Tears form a protective layer over the front of your eye (the cornea). This film helps wash away germs and debris that could cause an infection and keeps your vision clear.
When you don’t produce enough quality tears or the tears evaporate too quickly, symptoms of dry eyes can develop. Treatment options include using lubricating drops and ointments. Contact Eye Dry Baltimore, MD, to learn more.
Tears provide lubrication, reduce the risk of eye infection, wash away foreign material from the surface of the eye and help maintain the health of the front of the eyes (the cornea). The tears are formed by three layers: an oil layer, a water layer and a mucin layer. If any of these layers are deficient or if the tears evaporate too quickly, symptoms of dry eye develop.
Many factors can contribute to dry eyes, including age, environmental conditions such as windy or low humidity, and lifestyle choices such as smoking or the use of contact lenses. Certain medications also can contribute to dry eyes, especially antihistamines, diuretics, sedatives and birth control pills. In addition, medical conditions such as rheumatoid arthritis, diabetes and rosacea may cause dry eyes.
There are a variety of treatments for dry eyes, and the type your eye care provider recommends will depend on what’s causing your symptoms. Most people with mild symptoms can benefit from using over-the-counter lubricating eye drops or ointments. For severe or persistent symptoms, your eye care provider may prescribe preservative-free artificial tear drops or ointments in single use vials.
Your eye care professional can also prescribe a topical medication that stimulates your tear glands to produce more tears. Cyclosporine (Restasis) and lifitegrast (Xiidra) are two FDA-approved medications that decrease inflammation and increase tear production. Both require regular usage to produce results.
In some cases, your eye care specialist may recommend a procedure that closes your tear ducts to keep your tears from draining away too quickly. This can be done with silicone plugs that are temporarily removed or with a more permanent solution called thermal cautery. Your eye care specialist can also refer you to a plastic surgeon who specializes in the treatment of the eyelids (oculoplastic surgery). Eyelid problems such as anatomic abnormalities and incomplete blinking can contribute to dry eyes, so treating them may provide relief. In addition, your eye care provider can recommend dietary supplements that contain omega-3 fatty acids to help decrease dry eye symptoms in some people. Drinking adequate amounts of water can also help decrease dry eye symptoms.
Symptoms
Eye dryness symptoms are caused by changes in the quality and quantity of tears. The condition is usually painless and self-limiting. However, severe dry eye syndrome can lead to a variety of problems including inflammation of the corneal surface, scarring and abrasion of the corneal tissue. This may result in permanent vision loss. In the early stages of dry eye, you may notice a gritty or sandy feeling when you blink. Other symptoms include a stinging sensation or the feeling that something is stuck in your eye. These symptoms may be aggravated by certain environmental factors such as air pollution, smoke, dust or cold air (from fans, heating systems or wind).
Dry eye is a complex problem, and the treatment options vary depending on the type of dry eye you have. There are two main types of dry eyes: aqueous tear-deficient dry eye syndrome and evaporative dry eye syndrome. Aqueous tear-deficient dry eye syndrome occurs when the lacrimal glands are unable to produce enough watery tears to adequately lubricate your eyes. This is a very common condition. Evaporative dry eye syndrome occurs when the meibomian glands of your eyelids produce an oily layer over your watery tears to slow down their evaporation. The lipids in these glands help stabilize the tear film. This type of dry eye is more severe and usually requires medical intervention.
Mild cases of dry eye are often treated with lubricating drops. Your eye care professional will advise you which kind of drops might be best for your particular situation. It is important to use the drops frequently, as often as every hour, and to be sure to choose preservative-free drops if you have a sensitivity to preservatives. Ointments may also be used to lubricate the eyes, but they can blur your vision so are often recommended for nighttime use only.
Other short-term treatments can include using a humidifier in the home during winter and wearing protective wraps or masks when outdoors in windy weather. Changing to blue light-filtering lenses on computer monitors can decrease the amount of dryness that results from staring at screens for long periods of time. Limiting contact lens wear and using a gentle cleaner to remove residues can help reduce your symptoms. Taking omega-3 fatty acid supplements may also benefit some people with dry eye.
Treatment
The good news is that there are many treatment options available to relieve the symptoms of dry eye syndrome. Your eye care specialist will start by doing a thorough exam, including looking at the eyelids and cornea with magnification, and watching how you blink. They may also use a special dye to help detect any signs of inflammation.
Tear drops and ointments are the mainstays of most treatment plans for dry eyes. You’ll need to try different brands and formulations until you find one that works best for your condition. Preservative-free drops are usually recommended to avoid any potential allergic reactions or eye infections.
In mild cases, lubricating eye drops can provide significant relief from irritation and grittiness. Your eye care professional can recommend the right drop for you and advise you on how frequently you should use it. Ointments, which are thicker and more viscous than drops, can be used as needed, especially before activities that tend to irritate your eyes.
More serious symptoms of dry eye can be helped with prescription eye drops to increase tear production. These medicines are called cholinergics and can be taken as tablets or gels. Another option is a new class of medications, known as cyclosporine eye drops (Restasis, Cequa) and lifitegrast (Xiidra). These drugs stimulate the eyelid glands to secrete healthy oils that block tears from evaporating too quickly.
Meibomian gland dysfunction is a major cause of evaporative dry eye. Your eye doctor can perform an in-office procedure to unclog the openings of the glands at the base of your eyelashes, which should improve your symptomatic dry eye.
Other treatment options include a temporary punctal plug to close the tear ducts and slow tear loss. Your eye care professional will likely first try a small, plastic plug that is designed to dissolve over time, and then switch to permanent plugs if they don’t help you regain control of your symptoms. Your eye care specialist can also prescribe changes to your medication if the medicines you take are worsening your dry eye symptoms. For example, antihistamines, birth control pills, and blood pressure medicines can all make dry eye symptoms worse.
Prevention
Nearly everyone experiences that gritty, uncomfortable feeling of dry eyes at one time or another. However, for some people, dry eye is a constant and ongoing problem that can cause significant discomfort. The condition, called ocular surface disease, occurs when the eyes do not produce enough tears or the right quality of tears to clear away debris from the eye surface and keep it well-lubricated. It can be caused by aging, hormonal changes, medications, or certain diseases, such as Sjogren’s syndrome.
If you suffer from chronic dry eye, you can try some of these self-care strategies to improve your symptoms. You can use artificial tears (available over the counter at pharmacies and many grocery stores) to help lubricate your eyes. Always use preservative-free drops because the preservatives can actually damage the surface of the eye over time. You can also try ointment at bedtime, which is thicker and helps coat the eye more completely than drops.
You can add moisture to the air by using a humidifier during the winter, especially if you live in a cold climate. Avoid getting air blown in your eyes by directing hair dryers, car heaters and fans away from your face. You can also wear glasses that filter blue light from electronic screens to reduce the irritation they can cause. Take frequent breaks from the screen to rest your eyes. When you do look at a screen, follow the 20/20/20 rule: every 20 minutes, focus on something 20 feet away for about 20 seconds.
In addition, you can take omega-3 fatty acid supplements, which some research suggests may support tear production and relieve eye dryness. However, before taking any supplements, talk with your doctor to make sure they are safe for you.
Blepharitis, an infection of the glands on your eyelids, can also contribute to the symptoms of dry eye. This can result in crusting around the lashes and lid margins, red and irritated eyes and itching. You can prevent blepharitis by soaking a cotton flannel in warm water and gently wiping the area around your eyes to remove oil, crusts, bacteria or dust.