Are your eyes dry? Are they painful? Let's talk about Dry Eye!

Do you sometimes feel a strange, dry, or itchy feeling in your eyes? Like something is stuck inside your eye, or do you feel like your eyes are burning? Then you may also have "dry eyes" or as we doctors call it (Dry Eye). Don't worry, this is something that happens to many people. Let's talk about this in detail.

What exactly is dry eye?

Simply put, dry eyes are a condition that affects the tear film in our eyes. Did you know that our eyes have a three-layered tear film that protects the surface of our eyes and helps us see clearly? When this tear film is smooth and stable, we can see clearly and comfortably. So, if something interferes with this tear film, we can experience uncomfortable symptoms like burning, itching, watery eyes, and blurred vision.

Think of it this way: our eyes are like the windshield of a car. They need to be clean and moist to see the road clearly. Tears are like the wiper fluid. If they're not there, vision becomes blurry, which is what causes dry eyes.

There are many reasons why this tear film may not work properly. That's why doctors consider it a multifactorial disease . This means that the causes and risk factors are very complex. Therefore, it can sometimes take a while to find the cause of your symptoms. If you have symptoms of dry eyes, it's important to see an ophthalmologist or optometrist for treatment.

What are the main types of dry eyes?

When you hear the name, you might think that dry eyes just mean that your eyes don't produce enough tears. But that's not the whole story. There are several main types of dry eyes:

1. Dry eyes due to a lack of aqueous tears (Aqueous deficient dry eye)

This means that your eyes are not producing enough tears . These watery tears are produced by the lacrimal glands, which are located at the top and outer corners of our eyes. These are the ones that make up the middle, watery layer of the tear film. Some autoimmune conditions can cause inflammation of these tear glands, preventing them from producing enough watery tears.

2. Dry eyes due to rapid evaporation of tears (Evaporative dry eye)

This is when your tears evaporate too quickly . The main cause of this is Meibomian gland dysfunction . This means that the glands inside our eyelids that produce the oily layer on top of the tear film are not working properly. Then, that oil layer becomes unstable and cannot protect the water layer from drying out. Imagine that when you put a layer of oil on top of water, the water evaporates less quickly. If that oil layer is not working properly, the water evaporates too quickly.

3. Mixed dry eye

Some people may have both . This means that the eyes do not produce enough tears, and the tear film is unstable and evaporates quickly. Both of these problems cause symptoms of dry eyes.

How common is dry eyes?

Dry eyes are a very common condition . Research suggests that about 16 million people in the United States have this condition. Worldwide, tens of millions of people suffer from it. The condition is more common in Asia than in North America and Europe. It is also more common in postmenopausal women.

Can dry eyes be a symptom of another disease?

Dry eyes can occur on their own, or they can occur along with other medical conditions. Sometimes, dry eyes can be a symptom of a medical condition such as:

• (Sjögren's syndrome) (About 10% of people with aqueous tear deficiency have this)
• Diabetes (If you have diabetes, you have a 50% chance of developing dry eyes as a complication)
• (Thyroid eye disease )
• Blepharitis (inflammation of the eyelid margin)

What are the symptoms of dry eyes?

When you have dry eyes, you may feel like something is stuck in your eye and won't come out. This can feel like sand, grittiness, or a gritty feeling in your eye . You may also have these symptoms:

• A burning sensation, like the eyes are burning.
• Light sensitivity.
• Blurred or changing vision.
• A discharge from the ear that resembles mucus.
• Water flowing from the eyes, tears running down the cheeks.

Yes, that last one is a bit confusing, isn't it? You might be wondering how your eyes can water if they are dry. But that's a common symptom of dry eyes. This happens when your meibomian glands don't produce enough oil to cover the outer layer of the tear film. Then, the water layer in the middle evaporates too quickly. In response, your tear glands try to make more watery tears. But, these tears can't properly cover your eyes because the oil layer isn't there. So, those tears don't really solve the problem.

What are the causes of dry eyes?

Dry eyes are caused by:

• When your eyes don't produce enough tears.
• When your tears evaporate quickly.
• When both of these happen together.

There are many factors that can cause dry eye symptoms to worsen or develop over time.

Risk Factors for Dry Eyes

Some risk factors are beyond our control. For example, dry eyes are more likely to occur as we age. However, some other risks can be managed by making lifestyle changes or changing the medications you take.

If you have any of the following risk factors, talk to your doctor. You may be able to make some changes to reduce your risk of dry eyes or reduce bothersome symptoms.

Environmental and lifestyle factors:

Things like weather, how long you spend looking at screens , contact lens use, smoking , and allergies can increase your risk of dry eyes. For example, if you're constantly exposed to an AC or working in a dusty environment, your eyes may become more dry.

Medicines:

Taking certain medications can increase the risk of dry eyes. For example, some medications for depression , allergies , high blood pressure , glaucoma , menopause, and pain . Also, medications such as anticholinergics , oral contraceptives , and systemic retinoids increase the risk.

Disease conditions:

Various neurological conditions , eye conditions , autoimmune conditions , and endocrine conditions can increase the risk of dry eyes.

Surgery:

Some eye surgeries, such as LASIK , cataract surgery, and surgeries on the cornea, the transparent front layer of the eye, can increase the risk of dry eyes.

How to diagnose dry eyes? (Diagnosis)

Doctors diagnose dry eyes through your medical history, an eye exam, and some tests.

Medical History

Your doctor may ask you to fill out a questionnaire to learn about your symptoms and medical history. You should be prepared to provide information such as:

• Eye symptoms and how long they have been present.
• Environmental factors that aggravate your symptoms.
• Other symptoms, for example, dry mouth, cavities, mouth sores, fatigue, and joint pain.
• Allergies.
• Pre-existing eye diseases.
• Other medical conditions, including allergies and chronic viral infections.
• Surgery performed.
• Whether you smoke or are exposed to other people's smoke.
• How often do you wash your eyelids and what products do you use?
• Injuries to your eye area.

Eye Exam

Your doctor will perform a complete eye exam to check the health of your eyes and find the cause of your symptoms. During this exam, the doctor will:

• Check for signs of dry eyes.
• They will check if there are other causes for your symptoms besides dry eyes.
• Checks the health of your tear film (the three layers of tear film that cover the cornea).
• Special tests are performed.

Tests to diagnose dry eyes

There is no single test to diagnose dry eyes. Instead, doctors may use several tests, such as:

• Slit lamp exam: This test measures the amount of tears your eyes produce. The doctor shines a light into your eyes and examines your eyes and eyelids with a microscope.
• (Schirmer's test): This is another way to test tear production. The doctor places a small piece of paper on the edge of your eyelid for a few minutes. This causes your eye to produce tears. The doctor then measures the amount of tears by measuring how much the paper is stained with tears.
• Tear breakup time (TBUT) test: This test measures how quickly your tears evaporate. Your doctor will put a special dye in your eye and look at your tear film under a microscope to see how long it takes for your tear film to remain stable (not break down). They will measure the time it takes for the first dry spot on your cornea to appear after you last blinked. If it takes less than 10 seconds, it could be a sign of dry eyes.

Doctors may also order other tests, such as antibody tests, to check for underlying medical conditions that may be causing dry eyes.

How to treat dry eyes? (Treatment)

The main goals of dry eye treatment are:

• Reducing your symptoms and healing your eyes.
• Helping you see clearly.
• Minimizing or preventing damage to the surface of your eyes.
• Treating the underlying cause.

There are many treatments that can help you (described below). Your doctor will decide which treatment is best for you, depending on the severity of your symptoms and any other underlying conditions you may have. You may need to try several treatments to find the solution that works best for you.

Things you can do at home and changes in your environment

If your symptoms are mild, your doctor may tell you to start with simple things you can do at home. Here are some things you can do:

• Avoid environmental triggers. This means anything that makes your symptoms worse. Common triggers include cigarette smoke, air vents that blow air into your face, strong winds, and allergens. Wearing wraparound glasses or sunglasses when you go outside can help.
• Use a humidifier in your bedroom. Depending on where you live, turning on the heater in the winter can cause the humidity in your home to drop significantly (below 25%). This can worsen your dry eye symptoms. A humidifier can help with this.
• Apply a warm compress to your eyes. Get a heat mask from a pharmacy and place it on your eyes for about 10 minutes. This will help reduce your symptoms and help your meibomian glands produce more oil (lipids).
• Give your eyes a break. Whether you're reading a book or using a computer, take regular breaks. Following the 20/20/20 rule can help. That means every 20 minutes, look away from the screen for 20 seconds and look at something about 20 feet away. Also, remember to blink frequently while reading or looking at the screen to help produce tears.
• Take omega-3 fatty acid supplements. Some research has shown that these supplements can help produce tears and reduce symptoms. However, talk to your doctor before taking any supplements, as they can interact with some medications.

Eye Drops

There are many types of eye drops that your doctor can prescribe. Talk to your doctor about the options that are best for you.

• Artificial tears: Artificial tears lubricate the eyes, provide relief, and temporarily relieve symptoms. These are available over the counter, but check with your doctor before using them. Some types contain lipids , which can help prevent tears from evaporating. However, artificial tears do not treat the underlying cause of dry eyes.
• Ointments: If your eyes get dry while you sleep, you can use a thick lubricant, such as an ointment, at night.
• Topical cyclosporine A eye drops (Restasis®): Cyclosporine A eye drops treat inflammation in your tear glands, causing them to produce more and better quality tears. They are applied to each eye twice a day. Most people see a significant improvement in their symptoms after about three months. You may feel a little stinging when you first start using these drops, but this will go away with continued use.
• (Lifitegrast (Xildra®)) Eye Drops: (Lifitegrast) eye drops also treat inflammation of the tear glands and should be used twice a day. These drops treat both the signs and symptoms of dry eye. Although it may take up to 90 days to fully heal, you may feel some relief within two weeks.
• (Varenicline (Tyrvaya®)) Nasal Spray: Varenicline directly stimulates your trigeminal nerve and increases basal tear production.
• Autologous serum drops: If your dry eyes are severe, your doctor may recommend autologous serum drops. These are a special type of artificial tear made from the serum part of your own blood. This treatment is often effective, but it is expensive and may not be covered by your insurance.

Punctal occlusion

If your eyes don't produce enough tears, a punctal occlusion (temporary or permanent) may help. In a painless procedure, a doctor inserts a small plug into the tear duct (punctum) in your lower eyelid. This "blockage" causes more tears to accumulate in your eyes.

In a temporary tear duct blockage, the plug dissolves quickly. If your dry eyes improve, your doctor may suggest a permanent tear duct blockage. In that case, your doctor will use a silicone plug that will remain in your tear duct for as long as necessary.

In-office Procedures

There are treatments your doctor can give you in the clinic to help with your dry eyes. Some common options include:

• Thermal pulsation therapy (Lipiflow®): This treatment helps people with unstable tear film due to meibomian gland dysfunction. It gently massages and warms your eyelids, which helps your meibomian glands produce oil.
• Intense pulsed light (IPL) therapy: This treatment uses pulses of light to dissolve the solid material blocking your meibomian glands. This opens up your glands and helps oil flow freely.

Therapeutic Contact Lenses

Dry eye disease can make even the simple act of blinking very painful. This is because your eyelids rub against the dry, irritated surface of your eye. Therapeutic contact lenses can help by protecting and lubricating the surface of your eye. These lenses come in several types:

• Soft bandage lenses: These lenses protect your eyes and help heal damage to the cornea.
• Rigid scleral lenses: These lenses are larger and come into contact with the white part of your eye (sclera) instead of the cornea. They protect and lubricate your eyes while also correcting your vision.

Your doctor will talk to you about different contact lens options to find the option that best suits you.

Important: Not all of these treatments are suitable for everyone. Your doctor will determine what is best for your condition. Therefore, be sure to seek medical advice before doing anything you feel like doing.

How can you reduce the risk of dry eyes?

Since there are many causes of dry eyes, it can be difficult to prevent them. However, you can reduce your risk by doing the following:

• Go for annual checkups. A primary care physician can help you with your overall health. If you are concerned that you may have dry eyes, talk to your doctor. Ask about any risk factors in your medical history or your medication list. Also, ask what you can do to reduce your risk.
• Manage underlying medical conditions. Various medical conditions, including diabetes, can cause dry eyes. Talk to your doctor about the risks of diabetes and follow their advice to manage your blood sugar levels.
• Make lifestyle and environmental changes. There are many things you can do in your daily life to reduce your risk of dry eyes. If you use a computer daily, take frequent breaks. Avoid cigarette smoke. Add a humidifier to your bedroom and other rooms you spend a lot of time in. Also, ask a doctor about other suggestions that can help keep your eyes lubricated and healthy.

Can dry eyes be completely cured?

Dry eyes are a chronic condition . There is no cure for it, but treatment can help manage your symptoms.

You may need to try several different treatments to find the one that works best for you. This can be a stressful process, but it's worth the effort. If your current treatments aren't helping, or you want to talk about other options, talk to your doctor.

How can I take care of myself? / When should I see a doctor?

Living with dry eyes is not easy. Many people experience stress , anxiety, and exhaustion as they try to manage their symptoms. If your condition is affecting your quality of life, talk to your doctor. You may need to try several different treatments to find an approach that works for you to manage your symptoms.

Remember, millions of people have dry eyes. So, you don't have to deal with this alone. Join online support communities, and ask your doctor for suggestions. Sharing your challenges with others who understand what you're going through can be a big help in your daily life.

Your ophthalmologist will tell you how often you need to come in for checkups. If you have other medical conditions that cause dry eyes, you may need to see other doctors more often. Be sure to keep all your appointments so your care team can monitor your condition and help you get the treatment you need.

Talk to your eye doctor if you have any of these:

• New symptoms.
• Worsening of symptoms.
• New side effects from treatment.

Dry eye disease can affect more than just the comfort of your eyes. It can affect your ability to work, socialize, and enjoy life. Dry eye can also affect your emotions and mental health. You may feel lonely, but you are not alone. Connect with others who have this condition and share your experiences. It takes patience and perseverance, but finding relief is definitely possible.

If your current treatments aren't helping, don't hesitate to talk to your doctor. Tell them how you're feeling, ask them what other treatments are available to help you manage your condition and restore your quality of life.

Take-Home Message

Dry eyes are a condition that causes discomfort to the eyes and can sometimes affect vision. There is not one cause, but many. The main ones are that tears are not produced properly, or the tears that are produced evaporate too quickly .

• Symptoms: Itchy, burning, red, blurry eyes, a feeling of something stuck inside, and sometimes just watery eyes.
• Causes: Age, environment (AC, dust, wind), certain medications, other illnesses (like diabetes), and excessive staring at computer screens.
• Treatment: Artificial tears, special eye drops, warm compresses for the eyes, lifestyle changes, and sometimes minor treatments performed by a doctor.
• Most importantly: If you have these symptoms, definitely see an ophthalmologist . They will find the exact cause and give you the most appropriate treatment. Don't just do whatever you feel like doing.

Remember, your eyes are very precious, so it is your responsibility to take care of them.

` Dry eyes, Dry Eye, Eye diseases, Tear film, Eye health, Eye pain, Ophthalmologist