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Why Are My Eyes so Dry? A Quick Guide to Dry Eye Syndrome
Most of us encounter dry eyes at some point in our lives. For some, it’s a daily struggle, while others encounter it only in certain situations. Some of us may even experience it without us knowing. I’ve seen patients who come to see me worried about an eye infection only to find out that they were suffering from dry eyes.
You might be thinking to yourself, isn’t it easy to know or obvious when our eyes are dry? Sometimes it is not so simple, everyone has different tolerance levels to pain or discomfort, and sometimes, symptoms of dry eyes are so commonly associated with other eye conditions that it can be hard to differentiate between the two.
What is dry eye syndrome?
Dry eye syndrome or dry eyes. for short, is a common condition that affects around 20% of the population. Dry eye occurs due to either insufficient tear volume or poor tear quality, resulting in an unstable tear film that is unable to provide sufficient lubrication across the surface of the eye.
So why do I have dry eyes?
Reasons for insufficient tear volume. There are several glands in and around our eyelids responsible for producing tears. The amount produced can be affected by several underlying reasons. Ageing reduces tear production and individuals over 65 are more susceptible to experiencing dry eyes. Windy, dry and smoky environments disrupt the tear film resulting in increased evaporation thus leading to decreased tear volume. Certain medications and eye conditions may cause dry eyes as a side effect. Any inflammation or damage to the eyelids can cause obstruction of the tear glands. When the amount of tears in the eye or the production of tears is decreased, you will start to experience the symptoms of dry eyes.
Reasons for poor tear quality. The quality of the tears is essentially to maintain the stability of our tear film. The tear film is the outermost layer that covers the entire front surface of the eye and is made up of 3 layers – the lipid (oily) layer, the aqueous (watery) layer and the mucus (sticky) layer. The role of the lipid layer is to prevent the underlying aqueous layer from evaporating, similar to a layer of oil on the surface of water. The aqueous layer forms the bulk of our tear film and provides nutrients to the front surface of the eye while the mucin layer ensures that the tear film adheres to the eye’s surface. Dry eye symptoms develop when the tears evaporate too quickly due to either instability of the lipid layer or the aqueous layer.
Other factors that can contribute to dry eyes are:
- Gender. Women are more likely to develop dry eyes due to hormonal changes, pregnancy, taking oral contraceptives and menopause.
- Low blink rate. Our tears evaporate over time, blinking helps to replenish the tear film across the eye. Reduced blink rates result in longer exposure of the tear film, leading to increased evaporation of the tears before the next blink.
- LASIK refractive surgery. LASIKreduces tear production due to reduced corneal sensitivity.
- Contact Lens wear. Contact lenses in our eyes disrupt the layers of the tear film causing the tears to evaporate approximately 2 times faster than normal.
- Autoimmune diseases. Conditions such as rheumatoid arthritis, Sjogren’s syndrome, thyroid eye disease, systemic lupus erythematosus (SLE) are associated with dry eyes.
- Lagophthalmos (incomplete closure of eyelids). Lagophthalmos results in poor tear film stability and such individuals are at a higher risk of corneal exposure and increase tear evaporation.
- Other eye conditions. Eye conditions like blepharitis and meibomian gland dysfunction can affect the tear quality resulting in increased evaporation of tears.
- Side effects of medication. Glaucoma eye drops, contraceptives, antihistamines, decongestants, antidepressants have been associated with dry eyes.
- Vitamin deficiency. Deficiencies in Vitamin A and D result in dry eyes due to increase in ocular surface inflammation.
How do I know if I have dry eyes?
Patients suffering from dry eyes may not always share the same symptoms as symptoms are subjective and are based on the severity of the dry eye. Common symptoms my patients have experienced are one or a combination of eye redness, stinging sensation, blurry vision, grittiness, itchiness, foreign body sensation, glares and paradoxically, teary eyes.
Paradoxically, teary eyes are a sign of dry eyes. Most patients are a little puzzled to find that watery eyes can be due to dryness. This is because when the eyes are dried out or become irritated due to the patches of dryness on the eyes. As our body senses these dry spots on the eye, the tear glands are prompted to release more tears into the eye. This excessive production of reflex tears tends to overwhelm the eye’s drainage system, which often results in tears spilling over our eyelids, hence the teary eyes. Ironically, reflex tears are unable to relieve the dry eye symptoms as the tears are unable to remain in the eyes long enough to keep them well lubricated, which repeats the cycle of dryness leading to another round of reflex tears and so on.
What’s the best treatment for dry eyes?
As there are many underlying reasons that can cause dry eyes, there are a myriad of treatment options available. One thing I tell my patients is that treating their symptoms alone will not solve the dry eyes and hence not the most effective way of treating them. I like to identify the cause of the dryness, then treat root cause of your dry eyes.
Firstly, you can keep your eyes lubricated by using artificial tears, which you can find easily over the counter in pharmacies. You should aim for the preservative free artificial tears that come in individual minims, as preservatives can cause allergies which may also contribute to eye discomfort, itchiness and redness.
Eye ointments like vidisic gel provide better lubrication over the eyes due to their viscosity. However, because the gel is more viscous, your vision will become momentarily blurry when you use it. My advice is to use artificial tears during the day while you’re out and about, and eye ointment just before you sleep to keep your eyes lubricated overnight. If the dryness is due to an underlying eye condition, (for example, blepharitis), I might prescribe antibiotic eye drops or anti-inflammatory eye drops to treat that condition.
If the underlying cause of your dry eyes is due to incomplete closure of the eyes overnight and lubricating ointment is insufficient, eyelid mask or tape can be used to keep the underlying ocular surface from being exposed while sleeping.
Should the use of lubricating eye drops be insufficient, I may recommend some specialized treatments for you. If the underlying reason is due to insufficient tear volume, I may insert some collagen plugs into the eye’s drainage system to improve the tear volume. With the plug, we reduce the tears’ drainage rate, thereby allowing more tears to accumulate and stay in your eye, hence increasing tear volume. These temporary plugs will dissolve within 4 to 6 months. It is a painless treatment option that can be done easily within 5 minutes.
If you are a contact lens wearer, reducing the number of hours of wearing them can help but may not be the most realistic option for some. Over the years, we have seen more and more lens options in the commercial market. If you have been wearing the same brand of lenses for many years, you might be using an outdated lens material that may be contributing to your dry eyes. Newer lenses are being introduced into the market with better technology that helps reduce dryness when wearing them. Often times, the adage: “if it ain’t broke, don’t fix it” prevents us from wanting to consider something new. Therefore, you can consider asking your optometrist if you are already using the best lenses or what new lenses have been introduced in the market that can help with dry eyes.
Another treatment option is the use of light and heat therapy. In my clinic, I use specialized devices to help stimulate your tear glands and increase tear flow. This treatment uses light pulses and thermal mechanical action to stimulate our tear glands and increase tear flow. Normally, patients require at least 3 sessions before experiencing significant improvement. However, some have told me that they feel an improvement shortly after their first session.
How can I prevent dry eyes?
Blepharitis and dry eyes are conditions that often coexist. Good lid hygiene maintenance and certain lifestyle changes have been shown to be beneficial in managing the associated symptoms.
Practice good eyelid hygiene
I am a strong advocate for good eyelid hygiene. Our eyelids house some of the tear glands and keeping them clean will in turn allow our tears to flow into the eye more efficiently. I cannot stress how important it is to keep our eyelids clean as residual makeup on the eyelids can block the oil glands which subsequently affects the tear quality. Using an eyelid cleanser or foam scrub on our eyelids will prevent any debris from blocking the glands and prevent eyelid infections.
Use a warm compress
Using a warm compress for 5-10 minutes twice a day is also beneficial for our eyes to liquify and soften any hardened oil within the glands. Although the economical choice of warm compresses is using a warm towel to place over your eyes, it is also the least effective as it is troublesome to set up and is difficult to maintain the right temperature for the entire duration.
Therefore, I would recommend using commercial products in the market specifically for warm compress. My clinic offers a USB-powered eyelid warming device that cuts the fuss and hassle of warm compress. Simply plug it in and put it over the eyes for 10 minutes as the device gently heats up. Should there be stubborn crusting on your eyelids/lashes, I can also use a medical grade microsponge exfoliative cleaner, BlephEx, to help clean your eyelids. Just as our face benefits from regular exfoliation, our eyelids require exfoliation too.
Practice good eyecare habits
General lifestyle tips include optimizing your work environment in the office or at home by sitting away from the air conditioner, avoiding direct fans or using a humidifier beside your desk to allow more moisture in the air, taking frequent visual breaks throughout the day and blinking your eyes more frequently when working on the computer. Lowering the height of your screen causes you to look downwards, which reduces the ocular surface area that is exposed to air, thus reducing tear evaporation and dry eyes.
Staying hydrated helps with tear production. Avoiding smoky places can help prevent irritation and tear film disruption. Including omega 3 fatty acids into your diet via supplements or food can help improve dry eyes. Natural sources of omega 3 include salmon, flaxseed oil, nuts and chia seeds.
When all else fails, visit your eye specialist to assess the need for medicated eye drops and specialized therapies customized for your eyes.
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