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What Is Dry Eye Syndrome?
Dry eye syndrome occurs when decreased tear production or tear film abnormalities do not allow for adequate lubrication of the surface of your eye. Although dry eye syndrome can occur in both men and women at any age, women are most often affected.
Symptoms related to dry eye syndrome include:
- Stinging or burning
- Decreased or fluctuating vision
- Eye irritation or scratchiness
- Excess tearing, especially when reading, driving, or watching television
- Stringy mucus in or around the eyes
- Difficulty wearing contact lenses
The symptoms described above may not necessarily mean that you have dry eye. However, if you experience one or more of these symptoms, contact your ophthalmologist for a complete exam.
The proper balance of oil, water, and mucus must be maintained to allow tears to lubricate and protect your eyes. Deficiency in any of these components can lead to eyes becoming dry and irritated. If high-quality tears are not produced at a steady rate, the surface of your eyes becomes irritated and your eyes will tear excessively in an attempt to lubricate them. This is why excess tearing can occur from dry eyes.
Tear production normally decreases as we age. Furthermore, people often lose the proper balance of oil, water, and mucus in their tears as they grow older, leading to an unhealthy tear film and the symptoms of dry eye. Dry eye syndrome also can be associated with systemic diseases like arthritis and occasionally with a dry mouth. Medications sometimes cause dry eye syndrome by reducing tear secretion. Among the common medications that can cause dry eye are diuretics, beta-blockers, antihistamines, sleeping pills, anxiety medications, pain relievers, or alcohol. Be sure to tell your ophthalmologist the names of all the medications you are taking. Additionally, wearing contact lenses can sometimes worsen dry eye syndrome because an adequate tear film is necessary to tolerate a contact lens comfortably on the surface of the eye.
Tests and Diagnosis
Diagnosis begins with a complete eye examination by your ophthalmologist to look for signs of dryness or an irregular tear film as well as common causes of these symptoms such as eyelid inflammation or plugging of your eye’s natural oil glands. Your doctor also may measure your eye’s baseline rate of tear production by placing filter-paper strips under your lower eyelids. Occasionally, the composition of tears being produced can be analyzed. A review of your overall health and medication use is also important.
Treatment and Drugs
- Eyelid Hygiene
Plugged or inflamed oil glands along the eyelid can lead to poor quality tears and dry eye syndrome. This often can be treated by attention to eyelid hygiene, which involves applying warm compresses to the eyelids to open blocked glands and allow them to release natural oils into the tear film. Eyelids also can be cleaned with over-the-counter eyelid scrubs or by mixing baby shampoo with water and scrubbing the eyelids with this mixture on a cotton-tip applicator (Q-tip).
Some patients with mild dryness may benefit from blinking more frequently, especially when reading, driving, or watching television.
- Artificial Tears
Dry eye is often treated using eye drops called "artificial tears." Artificial tears are available without a prescription. You may want to try several brands to find the one that you like best. Preservative-free eye drops are available if you are sensitive to the preservatives in artificial tears. If you need to use artificial tears more than every two hours, preservative-free brands may be better for you. Thicker artificial tear gels and ointments can also be used to provide longer relief, but can temporarily blur the vision. Solid lid inserts that gradually release lubricants during the day also may be beneficial for some people.
- Conserving tears
Conserving the tears in your eyes is another approach to keeping the eyes moist. Tears drain out of the eye through a small canal into the nose (that is why your nose runs when you cry). Your ophthalmologist may close these canals either temporarily or permanently in order to conserve your own tears and make artificial tears last longer.
- Restasis and topical steroids
A medicated eye drop called Restasis that reduces inflammation on the ocular surface is sometimes used to increase the production of tears. Steroid eye drops can also be used for short periods of time to decrease symptoms of dry eye syndrome by reducing inflammation.
- Serum tears
In more severe cases of dry eye syndrome, specially formulated tear drops that are made from the clear part of a patient’s own blood, called serum tears, are used. Serum tears contain growth factors and other nutrients that can decrease the symptoms of dry eye syndrome.
- PROSE device
For patients with severe dry eye syndrome, a special contact called Prosthetic Rehabilitation of the Ocular Surface Ecosystem (PROSE) can be used. This device is highly customized for each patient and bathes the front of the eye in artificial tears.
- Intense pulsed light treatment (IPL)
For dry eye caused by meibomian gland dysfunction, IPL treatment warms the lid, which reduces inflammation in the blood vessels of the lid that get irritated and prevent the meibomian glands from functioning correctly.
- Other methods to prevent the evaporation of tears
- In winter, add moisture to the air by placing a humidifier or a pan of water on the radiator
- Wear wrap-around glasses (illegal to wear while driving in some states) that may reduce the drying effect of the wind
- Avoid anything that adds to dryness, such as an overly warm room, hair dryers, or wind
- Stop smoking or being around smoke
- Use ointment at bedtime if you have "scratchy eyes" when you wake up. Use the smallest amount of ointment necessary for comfort since it can cause your vision to blur temporarily.
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Reviewed by Christopher T. Hood, M.D.