Dry eye is one of the most common eye conditions eye doctors diagnose and treat. In fact, it is estimated over 25 million Americans experience dry eye. Dry eye occurs when there are either not enough tears to adequately lubricate the eye or the tears are of poor quality.
To better understand dry eye, it is helpful to understand the components of a tear. The main layers of tears are:
- Mucus layer: This layer helps spread the water layer and adhere it to the surface of the eye.
- Water layer: This layer keeps the surface of the eye healthy and hydrated.
- Oil layer: This layer prevents tears from evaporating.
When one or more of these layers of tears becomes inadequate, dry eye can occur.
What Causes Dry Eye?
There are many different causes of dry eye including:
- Age: Dry eye particularly affects those over the age of 50. As we age, we naturally produce less tears.
- Environment: Dry, dusty, windy, or smoky environments can increase dry eye.
- Digital screen use: Staring at a computer, smartphone, or TV for prolonged periods can result in decreased blinking.
- Eyelid health: Certain eyelid conditions increase the risk of dry eye including blepharitis (inflammation of the eyelid) and entropion/ectropion (eyelids turn inward or outward).
- Certain medications such as antidepressants, antihistamines, and decongestants
- Certain diseases such as diabetes, Sjogren's, and rheumatoid arthritis
- Hormonal changes: Women are more likely to develop dry eye during menopause and pregnancy.
- Meibomian gland dysfunction: A condition in which the meibomian glands become clogged and do not produce enough oil for the tears. This causes tears to evaporate too quickly.
What are the Symptoms of Dry Eye?
Dry eye typically affects both eyes. Symptoms that appear may include:
- Red eyes
- Itchy eyes
- Burning sensation
- Eyes feel scratchy or gritty
- Watery eyes
- Blurry vision
- Difficulty wearing contact lenses
How is Dry Eye Diagnosed?
Diagnosing dry eye requires your optometrist or ophthalmologist to perform a comprehensive eye exam in order to observe the surface of your eye. In addition, certain diagnostic tests may be done, including tests to determine the volume and quality of your tears. Over the past several years, the industry has seen an increase in the development of dry eye tests. Examples of tests that the doctor may use include:
- InflammaDry®: A test to see if tears contain the inflammatory marker, MMP-9. Those with higher levels of this marker have a greater likelihood of developing dry eye.
- TearLab: A device that measures the osmolarity, or saltiness, level of the tears. Saltiness is an indicator of dry eye. The higher the measurement, the saltier the tears.
With such a large selection of diagnostic tools available, dry eye is able to be diagnosed more accurately and quickly.
How is Dry Eye Treated?
There are numerous effective dry eye treatments available as technology has seen many advancements. Your eye doctor will discuss what treatments may work for you. One or more treatment options may be necessary including:
- Artificial Tears: This is the most common treatment for mild dry eye and is effective at lubricating the eye for temporary relief. There are a variety of over-the-counter eye drops available ranging from liquid drops to gel drops to preservative-free drops.
- Prescription Eye Drops: If artificial tears aren’t adequate, your doctor may recommend prescription eye drops such as ReStasis® or Xiidra®. These eye drops may help with lubricating the eye as well as reducing inflammation. Steroid eye drops may also be used.
- Warm Compresses: Placing warm compresses on the eyelids can help warm up clogged meibomian glands, which is a common cause of dry eye.
- Lid Scrubs: Cleaning your eyelids with lid scrubs can help reduce inflammation of the meibomian glands.
- Punctal Plugs: If eye drops are determined to be insufficient, punctal plugs may be used. A punctal plug is placed into the tear duct to prevent tears from draining out of the ducts. This allows the tears to remain in the eye and keep it lubricated.
- LipiFlow®: This is a device that targets clogged meibomian glands. It is placed directly on the eyelids and applies mild heat to warm up the glands. Simultaneously, it also gently massages the eyelids to release the blockages in the glands and help restore normal oil production.
- IPL: IPL, or Intense Pulsed Light, is a device that delivers pulses of light to the area beneath the eye which ultimately warms the meibomian glands. By warming up the meibomian glands, the doctor can then break up any blockages to help the glands function normally again.