What is dry eye and how can I get rid of it?

ZDry eye syndrome can occur at any age, and in people who are otherwise healthy. It is more common with older age, when the individual produces fewer tears. It is also more common in women than in men.

It is more common in places where malnutrition results in a vitamin A deficiency.

Causes

The eyes produce tears all the time, not only when we yawn or experience emotion. Healthy eyes are constantly covered with a fluid, known as a tear film. It is designed to remain stable between each blink. This prevents the eyes from becoming dry and enables clear vision.

If the tear glands produce fewer tears, the tear film can become unstable. It can break down quickly, creating dry spots on the surface of the eyes.

Tears are made of water, fatty oils, protein, electrolytes, substances to fight off bacteria, and growth factors. The mixture helps keep the surface of the eyes smooth and clear, so that we can see properly.

Dry eyes can result from:
  • an imbalance in the tear mixture, so that it evaporates too fast
  • insufficient tear production for good eye health
Other causes include eyelid problems, some drugs, and environmental factors.

Imbalance in the tear mixture

Symptoms

A patient with dry eye syndrome may experience a range of symptoms, including:
  • a stinging or burning sensation, and a feeling of dryness, grittiness, and soreness in the eyes
  • a feeling like sand in the eye
  • stringy mucus in or around the eyes
  • eye sensitivity to smoke or wind
  • redness of the eyes
  • difficulty keeping the eyes open
  • eye fatigue after reading, even for a short time
  • blurred vision, especially towards the end of the day
  • sensitivity to light
  • discomfort when wearing contact lenses
  • tearing
  • double vision
  • eyelids sticking together when waking up
Some people find the pain very strong, and this can lead to frustration, anxiety, and difficulty functioning in daily life.

Complications may include a worsening of eye redness and light sensitivity, increasing painful eyes, and deterioration of eyesight.

Treatment

A doctor will do a physical examination and ask the patient about symptoms, their medical history, any current medications, and about their occupation and personal circumstances.

Tests can reveal the quantity of tears behind the eyelid, whether the tear film is functioning properly, and the rate of evaporation.

Treatment aims to keep the eyes well lubricated, but the approach depends on the underlying cause.

Three ways of keeping the eyes lubricated are:
  • making the most of natural tears
  • using artificial tears or eye drops
  • reducing tear drainage
If the problem stems from an ophthalmic or systemic condition, such as an eye infection or psoriasis, the underlying condition needs to be treated first.

Medications for patients with chronic dry eyes include cyclosporine eye drops, or Restasis. Cyclosporine reduces eye-surface inflammation and triggers increased production of tears. Patients should not use this drug if they have an eye infection or a history of herpes viral infection of the eye.

If the patient has blepharitis, they may need to clean the affected area regularly with a dilute solution of baby shampoo. The doctor may prescribe antibiotic drops or ointment for night time use. Sometimes, an oral antibiotic, such as tetracycline or doxycycline, is used.

Steroid drops may help reduce inflammation if symptoms remain severe, even after the frequent use of eyedrops.

Surgery

Eyelid problems, such as an incomplete blink, may be treated by an oculoplastic surgeon, who specializes in eyelid problems.

In more severe cases, tear ducts, which drain away the tears, may be deliberately blocked, partially or completely, to conserve tears. Silicone plugs can be placed in the tear ducts to block them. This helps keep both natural and artificial tears on the eyes for longer.

A surgeon can shrink the tissues of the drainage area by using a heated wire in a minor operation known as thermal cautery.

A Boston Scleral Lens is a contact lens that rests on the sclera, the white part of the eye. It creates a fluid-filled layer over the cornea, preventing it from drying out.

Salivary gland transplantation is a surgical procedure that is occasionally considered in persistent and severe cases that have not responded to other treatments.

Some of the salivary glands are removed from the lower lip and grafted, or placed into the side of the eyes. The saliva they produce becomes a substitute for tears.


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