relief. Often, the doctor will suggest changing environmental conditions, such as limiting screen time or increasing the use of humidifiers at home and work, to alleviate symptoms. In addition, oral supplements of essential fatty acids can decrease dry eye symptoms in some patients.
The ophthalmologist will also review the patient’s family history of autoimmune diseases, such as rheumatoid arthritis and lupus, and any medications they are taking. They will also examine the front of the eye and may perform a dilated exam to see the back of the eye (see below).
There are many diagnostic tests for dry eye syndrome, ranging from Schirmer’s test to an epithelial staining procedure. In the latter, the ophthalmologist administers painless drops into the eyes that stain abnormal, or devitalized, cells of the conjunctiva and cornea (see below). Typically, these cells are indicative of dry eye disease.
In some cases, the doctor will also recommend a blood test to evaluate for underlying systemic diseases that could be contributing to the dry eye disease. These include rheumatoid arthritis, lupus, progressive systemic sclerosis and dermatomyositis. In these cases, treatment of the underlying disease is necessary to treat the dry eye symptoms adequately.
Patients can take steps to help prevent dry eye by maintaining proper blinking, using artificial tears or ointments, and avoiding direct exposure to high airflow or fans and smoking. They can also consider wearing wraparound sunglasses to protect the eyes from wind and sunlight and drink plenty of water, especially if they are experiencing discomfort or redness around their eyes. They can also try dietary supplements that contain essential fatty acids or ask their primary care provider or rheumatologist for a medication adjustment, such as a reduction in the use of antidepressants, NSAIDs and oral contraceptives.
Treatment
Over-the-counter lubricating eye drops and ointments can provide temporary relief for dry eye symptoms. Several different types are available, so it’s important to find the one that works for you. Try switching brands or formulations until you find the one that works best for your symptoms and lifestyle.
If your symptoms are severe, talk to your doctor about prescription lubricating drops or ointments that are more effective and longer-lasting. Your doctor may also recommend a preservative-free corticosteroid drop (Restasis) that can improve the quality of your tears by inhibiting phospholipase A2 activity, thereby decreasing the production of arachidonic acid and blocking the inflammatory response.
Some medications can cause or worsen dry eye, including retinoids, antidepressants, diuretics and some antibiotics. If you suspect a medication is causing your dry eye, talk to your doctor about changing the dosage or switching to another medication.
Other treatments for dry eyes include hot compresses and eyelid massage, which can help decrease blocked meibomian gland excretory ducts. Topical cyclosporine, a medication that reduces inflammation and increases the production of tears, is also helpful for some people with dry eye. Finally, short-term use of a steroidal ointment, such as a cyclosporine/non-steroidal combination product (Restasis), can significantly improve tear film stability and thickness in some patients.
In most cases, the key to treating dry eye is to understand what causes it and make changes to your home or work environment to prevent symptoms. This includes taking frequent breaks from screens and using a lubricating ointment before bed. Staying well hydrated can also help.
For people who cannot make these changes, the American Academy of Ophthalmology recommends that you talk to your doctor about getting a referral to a rheumatologist in case an underlying systemic condition is causing the dry eye symptoms. This will help your primary care provider or ophthalmologist investigate and treat the underlying disease to relieve the dry eye symptoms. You can also ask your doctor about supplements that can support healthy eyes, such as omega-3 fatty acids. They are available as oily fish or in capsules.
Prevention
While everyone experiences the gritty, uncomfortable feeling of dry eye at some point, for many people it is a chronic problem that requires consistent management. The condition, formally known as ocular surface disease, occurs when the eyes don’t produce enough tears or the right quality of tears to keep them healthy and comfortable. Tears, which consist of three separate layers, are essential for good vision and clear eyesight. When the tear film is disrupted, symptoms such as itching and watering may occur.
There are a variety of factors that can cause or worsen dry eye, including age, the environment and certain medications. Women after menopause are more likely to develop the condition than men. Low-humidity climates and indoor environments can exacerbate symptoms. Certain medications, including antihistamines and decongestants, can decrease tear production. In addition, air pollution and cigarette smoke can irritate the eyes and trigger symptoms.
The most effective treatment for dry eye is using nonprescription artificial tears, available at pharmacies and grocery stores. The drops are sold in both preserved (screw-cap bottle) and unpreserved form. It’s important to use the unpreserved formula, as the preservatives can damage the surface of the eye over time. The drops should be used every 2 hours, or more often if symptoms persist. It’s also a good idea to use a humidifier, particularly during the winter.
Some other preventive steps include making lifestyle changes, such as avoiding second-hand smoke and direct wind and wearing wraparound sunglasses when going outdoors. Wearing a mask when mowing the lawn or working in the woodshop may help. In some cases, doctors recommend a prescription drop or ointment, warm compresses and lid massages, or the use of eyelid wipes to reduce inflammation. They may also recommend a dietary supplement that contains omega-3 fatty acids, which are found in oily fish such as tuna and salmon, or as a daily pill.
In severe cases, a doctor may recommend surgery to plug the tiny holes in the corners of the eyes, called lacrimal plugs. This is a quick procedure and is not painful. It can significantly improve symptoms for some people.