Dry Eye Syndrome

What Is Dry Eye Syndrome and How Can It Be Treated?

What is Dry Eye?

Dry eye is a condition in which the outer layer of the eye doesn’t have adequate moisture to function properly. Dry eye syndrome causes many eye issues including blurred or variable vision, discomfort, eye strain, and other irritative symptoms. This syndrome can even irritate the eyes to the point they create tears and cry, a seemingly confounding symptom.

The moisture layer on the front of the eye is comprised of a combination of water, salt, and oils. This moisture layer is intended to constantly lubricate your eyes. These tears keep your eyes from drying out, help sharpen vision, and help remove dust, pollen, and other substances from the eye surface. . These tears are differentiated from moisture that’s released when crying, after being exposed to irritative substances such as soap in the eyes.

There are two forms of dry eye syndrome. The first type occurs when the eye doesn’t generate enough fluid to keep the eye moist. The second type occurs when the eye moisture evaporates too quickly. Both types of dry eye syndrome have similar effects of blurred vision, discomfort, and irritation. There is some overlap in the treatment, but often different steps are required to treat the cause of dry eyes.

Dry eye tear deficiencies can be caused by a number of conditions, illnesses, or medications, and some populations are more at risk of dry eyes than others.

A lady with her wind blowing the wind at the beach.

Causes of Dry Eye

There are three types of dry eye: Reduced tear production, excessive evaporation, and incorrect tear composition. Many patients have all forms of dry eyes contributing.

Reduced Tear Production

When your eyes are dry due to a lack of tears, this means your moisture producing cells aren’t producing adequate moisture to keep your your eyes moist and healthy. Reduced tear production can be the result of a medical imbalance, deficiency, or condition slowing the function of your tear ducts to a less than optimal rate of tear production. For eye moisture, rather than crying, this means that your eyes are not producing enough moisture to lubricate fully every time you blink.

Causes of Reduced Tear Production

Aging – Patients over 40 are more likely to experience natural reduced tear production as a result of aging.
Hormonal Changes – Women are particularly susceptible to dry eye, especially after menopause or in response to other significant hormonal changes like pregnancy or a change in hormonal birth control.
Medical Conditions – Several medical conditions can incidentally cause your tear ducts to reduce their production. These include:
- Diabetes
- Rheumatoid Arthritis
- Psoriasis
- Lupus
- Scleroderma
- Sjogren’s Syndrome
- Thyroid Disorders
- Vitamin A Deficiency
- Parkinson’s Disease
Medications – Certain medications can have a similar effect, reducing your eye’s tear production rate. These can include:
- Antihistamines
- Decongestants
- Hormone Replacement Therapy
- Antidepressants
- Blood Pressure Medication
- Acne Treatments
- Birth Control
Damage to Your tear Glands – If your tear glands are damaged from an injury, harsh environment, or radiation, then tear production may reduce.

Risk Factors

Over 50 yeas old
Harsh Environment
Contact Lenses
Women / Hormonal Changes
Vitamin A Deficiency
Prolonged computer use
Low humidity environments

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Symptoms of Dry Eye

The symptoms for dry eyes are not always the same for each person. They vary depending both on the cause of the dryness, environmental conditions, and each person’s unique physiology. Take a look through the symptoms and see which ones apply to you and which ones you may not have even realized were related to your dry eye problems.

Stinging and Burning
Dry eye syndrome is a leading cause of irritation Redness

Dry eye disease can cause the eyes to turn red.

Scratchy Sensation

When your eyes can’t lubricate properly, your eyelids themselves may feel scratchy all the time because they are not moist enough to slide comfortably over your eyes.

Feeling Like There’s Something in Your Eye (foreign body sensation)

This is also common with dry-eye, and is due to inadequate lubrication.

Stringy Mucus Around Eyes

Dry eye can also occur if your tears are too thick, leaving a stringy mucus that doesn’t soothe or wash the eye as it should.

Blurred Vision

Blurred vision is often a result of other symptoms, as they reduce your eye’s ability to function. A smooth moisture layer is required to focus clearly

Eye Fatigue

Lack of moisture may cause your eyes to become weary to the point of discomfort.

Poor Night Vision or Difficulty Driving at Night

When your eyes cannot focus, you may have trouble adjusting to dark roads or seeing past bright headlights while driving at night.

Tearing or watering. If the eye surface becomes too irritated the eyes may actually make tears to try to maintain adequate moisture levels.

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Increased Tear Evaporation (Meibomian Gland Dysfunction)

Tear evaporation is not a problem with your tear ducts (unless it’s a tear composition problem, see next section). Instead, it is the result of environmental or eye mechanical problems that create the standard dry eye symptoms. Wind and other air environmental factors can play a major role, as can contacts. But tear evaporation problems may also relate to the function of your eyelids.

Causes for Increased Tear Evaporation

With tear evaporation, the existing tears evaporate too quickly to keep the eyes moist. Wind and other air environmental factors can play a major role, as can contact lenses. Oftentimes this form of dry eye is caused by inadequate release of natural oils from the eyelids, as this oil layer helps trap moisture.

Constant Exposure to Dry, Hot, or Smokey Air – If your home or work environment involves constant exposure to incredibly dry or drying air, this can be the cause of your dry eye syndrome as your tears are evaporating or blowing away too fast to be of use.

Blinking Less Often than You Should – Some people blink less often when they are reading, concentrating, or driving. This may also relate to physical or neurological problems for people who forget to blink involuntarily.

Eyelid Malformations or Dysfunction – Your eyelid is responsible for spreading your passive moisturizing tears. If the eyelid does not blink correctly or does not contact the surface of your eye properly , it will not moisten fully.

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Tear Composition Problems

In some cases, eyes experience dryness because the tears aren’t made right. Your tears are made of three different layers. The oil layer on top is your outside protection and keeps the surface of your eye smooth. It also protects your eye from evaporation. The inner layer is watery and made up of the tears that moisturize and constantly wash your eye. And the inner layer is a thin mucus that helps distribute the tears.

If anyone of the three layers is not working right, you can experience dry eye and discomfort. Your tears may be too thin and evaporate too easily, or they may be too thick and form as stringy goo instead of a thin liquid coating.

Causes of Tear Composition Problems

Meibomian Gland Dysfunction – The meibomian glands produce the oil for the outer protective layer of your tears. When the glands are blocked, there is a lack of oil on the surface layer of your tears and your tears evaporate more quickly leading to a vicious cycle of perpetual dry eye. More common for patients with rosacea or blepharitis (inflamed eyelid edges)
Medical Conditions – Certain illnesses can potentially cause your tears to change in composition.
Hormonal Changes – Significant hormone changes may affect your eye dryness or tear composition.

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Conditional Causes of Dry Eye

Dry eyes can also be caused by environmental conditions or life events that affect your eyes.

Harsh Environment – Constant wind, hot air, smoke, and chemical exposure can all cause irritation and dry eyes.
- Can cause long-term symptoms or damage to the eyes.
Tear Gland Damage – If you suffer an injury or condition that damages your tear glands or eyelids, this can affect your ability to keep your eyes moist.
Contact Lenses – Many people do not produce enough tears to comfortably wear contacts and experience dry eye as a result.
LASIK surgery – Many people do not produce enough tears to comfortably wear contacts and experience dry eye as a result.

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Treatments for Dry Eye Syndrome

Artificial Tear Drops – You can buy artificial tears in dropper bottles, aka eye drops. These will moisturize your eye in the way that your natural tears or eyelids cannot. Many people only need to use eye drops a few times a day.
Punctual Plugs – Smaller than a grain of rice, these biocompatible plugs prevent your eyes from excessively draining tears, which can cause types of medical-related dry eye.
Prescription Eye Drops – Restasis, Xiidra or Cequa – If your eyes are dry due to constant inflammation or lacking natural tear production, Restasis, Xiidra or Cequa are different types of the prescription eye drops that are commonly prescribed. Each can reduce the inflammation on your ocular surface from chronic dry eye and help to increase tear production
Topical Steroid drops (Lotemax, Eysuvis, Flarex) – Sometimes patients who have a flare up of their dry eye can use a short course of low potency topical steroid (brands listed above) to quickly reduce the inflammation on the surface of their eye to help with acute dry eye symptoms. Your doctor will let you know how frequently and how long to use these medications safely
Lipiflow – Lipiflow is a comfortable in-office procedure that treats blocked meibomian glands by opening them up and allowing the oil (lipid) to flow and coat your eyeball. (https://www.jnjvisionpro.com/products/eye-medical-devices/lipiflow-treatment)
TearCare – TearCare is another comfortable office based treatment similar to Lipiflow that can accurately and precisely heat, unclog and decompress your meibomian glands. (https://tearcare.com)
Prokera Amniotic Membrane Treatment – For patients with moderate to severe dry eye that does not improve with artificial tears or prescription eye drops, placing a Prokera Amniotic Membrane (in contact lens form) can rehabilitate and heal the surface of your eye from the wear and tear of chronic dry eye. (https://biotissue.com/prokera-for-patients) The effects of this treatment can last many months after its placement.
Serum Tears – For patients with severe dry eye, many of whom have autoimmune conditions like Rheumatoid Arthritis or Sjogren’s syndrome, serum tears that are made from your body’s blood serum can provide additional relief from dry eye that may not respond well to prescription eye drops and artificial tears. Contact your doctor to learn more about this therapy

Clinical Studies for Dry Eye

At Eye Consultants of Atlanta, several of our board-certified ophthalmologists are principal investigators in cutting-edge clinical trials for emerging therapeutics for many types of dry eye. If you have symptoms of dry eye or feel that your current dry eye therapies are not providing the relief you desire, you may be a candidate for one of our clinical trials. Please contact our office to learn more about participating.

Finding the Right Treatment for Your Dry Eye

It is possible to treat many of the symptoms of dry eye at home or with over-the-counter medications. However, to solve the underlying problem or treat more severe symptoms, you will need the help of a medical professional. If you or someone you know is suffering from ongoing dry eye syndrome, we can help. Contact our office today to schedule an appointment.

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