Dry Eye Center
What Are the Symptoms of Dry Eye?
Dry eye symptoms can vary from person to person. Some of these symptoms happen regularly, and others occur intermittently. Most people’s symptoms are different and can vary depending on whether they’re indoors or outdoors. Dry eye disease occurs when your eyes are affected at least once per day. Believe it or not, watery eyes or excessive tearing can be a symptom of dry eyes. If the normal tear quality is reduced, the body creates an over-production of watery tears.
What is Dry Eye Disease?
Dry eye disease affects the surface of the eye and results in a loss of the normal balance of things that keep your eyes comfortable and clear. Tears spread across the cornea or the surface of the eye with every blink. The amount and quality of one’s tears are essential for one’s eyes. At the surface of the eyes, there are many parts that work together in harmony. The parts that must work together are muscles, nerves, glands, tear ducts, and connective tissue. They all play a vital role in keeping the eyes moist.
Dry eye disease usually occurs when one of these factors is out of balance. This causes imbalance to the other factors, perpetuating the cycle of dry eye disease.
The risk of developing dry eye disease increases with age. Women are more likely to develop the condition compared with men. However, dry eye disease is becoming increasingly common in younger people with more device use like smartphones, laptops, and tablets. Increasing device and smartphone use has made dry eyes more prominent than ever before. According to research, over 16 million Americans have dry eyes. Those who develop dry eye disease can experience problems with daily activities like reading, watching television, using the computer and mobile phones, dealing with work, and driving.
What Role Do Our Tears Have in Dry Eye Disease?
Tears have three layers: the outer lipid layer, the middle aqueous layer, and the inner mucin layer. Each layer serves a purpose.
Dry eyes can occur when there is a loss of natural balance (either from external or internal problems) with any of these layers.
Tears play an essential role in protecting and keeping your eyes healthy. There are three types of tears: basal tears, reflex tears, and emotional tears:
The right amount and quality of tears keep the eyes nourished and lubricated. Every time you blink, a protective film of basal tears spreads over the surface of your eye. Tears help with:
What Are the Causes of Dry Eyes?
There are two leading causes of dry eyes, and often there is overlap between these two main causes of dry eyes.
Several factors can affect tear production or the condition of the eye in general. Dry eyes can result from many factors, including but not limited to:
Incomplete Blink
When we concentrate on a smartphone, tablet, or detailed task, we do not blink as often as we should. Proper blinking spreads our tears and helps our lids secrete oil from our Meibomian glands.
Age
The amount and quality of tears the eyes produce decrease with age. Dry eyes increase in prevalence for people aged 55 and above.
Gender
Due to hormonal changes, pregnancy, the use of contraceptives, and menopause, women have a higher chance of developing dry eyes.
Cosmetics & Skincare Products
You may find ingredients that are toxic and cause dry eyes in cosmetic and skin care products. Products exist that are hypoallergenic, organic, or vegan.
Eyelid Problems
Conditions such as ectropion (out-turning of the lids) and entropion (in-turning of the lids) can produce more exposure or friction and cause the normal tear film to break up faster.
Recent Surgical Procedures
Refractive eye surgery like LASIK can cause decreased tear production. This is due to a permanent change to the front surface of the eye. For some people, dry eye symptoms related to eye procedures can be temporary. Others can have persistent symptoms.
Medications
Most medicines have side effects, and some of these can affect tear production. Medications such as blood pressure medications, antidepressants, sleeping pills, heartburn tablets, drugs for acne, birth control, hormone replacement, allergies, cold, and Parkinson’s disease can reduce tear production.
Health Conditions
Autoimmune diseases like rheumatoid arthritis, Sjögren’s syndrome, scleroderma, lupus, and thyroid disease can directly affect the glands responsible for tear production. These conditions can cause imbalances in the three main layers of the tear: mucus, oil, and water. Vitamin A deficiency can also decrease tear production.
Indoor and Outdoor Environmental Conditions
Your eyes (and tears) are the most exposed parts of your body. Exposure to a dry environment, whether indoors or outdoors, can affect the eyes. People who live in places with dry climates are more likely to have dry eyes. Exposure to wind, smoke, and fumes can also aggravate your eyes. Dry indoor environments include air-conditioned rooms, hospitals, airplanes, and workplaces.
Daily Activities
Reading, staring at a smartphone or computer, driving, and other similar activities require concentration, leading people to blink less often, which causes increased tear evaporation.
Lifestyle
Contact lenses can also irritate the surface of the eye and contribute to dry eyes. Other activities like cigarette smoking, alcohol consumption, and not getting enough sleep can also affect the dryness of your eyes.
How Might Dry Eyes Affect You?
Short-term effects of dry eye disease include constant eye irritation, blurry vision, regularly tired eyes, and difficulty wearing contact lenses.
Therefore, diagnosing and treating dry eye disease in its early stages is essential.
How Does Concourse Optometry Diagnose Dry Eyes?
A person must undergo tests and imaging to determine what’s causing their dry eyes. Each case can be different and may require custom treatment.
A comprehensive eye exam notes a patient’s complete health history and lifestyle, which may be the underlying cause of dry eyes. It also involves a dry eye survey (OSDI) and an examination of the eyelids and the surface of the eye. If the dry eye is severe enough, a specialized medical dry eye evaluation will be scheduled.
A medical dry eye evaluation will assess the tear volume, how quickly the tears break up on the front surface of the eye, and image your Meibomian glands with our Antares imaging system. This analysis helps us determine if your dry eye disease is caused by aqueous deficiency (lack of tear volume/production), Meibomian gland dysfunction MGD (lack of the oily layer of the tear film), or a combination of both. Once the diagnosis is made, a customized treatment plan will be presented to you. Since a majority of dry eye disease is caused by meibomian gland dysfunction, our analysis will let you know what stage of loss you have, treatment options for maximizing current gland function, and preventative measures for gland preservation.
How Does Concourse Optometry Treat Dry Eyes?
Dry eye disease is often managed rather than cured. However, research and technology have given us significant improvements. Importantly, these can make a big difference to your quality of life.
After your dry eye evaluation, we will guide you through the appropriate treatment plan.
Self-Care to Prevent Dry Eye
Blink More Often
Avoid staring at computers and phones for an extended period of time. Make a conscious effort to rest your eyes at regular intervals, such as every twenty minutes. The rest is especially important when your daily activities require you to use smartphones and devices. Blinking exercises can really help, especially after you use a warm compress.
Don’t Overwear Your Contact Lenses
Always keep them clean, and never forget to take them out at night. Daily disposable lenses allow for a fresh coating every day.
Reduce Cigarette Smoking
Cigarettes contain hundreds of toxic chemicals that inflame and damage your eyes. Industrial chemicals, smoke, and fumes can also affect your eyes.
Apply Warm Compresses to Your Eyes
Brands like ThermaMedex are hygienic due to their sterile packaging and single-use disposable modality. A gentle lid massage will follow; our in-office procedures are designed to clear any blocked oil glands.
Diet and Supplements for Dry Eye Prevention
Water
Keeping your hydration levels up can help improve the comfort of your eyes. It’s great for your skin, bowels, kidneys, and eyes.
Omega-3 Fatty Acids
Ensure your Meibomian glands are secreting enough oil to keep the tears from evaporating too fast. Fish, leafy vegetables, vegetable oil, soybeans, nuts, and seeds are good sources of omega-3s. Fish oil supplements will also help to reduce inflammation of the Meibomian glands for proper oil secretion. Not all fish oil supplements are created equal. A correct DHA/EPA percentage and encapsulation are crucial for improving tear film quality. We partner with De3 by PRN to deliver a high-quality omega-3 source.
Medications for Dry Eye
Artificial Tears
This is probably the most common medication used to treat dry eyes due to its availability. Artificial tears help lubricate the eyes and treat irritation, dryness, and inflammation. While it can relieve some of the common symptoms, it will not be able to deal with the underlying cause of dry eyes. Look for preservative-free drops, especially when using multiple drops or using them more than four times per day.
Prescription Eye Drops
Prescription eye drops that contain the immune-suppressing medication cyclosporine (Restasis, Xiidra) or corticosteroids can help relieve inflammation in the cornea. Restasis and Xiidra normally take a period of time to take effect. Topical corticosteroids (e.g., EYsuVIS) are usually used in short-term doses to rein in inflammation. Unlike artificial tears, these medications require a prescription.
Eye Ointments
Eye ointments are helpful for uncomfortable eyes when you wake up. Sometimes, you can have a small gap between your eyelids overnight. This is called Lagophthalmos and can lead to exposure and dryness. Eye ointments (e.g., Systane Gel) give soothing relief to your eyes overnight.
Concourse Optometry In-Office Dry Eye Treatment Options
Heat Therapy
This treatment involves ThermaMedex EverTears eye pads, eyelid margin debridement, and manual Meibomian gland expression. This treatment will heat the meibum to the correct temperature for expression. The debridement removes skin that may be growing over the gland orifices to allow optimum oil flow. The manual expression is done with a Mastroda paddle to allow for a thorough expression.
Blepharitis Treatment
This treatment involves ZEST eyelid scrubs, heat therapy with ThermaMedex EverTears eye pads, eyelid margin debridement, and manual Meibomian gland expression. This treatment will involve a thorough cleaning of the eyelid margin with Zocular’s okra gel, and it will heat the meibum to the correct temperature for expression. The debridement removes skin that may be growing over the gland orifices to allow optimum oil flow. The manual expression is done with a Mastroda paddle to allow for a thorough expression.
Intense Pulse Light Therapy (IPL)
This treatment is designed to apply light therapy to the cascade of blood vessels (located along your cheeks/flanks of your nose), feeding inflammatory mediators to the meibomian glands along the eyelid margin. This treatment photo-disinfects bacteria and Demodex, desaturates meibum for expression, decreases inflammation in the treated areas, and increases mitochondrial activity in the glands for remaining meibomian gland preservation. It also stimulates collagen deposition in the periorbital skin. Four sessions are needed for four consecutive months to restore the meibomian gland's function. Maintenance after the four consecutive sessions usually occurs every 6 months to a year. If there is severe blepharitis, a ZEST eyelid treatment may be recommended prior to the first IPL session.
Punctal Occlusion
This treatment can bring great relief to patients with advanced aqueous deficient, dry eyes. The puncta are four tiny openings found in the inside corner of the eyelids toward the nose (one in each lid). These openings lead to unseen ducts responsible for draining tears into our nose and throat. Those suffering from severe aqueous deficiency often benefit by having their punctal openings painlessly occluded (blocked) to improve tear retention. Punctual occlusion options include a temporary “plug” (1 week up to 3 months) made of dissolvable collagen or synthetic materials or semi-permanent “plugs” made of silicone or hydrogel. These semi-permanent plugs are removableif the need arises to remove them.