What is Dry Eye?
Dry Eye is a common condition related to the tear system of the surface of the eye. It is usually a chronic, progressive problem and afflicts millions of people of all ages. If not managed properly, eye dryness can progress and permanently impact eye health, eye comfort, and ability to see clearly.
Symptoms of Dry Eye
- Scratchy feeling or grittiness
- Feeling there is something in your eye(s)
- Blurry vision
- Eye fatigue
- Stinging or burning sensation
- Contact lens discomfort
- Rapidly changing eyeglass prescriptions
- Eye discomfort and/or pain
- Excessive tearing
- Mucous buildup around the eye
What is the Tear Film?
Dry Eye occurs when the eyes do not produce enough tears, the tears are not of good quality, and/or the tears evaporate too quickly.
The tear film has three layers that cover, protect, and moisturize the eye:
- The outer oily (lipid) layer is produced by the Meibomian glands. It prevents the watery layer from evaporating too quickly.
- The middle (aqueous) layer is produced by the lacrimal glands. It is watery and nourishes and protects the eye with water-soluble proteins and other important components.
- The inner (mucin) layer spreads the watery layer over the entire eye and allows the tears to stick to the surface of the eye.
Causes of Dry Eye
There are many causes of dry eye. Patients who experience symptoms of dry eye should have a thorough eye examination and evaluation by a specialist. Treatments vary considerably depending on the underlying cause of the problem.
A major cause of dry eye is instability and rapid evaporation of the tear film, which can be triggered by:
- Meibomian Gland (small glands in eyelids that make oil) Dysfunction
- Blepharitis (inflammation of the eyelids)
- Rosacea (inflammatory skin disease)
- Exposure to windy, smoky, or dry environments
Another cause is when the eyes do not produce enough tears. Common reasons for decreased tear production include:
- The natural aging process
- Hormonal changes
- Side effects of medications such as antihistamines, decongestants, beta-blockers, hormone replacement therapy, antidepressants, anti-anxiety pills, and others
- Autoimmune disorders such as Sjogren’s syndrome, Rheumatoid Arthritis, Lupus, and more
- Insufficient blinking; especially when concentrating on computer, TV screens, and driving
- Side effect from LASIK, cornea, or other eye surgery
Tests for Dry Eye
Your doctor may perform special tests when evaluating dry eye symptoms. These involve measuring the volume and quality of tears, and/or scans to determine the health of the meibomian glands (oil glands) of the tear film.
- A brief questionnaire may reveal lifestyle and environmental triggers.
- Schirmer test – After numbing drops are instilled into each eye, thin strips of non-toxic filter paper are gently inserted into and behind the lower eyelids for 5 minutes to measure tear production.
- Tear breakup time involves looking at how quickly the tear film breaks up on the eye.
- Examination of the surface of the eye and eyelids with/without special dyes.
- Meibomian Gland Evaluation – Your doctor will examine the eyelids under the microscope, and/or scan the eyelids to see the structure of the glands inside the lids.
Treatments for Dry Eye
Caution: It is advisable to seek a full evaluation with a dry eye specialist before beginning treatments. Below are listed some of the treatments which may be appropriate for you based on your full evaluation. Effective treatment of Dry Eye depends on the identification of the underlying cause(s), and can only be determined after a full evaluation.
There are many simple lifestyle changes or non-prescription treatments that may improve mild dry eye symptoms:
- Periodically apply a warm washcloth over the eyes
- Try over-the-counter (OTC) artificial teardrops. Preservative-free drops are recommended.
- Use preservative-free artificial tear gels and ointments at bedtime
- Clean eyelids to reduce bacteria that cause blepharitis
- Increase blinking and take short breaks when reading and using the computer
- Consult your physician about changing medications to reduce side effects
- Wear wraparound sunglasses to protect your eyes from wind
- Drink more water to stay hydrated
- Increase air moisture in dry environments with a humidifier
- Quit smoking
Learn more about Dry Eye Treatment options in the videos below.
Sometimes your doctor may recommend prescription eye drops to be used in combination with, or instead of, artificial tears.
Restasis and Xiidra: contain ingredients that decrease inflammation resulting from dryness, and may help the eye produce more natural tears. They may take a few months of daily use to be effective. Some patients experience a burning sensation when beginning use. There may be other side effects; discuss it with your doctor.
Steroid eye drops: sometimes used in conjunction with artificial tears or other eyedrops. They can reduce inflammation faster than drugs like Restasis, but are not safe for long-term use. Short-term use is generally very safe, but complications such as increased eye pressure or cataracts can develop from extended use of steroid drops.
- Other specialty drops such as serum tears, amniotic cytokine extract tears, or other treatments may be needed.
- Oral medications may be needed in certain cases.
There are a variety of tiny punctal plugs that are used to plug the tear drains and retain tear film in the eye.
LipiFlow is an FDA-approved medical device used to treat blockage of the meibomian glands. It combines heat and pressure to stimulate the release of the oily layer of the tear film.
Permanent closure of the tear ducts with thermal puncture cautery may be recommended for very severe cases of dry eye.
Curious if you have dry eye disorder, or what treatments may help your eye comfort, eye health, and vision? Dr. Moarefi is the leading expert in dry eye treatment in Los Angeles and Long Beach, California.
Please call or email to arrange a consultation at Eye Physicians of Long Beach Dry Eye Center of Excellence!!