From redness and gritty discomfort to excessive tearing and blurred vision, chronic dry eye symptoms can take a toll on your quality of life, making it difficult to read a book or even drive.
Dry eye is a condition that can be frustrating for the patient because of chronic symptoms and discomfort. But relief is within reach for most patients, although it may take some trial and error.
The condition is a common affliction in older adults: According to a 2014 study, an estimated 20 percent of women and 10 percent of men are thought to be affected by dry eye disease, which also goes by the names dry eye syndrome, dysfunctional tear syndrome and keratoconjunctivitis sicca. It is a leading cause of patient visits to ophthalmologists and optometrists. A landmark 2003 study estimates that 3.2 million women ages 50 and older are affected by dry eye. What’s more, menopausal hormone therapy can contribute to make dry eye a problem for many older women.
Dry eye is the result of either a decrease in tear production (called aqueous tear deficiency) or tears that evaporate too quickly because they don’t contain enough oils to keep the eyes lubricated (evaporative dry eye). Dry eye is a syndrome, meaning that it is a particular collection of signs and symptoms that characterize the condition, although there can be various underlying causes behind poor- or low-quality tear production. One common reason for dry eye is that tear production naturally decreases as we age.
Other factors associated with dry eye span a wide range, including:
- Certain medications, such as antihistamines, decongestants, anticholinergics, antidepressants, pain relievers, sleeping pills, tranquilizers, diuretics, beta-blockers, and drugs for glaucoma, benign prostatic hyperplasia (BPH) and Parkinson’s disease
- Certain health conditions, including thyroid disease, skin diseases (psoriasis, eczema and rosacea), diabetes and shingles
- Autoimmune disorders such as rheumatoid arthritis, lupus and especially Sjogren’s syndrome, which affects about a third of dry eye patients and is accompanied by dry mouth, joint pain and fatigue
- Regular use of contact lenses
- A history of any eye surgery, including LASIK (corrective refractive laser surgery to improve vision) and eyelid surgery
- Eyelid inflammation
- Being of Asian descent
- An abnormally low blink rate (normal rate is 12 blinks per minute)-common among people while they look at computer or video screens or who spend prolonged time reading or watching TV-which deprives eyes of adequate lubrication
- Incomplete blinks, which can be a side effect of eyelid surgery (blepharoplasty)
- An anatomic eye abnormality, such as eyelids that turn inward or outward
- A diet lacking in adequate consumption of vitamin A or omega-3 fatty acids
Some experts believe that a chronic disorder called meibomian gland dysfunction (MGD) is behind most cases of evaporative dry eye. The eyelid’s meibomian glands produce the oily substance (meibum) in tears, which slows their evaporation. When the glands don’t function properly, they secrete low-quality tears that quickly evaporate, depriving the eyes of lubricants.
Regardless of its cause, dry eye can affect your ability to engage in activities you enjoy. In rare cases, chronic dry eye can damage the cornea or lead to infection. There are psychological burdens as well. In a review in the journal Optometry and Vision Science, researchers noted that depression and anxiety are common among people who have dry eye.
Easing mild to moderate dry eye
Dry eye typically can’t be cured, but it can be managed. Dry eye triggered by a medication, for instance, may be treated by switching to a similar drug that isn’t as harsh on the eyes. An important first step is to identify and treat any underlying condition that may be causing your dry eyes. If age or environmental factors are causing dry eye, the goal is to minimize symptoms by employing coping strategies, according to the American Academy of Ophthalmology (AAO).
Many people find that over-the-counter artificial tears, which come in liquid, gel or ointment form, are an effective solution to dryness because lubricating eyedrops that contain oil or lipids most resemble the human tear. The thicker the lubricant, the longer it stays in your eye. An ointment should be used only at bedtime since it blurs vision. Eyedrops can be used as needed to soothe eyes. However, if you find yourself using drops more than four to six times a day, you should see your ophthalmologist about other alternatives.
Some artificial tears contain preservatives that can irritate eyes and cause stinging or burning, especially when used more than four to six times a day. If this happens, try switching to a product without preservatives, the AAO advises, although you may pay more because they’re packaged for single use. The AAO cautions against continued use of drops that promise to “get the red out” because they contain vasoconstrictors (substances that shrink the tiny blood vessels on the white part of the eye) and can actually worsen redness and other symptoms.
Avoiding irritants and taking steps to soothe eyes can help relieve discomfort. Try these tips:
- Use a humidifier to combat dry air from both heat and air-conditioning, which can irritate eyes.
- Wear sunglasses, preferably wraparound shades, as a barrier to sun and wind.
- Remember to blink often when you’re staring at a computer or video screen.
- If you have eyelid inflammation (blepharitis), place warm compresses-a clean moist washcloth or cotton balls-over your eyes. You can also try baby shampoo or an over-the-counter eyelid cleaner. If your dry eye is associated with MGD, gently massaging your closed lids after applying compresses may help improve the glands’ function by aiding in the release of meibum.
- Avoid smoky, dusty, windy and dry environments.
- Stay hydrated by drinking sufficient liquids (about eight to 10 glasses of fluids a day).
Stepping up treatment
If artificial tears and lifestyle modifications don’t relieve your dry eye, your ophthalmologist may recommend one or more of the following treatments:
- Restasis (cyclosporine) is a prescription eyedrop that helps increase tear production diminished by inflammation. However, it can take several months of use before you see an improvement, and it can be costly.
- Steroid eyedrops can be used short term to reduce inflammation. Limit use to no more than two weeks to avoid a risk of serious side effects and vision loss.
- Omega-3 and omega-6 fatty acid supplements have been shown in some studies to help dry-eye symptoms, although not all experts agree on the benefits.
- Tear duct plugs, or punctal occlusion, is an in-office procedure during which temporary or permanent plugs made from collagen or silicon are inserted into the tear ducts in the eye’s inner corner to block tears from draining.
- Autologous serum tears use your blood serum to create eyedrops. These drops contain compounds found in natural tears that may help heal the eye’s surface. Evidence for recommending them over artificial tears is lacking, however.
- Surgery can correct eyelid abnormalities or reduce the surface area of the eye to help reduce tear evaporation.