Dry Eye Disease
What is Dry Eye Disease?
Dry Eye Disease (DED) affects millions of adults in the United States. Dry Eye Disease occurs when the quantity and/or quality of tears fails to keep the surface of the eye adequately lubricated.
In a healthy eye, tears continuously bathe the cornea, the clear, dome-shaped outer surface of the eye. When the composition of the tears changes, the health of the eye and vision are compromised.
Tears are a complex mixture of fatty oils, water, mucus, and more than 1500 different proteins that keep the surface of the eye smooth and protected from the environment, irritants, and infectious pathogens.
- The outer, oily (lipid) layer, produced by glands along the eyelid margin ( Meibomian glands), keeps tears from evaporating too quickly.
- Beneath the oily layer is a mixture of water and mucin.
- The water component is produced by a second gland (Lacrimal gland)
- The mucin component is produced by cells on the eye itself (Goblet cells) and helps bind the water component so that the tear film spreads evenly over the eye.
When any component is deficient, Dry Eye Disease develops
What are the symptoms of Dry Eye Disease?
Dry eye causes
- a scratchy sensation and/or feeling that something is in the eye.
- stinging or burning; possibly pain.
- episodes of excess tearing that follow periods of dryness.
- redness in the eye.
- heavy sensation in the eyelids.
- blurred vision.
What causes Dry Eye Disease?
When any component if the tear film is deficient ( see above), Dry Eye Disease develops.
Factors that can contribute to DED include the following:
- Medications: glaucoma eye drops, oral allergy medications, antidepressants, birth control pills, hormone replacement therapy. Medications for anxiety, and high blood pressure
- Advancing age.. Dry eye is more common in people age 50 years or older.
- Inflammatory eyelid disease such as Rosacea can disrupt the function of the Meibomian glands.
- Autoimmune disorders such as Sjögren’s syndrome, lupus, and rheumatoid arthritis disorders
- diabetes
- thyroid disorders
- hormonal changes associated with pregnancy and menopause
- Windy, smoky, or dry environments increase tear evaporation.
- Seasonal allergies can contribute to dry eye.
- Prolonged periods of screen time: Staring at computers and phones) which increases evaporation of tears and also exacerbates problems with the oil glands in the lids.
- Eye surgery may cause temporary dry eye symptoms.
What can I do to prevent Dry Eye Disease?
Staying well hydrated sounds very basic and it is, but it’s the first step to preventing dry eyes. When we become dehydrated the body diverts fluid towards functions other than producing tears, so staying hydrated is the first line of defense.
- Diet. A major component of dry eye disease is inflammation on the surface of the eye. A diet rich in Omega-3 fatty acids helps to prevent inflammation everywhere in the body including on the ocular surface. Foods that boost Omega-3’s are: Fatty fish, such as Salmon ,Halibut, Tuna; Walnuts, Flax-Seeds and Chia Seeds (seeds need to be ground before being ingested)
- Lid closure and remembering to blink regularly As we stare at computer screens and cell phones our blink rate decreases. The eyes are open longer than usual and the tears evaporate faster, leading to dry eyes. Taking breaks with moments of lid closure and remembering to blink regularly during long periods of computer use will go a long way to preventing excessive tear evaporation. Cutting back on screen time and taking periodic eye breaks may help.
- Wearing sunglasses when outside protects the eye from air and wind, thereby decreasing the amount of evaporation of the tears. Sunglasses that wrap around the face and have side shields that block wind and dry air can reduce symptoms in windy or dry conditions.
- Adequate sleep.The longer your eyes are open the dryer they become because of evaporation. That’s why you might notice more symptoms at the end of the day. Getting adequate sleep (7-8 hours for most) means your eyes get to rest and the lidsprevent evaporation of tears. Haven’t you noticed that your eyes are more uncomfortable when you haven’t gotten any “shut-eye?”
- Smoking cessation and limiting exposure to secondhand smoke also may help
- Environmental controls
- During winter you might consider a humidifier by your bedside.
- During warmer months remember that sitting under a fan or in front of air conditioning will increase evaporation of tears from your eyes.
- At work or home, don’t sit for long in front of moving air (heat/air vents)
What can I do to treat my Dry Eye Disease?
So you’ve done all you can to try to prevent dry eye disease but you are still having symptoms and/or your eye exam still shows that the eyes are dry,
What’s next?
First line of treatment is always prevention, so continue to work to prevent dry eyes, then add to those efforts:
- Mild dry eye symptoms may be treated with over-the-counter medications such as artificial tears, gels, and ointments. Preservative free formulas are best.
- Warm lid compresses and lid wipes help to open up oil glands and softens the oil in the glands so that when you blink, the muscles around the glands push the oil form the glands to the surface of the eye, resulting in a healthier tear composition.
- Prescription medications. Cyclosporine (Restasis) and lifitegrast (Xiidra) are prescription medications approved by the U.S. Food and Drug Administration for treating dry eye. Corticosteroid eye drops (Lotemax) also may be prescribed short-term to reduce eye inflammation.
- FDA Approved Devices:
- Punctal Plugs
- Lipiflow
Punctal Plugs
Punctal Plugs
Punctal Plugs
Punctal Plugs made of silicone or collagen may be inserted into the puncta on the lids to partially or completely plug the space on the inner corners of the eye to keep tears from draining from the eye. Plugs help keep your own tears on your eyes longer.
Lipiflow
Punctal Plugs
Punctal Plugs
86 % of patients with Dry Eye Disease have blocked Meibomian Glands (MGD). If the meibomian glands are blocked, the lipid layer will be reduced, allowing rapid evaporation of tears.
Furthermore, if the gland secretions become trapped inside the glands, inflammation and bacteria can follow, worsening the problem.
Lipiflow is an in-office treatment designed to restore the natural oil flow from the glands to support a healthy tear film.
