Dry Eye

Dry eye disease (DED) is an increasingly common eye condition that affects a significant number of people worldwide. It can be caused by several factors overall resulting in a lack of adequate lubrication and moisture on the surface of the eye, leading to discomfort and potential damage to the ocular surface.

Causes of Dry Eye:

Dry eyes can be caused by various factors disturbing the healthy layer of tears on the surface of our eyes either by inadequate tear production (not enough tears) or excess tear evaporation (tears dry up too quickly).
Older age is a significant risk factor as tear production declines as we age. Health conditions such as diabetes, autoimmune diseases (e.g. Sjogren’s syndrome), arthritis and thyroid disorders can also affect tear production as well as the use of certain medications such as antihistamines, decongestants and antidepressants.
Environmental factors such as exposure to smoke/pollution, dry climates or air conditioning can contribute to evaporative dry eye. Conditions affecting the eyelids or lashes such as outward turning eyelids (ectropion), eczema or blepharitis also contribute to excess tear evaporation or reduced tear production.
Women are more susceptible to dry eye due to the effect of hormones on the eyelid glands and ocular surface, particularly with age. Dry eye is also found to be more common in Asian populations and in Singapore one dry eye study revealed there was a strong correlation with contact lens wear.4

Symptoms

Symptoms of dry eye can vary in severity. They include:
  • Dryness or grittiness in the eyes
  • Red or bloodshot eyes
  • Burning or stinging sensation in the eyes
  • Watery eyes: Paradoxically, some individuals with dry eyes may experience excessive tearing as the eyes try to compensate for the lack of moisture
  • Intermittent blurry vision particularly during activities that require sustained visual concentration, such as reading or using a computer
  • Sensitivity to light

Complications

Dry eye can lead not only to symptoms of discomfort and irritation, but more severe forms can result in serious complications to the eye’s cornea, such as infections, ulcers and scarring which can lead to vision loss if untreated.These complications may also extend far beyond the eye itself as reduced quality of life scores, depression and migraines have been linked to dry eye disease.
Contact lens wearers may struggle more than most with dry eye and it is largely accepted that contact lens discomfort due to dry eye symptoms is the most common cause for wearer dropout.

Treatment

Treatment for dry eye aims to alleviate symptoms, improve tear quality and quantity, and prevent complications. You should consult an eye care professional if you have symptoms of dry eye as they can help determine the type and severity and therefore treat accordingly. Options may include:
  • Environment Modification: If the cause of dry eye is thought to be related to the environment such as long hours spent in front of screens, aircon or low humidity environments, these factors should be addressed and limited as much as possible. For example, take regular breaks from screen work, add an indoor humidifier, don’t sit directly under an air con fan etc.
  • Dietary Modifications: Maintaining a healthy diet, particularly including essential fatty acids omega 3&6, and keeping well hydrated can assist in reducing dry eye symptoms.
  • Artificial Tears: The use of artificial tear substitutes can help lubricate the eyes and provide relief from dryness.
  • Treat the Underlying Cause: If dry eye is thought to be caused by other systemic/ocular conditions, treating these conditions may alleviate symptoms. For example conditions such as blepharitis can be treated by gentle eyelid cleansing before dry eye symptoms occur.
  • Prescription Eye Drops: On some occasions more severe intervention is required and some doctors may prescribe medicated eye drops to relieve symptoms, especially if an infection is suspected.
  • Monitor Contact Lens Wear: Patients who wear contact lenses may be more susceptible to dry eyes, particularly if they wear for longer than recommended by their eye care professional. Having regular checks with your eye care professional can allow them to test for dry eye and help to limit any adverse side effects that may occur.
  • Surgery: For dry eye associated with eyelid abnormalities such as severe blockage of tear duct or improper eyelid position, surgical intervention may be required. For cases of excess tear evaporation tiny plugs can be inserted into the tear duct to block and prevent drainage therefore increasing the amount of tears left on the eyes surface.
Dry eye syndrome is a common and often chronic condition that can significantly impact day to day quality of life if left untreated. However, with proper management, including the use of artificial tears, lifestyle & environmental modifications, and other interventions, most individuals with dry eye can find relief from their symptoms and maintain their eye health. If you experience persistent eye discomfort or vision changes, it’s essential to consult an eye care professional for evaluation and personalised treatment recommendations.

Click here to see our article on Blepharitis
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References

  1. R. Dana, J. L. Bradley, A. Guerin, I. Ö. Stillman, A. M. Evans, D. A. Schaumberg. Estimated Prevalence and Incidence of Dry Eye Disease Based on Coding Analysis of a Large, All-age United States Health Care System. American Journal of Ophthalmology (2019). doi:10.1016/j.ajo.2019.01.026 (https://www.ajo.com/article/S0002-9394(19)30047-9/fulltext)
  2. L. Qian, W. Wei. Identified risk factors for dry eye syndrome: A systematic review and meta-analysis. PLoS One (2022). doi:10.1371/journal.pone.0271267 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9390932/)
  3. M. I. Golden, J. J. Meyer, B. C. Patel. Dry Eye Syndrome. NIH Stat Pearls (2023). (https://www.ncbi.nlm.nih.gov/books/NBK470411/)
  4. L.L. Tan, P. Morgan, Z. Q. Cai, R. A. Straughan. Prevalence of and risk factors for symptomatic dry eye disease in Singapore. NIH Clin Exp Optom (2015). doi:10.111/cxo.12210 (https://pubmed.ncbi.nlm.nih.gov/25269444/)
  5. Mayo Clinic. Dry eyes. (2022). (https://www.mayoclinic.org/diseases-conditions/dry-eyes/symptoms-causes/syc-20371863)
  6. C. Şimşek, M. Doğru, T. Kojima and K. Tsubota. Current Management and Treatment of Dry Eye Disease. Turk J Ophthalmol (2018). doi:10.4274/tjo.69320. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330664/)
  7. M. Markoulli and S. Kolanu. Contact lens wear and dry eyes: challenges and solutions. Clin Optom (Auckl) (2017). doi:10.2147/OPTO.S111130. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6095561/)