While it may sound like a relatively simple problem, it can actually be rather complex and affect more than just the feeling of dryness.
What is Dry Eye?
Dry eye is a chronic condition in which either your natural tear film evaporates too quickly or the tears produced are not of sufficient quality.
The tears are made up of 3 layers—lipid, aqueous, and mucin layers. If one layer is lacking, it affects the integrity of the entire tear film.
That being said, there are roughly 20-30 oil glands running vertically within the lower eyelid and 40-50 in the upper eyelid of each eye.
These glands can become clogged. When this happens, the oils within the eyelids are not expressed onto the eyes and therefore can make the eyes dry out.
If the glands are not expressed, the oils remain stagnant within the glands and can harden and even become infected causing a stye (hordeolum). Over time, if this problem becomes chronic, the glands of the eyelids can begin to die, exacerbating the condition.
Dry eye can occur in anyone, however there are some situations that increase risk of the condition. Dry eye is more commonly seen in post-menopausal women, contact lens wearers, individuals who have autoimmune diseases such as arthritis, Lupus, Sjogren’s, vitamin A deficiency, Sarcoid, Thyroid problems, and individuals taking medications such as anti-histamines, anti-depressants, and anti-anxiety.
Symptoms of Dry Eye
Dry eye presents in a variety of ways. Some commonly reported symptoms include:
- Dryness – A gritty, sandy, or foreign body sensation of the eyes
- Burning – Excessive watering of the eyes
- Intermittently blurry eyes
- A “film” over your vision
- Asymptomatic
If some of those symptoms, like excessively watery eyes, seem a little counter-intuitive, you’re not alone! We’ll break down why some of these symptoms occur.
Excessive Watering of the Eyes: When our eyes are dry, the nerves within the cornea (the front most, clear layer of the eye) send signals to the brain to produce more tears. The tears produced, however, are not of properly quality. They evaporate quickly and are much more watery than other tears. Therefore, these tears do not relieve symptoms.
Intermittent Blur: Intermittent blur occurs as the tears evaporate and become unstable. Think about a car windshield on a misty morning. It is more difficult to see through the windshield when there are random droplets making the water layer on the windshield non-uniform. Looking through a non-uniform windshield is fuzzy and hazy. When the eyes (windshield wipers) blink, it evens out the tear layer making it more uniform again. Hence why blinking tends to improve vision slightly in these circumstances.
Asymptomatic: Sometimes the eyes show signs of dry eye disease without feeling symptoms of dryness. In these circumstances, treatment may be warranted to help prevent symptoms from rising up.
Dry Eye Treatments
Dry eye treatment usually begins with over-the-counter treatments.
Ultimately, the goal of treatment is to get the eyes to produce quality tears on their own.
To help unclog glands and liquify lipids to stimulate better tears, warm compresses with gentle massage for 10-15 minutes each day are recommended to help. Warm compresses can be made with a damp, clean washcloth heated up in the microwave, or you can purchase a special eye mask called a Bruder mask from local drug stores or online retailers.
Gentle cleaning of the lid margins each morning and evening also help to remove any outside debris that could be clogging the glands. Make-up, dust, dirt, and naturally produced mucus are common culprits of gland build-up.
Artificial tears can also be bought over the counter. Popular brands include Refresh, Systane, GenTeal, TheraTears, and FreshKote. Tears can be used 4-6 times a day.
It is often recommended to put a drop in prior to doing focus-intensive activities such as reading, writing, computer work, and driving, as these activities result in a decreased blink rate and therefore can exacerbate dry eye symptoms.
If these methods do not work to help relieve symptoms, prescription dry eye medications are also available such as Restasis, Xiidra, Cequa, or even special tears made from your own blood.
Dry eye treatment is often something that may be necessary long-term. Treatment for dry eyes is similar to chapstick—you can use therapies when symptomatic, but if you use them regularly it can help prevent flair-ups from occurring.
If you think you may have dry eye, call your eye doctor today!
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