Four years ago, Carolyn Adelsten woke up feeling like something was in her eye and it wouldn’t come out. She visited an eye specialist, got a diagnosis of mild dry eye disease and was told to use simple over-the-counter-eye drops to alleviate her discomfort. Two months later, she fell to the floor in agony.
“It felt like someone had thrown acid in my eyes,” she says.
From that day on, she’d wake up every morning feeling that her eyes were glued shut. All she could do was sit in a chair all day every day with her eyes closed. No amount of eye drops or other remedies her doctors ordered were giving her relief.
Adelsten searched for answers, continuing to consult with a series of eye specialists. Each one diagnosed her with mild dry eye disease, recommended various at home remedies, but still nothing helped. Finally, at a loss, one of the ophthalmologists referred her to Johns Hopkins Wilmer Eye Institute, where physicians worked with her for months to search for and treat both her visible and underlying symptoms.
More than a year after Adelsten’s first symptoms appeared, Johns Hopkins doctors ultimately diagnosed her with Sjogren’s syndrome, an autoimmune disease often associated with dry eye and dry mouth. With much ongoing top notch, diligent care, Adelsten, who is now 60 years old, has resumed an active life and is once again able to focus, drive, read, watch television, use her computer and ride her bicycle.
“Dry eye disease is not always a simple disease ? it can be debilitating and very serious,” says Dr. Sezen Karakus, assistant professor of ophthalmology at Wilmer Eye Institute at Johns Hopkins. She is one of the doctors who diagnosed Sjogren’s syndrome in Adelsten and continues to provide ongoing treatment for her dry eye.
When dry eye becomes severe, notes Karakus, it can have a significant impact on your quality of life, making it crucial to find a skilled specialist who will give you a comprehensive assessment and work with you to find effective solutions.
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What Is Dry Eye Disease?
Tears are important for keeping your eyes healthy. They provide protective lubrication, reducing the risk of eye infection, washing away foreign particles and keeping the surface of your eyes smooth and clear.
When not enough tears are produced, the wrong kind of tears are produced, or when tears evaporate, you can end up with dry eye disease.
If not properly treated, dry eye can cause lasting damage to the surface of your cornea and affect your vision.
Each time you blink, a protective coating of tears is spread like a film over the front of your eye. If you don’t blink enough, dry spots can develop and affect your vision.
Your tear film is comprised of the following three layers:
— Oily (lipid) layer. The outer layer of your tear film has an oil or lipid base. Its job is to seal the tear film, which helps reduce evaporation of natural tears.
— Water (aqueous) layer. The middle layer is comprised mostly of water. Its purpose is to lubricate the eye, wash away particles and prevent infection. This layer also contains nutrients as well as proteins that help fight infections and reduce inflammation.
— Mucin layer. The inner layer is the mucin layer, which allows the watery layer to spread evenly over the surface of the eye to keep it lubricated and moist. It also provides the cornea with nourishment and helps tears stick to the the eye’s surface to protect it.
“For the eye to function properly, be healthy and ward off infection, all three layers of tears have to work together,” says Karakus.
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What Are the Types of Dry Eye Disease?
There are two main types of dry eye disease: evaporative dry eye and aqueous tear-deficient dry eye.
Evaporative dry eye
Your eyes produce tears, but these tears evaporate too quickly from the ocular surface. This usually happens because there’s dysfunction of the meibomian glands, tiny gland in the eyelids that help lubricate the eyes by producing the oil layer of the tear film. Unlike aqueous tear-deficient dry eye, this type of dry eye disease may cause your eyelids to be inflamed.
Aqueous tear-deficient dry eye
The lacrimal glands (structures above the eye that cleanse and protect the eye’s surface by lubricating and moistening it) don’t produce enough tears to maintain a healthy eye surface. This type is less common than evaporative dry eye.
What Causes Dry Eye Disease?
Dry eye affects millions of people every year and is common in men, women and children. Children are being diagnosed with dry eye more than ever due to screen use, which can prevent enough blinking to keep the eyes moist.
A host of other factors can trigger dry eye:
Hormones
As you age, changing hormones can affect tear production. Women going through menopause are particularly susceptible to dry eye, as levels of protective estrogen drop.
Diseases
Certain diseases, like rheumatoid arthritis, lupus, thyroid disease and Sjogren’s syndrome, can lead to dry eye in the following ways:
— Rheumatoid arthritis is a chronic inflammatory disease that usually affects your joints, but sometimes can cause dry eye.
— Thyroid disorders can cause inflammation and damage to the tissue around the eye.
— Lupus is a disease that causes the immune system to attack healthy tissues and organs and affects eye tissues involved in tear production. Dry eye is common in lupus patients.
— Sjogren’s syndrome is a disorder of the immune system. Primary symptoms include dry eyes and dry mouth. This condition often accompanies other immune disorders like rheumatoid arthritis and lupus.
Eye issues
Certain eye health issues may also cause dry eye disease:
— Blepharitis is a condition that causes inflammation in the oil glands in the eyelid and is a common cause of dry eye.
— Entropion is a medical condition in which the eyelid folds inward. It is present in more than 70% of dry eye patients.
— Ectropion occurs when the lower eyelid sags away from the eye. The eye can’t close completely when you blink, leading to a lack of protection and dry eye.
— Inflammation, blockage or other dysfunction of the lacrimal glands which are tear glands located above the eyeball.
Lifestyle factors
— Smoky, windy or very dry climates can lead to or worsen dry eye.
— Computer screens can affect your eyes, as can prolonged reading and other activities that cause you to reduce blinking.
— Contact lenses can cause dry eye if they’re worn for too long.
— Refractive eye surgery to correct errors like nearsightedness, farsightedness, astigmatism and LASIK can lead to dry eye.
Medications
Certain medications can cause dry eye as a side effect. Some of these medications:
— Diuretics (water pills) for high blood pressure
— Beta blockers for heart problems or high blood pressure
— Allergy and cold medications
— Anxiety and depression medications
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What Are Symptoms of Dry Eye Disease?
Dry eye disease usually affects both eyes. The most common symptom is eye discomfort, but counterintuitively, you can also experience watery eyes, because your eyes produce more tears as a reaction to the dryness.
Here are other symptoms of dry eye disease:
— Gritty, dry or scratchy feeling in the eye
— Eye redness
— Burning or stinging feeling in the eye
— Intermittent blurred vision
— Eye fatigue
— Sensitivity to light
— Eye discomfort in windy or dry conditions
— Eye crusting
— Persistent dryness
— Watery eyes
— Difficulty wearing contact lenses
— Difficulty driving at night
— Stringy mucus in and around the eyes
Most people with dry eye are symptomatic, and for those with advanced disease, these symptoms may be debilitating, reducing their quality of life, notes Dr. Rudrani Banik, associate professor of ophthalmology at Icahn School of Medicine at Mount Sinai in New York. However, some people with dry eye have no symptoms at all.
“Dry eye can be a silent condition that is only picked up during a visit to the eye doctor,” she says. “That’s why it’s important that, beginning at the age of 40, you schedule an annual exam to keep your eyes healthy.”
What Are Risk Factors for Dry Eye Disease?
There are a host of risk factors for dry eye disease. Some you can try to remedy through lifestyle choices while others are unavoidable: Some of the factors that will put you at higher risk for dry eye disease:
— Being older than 50. As you age, tear production diminishes.
— The hormonal changes of pregnancy and menopause put women at higher risk for dry eye.
— Having a history of refractive surgery
— Lack of vitamin A is a risk factor for dry eye, although it’s not common in the U.S., because we usually get plenty in our diet. If there’s concern about your levels, your doctor may suggest taking a supplement.
— Not getting enough omega-3 fatty acids, the “healthy fats” that have many functions including giving your body energy and keeping your eyes healthy. If you don’t get enough from foods such as fish, nuts and seeds, you can consider taking a supplement if your doctor agrees.
— Stressing the eyes with prolong intense focus such as staring at a computer screen, reading or driving, all of which decrease your blinking rate. Blinking helps to recoat the eye with a fresh layer of tears.
— Contact lens use. Soft contact lenses absorb tears to maintain their water content while you’re wearing them. The presence of a lens on the cornea can limit oxygen and tear flow to the eye. Having properly fitting contact lenses, limiting their use and keeping them clean can reduce the risk for dry eye.
— Allergies triggered by pollen, dust mites, pet dander or smoke can cause inflammation in the eye area, which can diminish tear quality and lead to dry eye.
“It’s important to be aware that dry eye exists, and if your eyes are uncomfortable or are giving you problems, don’t ignore it. See a professional who can help,” says Dr. Himani Goyal, clinical associate professor of ophthalmology at NYU Langone.
How Is Dry Eye Disease Diagnosed?
If you have symptoms of dry eye disease, see a specialist for tests to determine the cause. In addition to asking for your complete medical history, an eye specialist should do a comprehensive exam during which you’ll be given drops to dilate your pupils. Dilating your pupils allows more light to enter your eyes so your doctor can better identify any problems. Various additional tests can check for underlying conditions that may be causing dry eye.
These are most common tests used to diagnose the condition:
— Slit lamp. In this common part of a routine eye exam, your doctor shines a light into each eye and uses a microscope to examine your eyelids. This test checks the overall health of your eyes and reveal certain problems, including dry eye.
— Schirmer’s test. This test determines whether the volume of tears produced by your eyes is enough to keep them moist. Your doctor will place a tiny piece of paper inside the lower lid of your eye and leave it there for five minutes. When it’s removed, your doctor will measure the paper’s moisture content.
— Phenol red thread test. This test was developed as an alternative to the Schirmer’s test. Red strips of thread are used instead of paper strips, numbing drops are not needed, and it takes less than 15 seconds
— Tear break-up time. This test adds a small amount of dye to your eye to determine how long your tear film (layers of tears on your eye) lasts after you blink. It measures the amount of time between your last blink and when the first dryness shows up in your cornea. If the tear film doesn’t last long, you may have dry eye.
What Are Treatments for Dry Eye Disease?
Depending on the severity of dry eye disease symptoms and their underlying causes, there are treatments that can help produce more tears, soothe your eyes and ease your discomfort. Treatments can minimize or avoid damage to the surface of your eyes.
Here are some of the many treatments available:
Over-the-counter options:
— Artificial tears. Over-the-counter artificial tears or eye drops can help with simple dry eye disease and treat corneal inflammation. If they don’t work, your doctor may recommend prescription eye drops.
Prescription medications:
— Anti-inflammatory eye drops. Short-term corticosteroids (Eysuvis) for quick relief as well as long-term treatments like cyclosporine (Restasis, Cequa, Vevye) or lifitegrast (Xiidra) can control chronic inflammation on the surface of the eye in moderate or severe dry eye.
— Autologous serum eye drops. An eye drop made from your own blood, rich in nutrients and regenerative factors, can be used to treat moderate to severe dry eye disease.
— Nasal spray. Recently approved by the FDA, varenicline (Tyrvaya) is the first and only treatment that can be sprayed up each nostril and used to increase tear production and treat dry eye.
— Eye drops against evaporation. Recently approved by the FDA, perfluorohexyloctane (Miebo) forms a protective layer over the surface of the eye to reduce evaporation.
In-office treatments:
— Eye inserts. When artificial tears don’t work for moderate to severe dry eye symptoms, tiny lubricating eye inserts that look like clear grains of rice are placed between the lower eyelids and eyeballs. They work by thickening the tear film on the surface of your eyes to moisten and soothe them.
— Punctal plugs. These are tiny devices that are inserted into your puncta, the small openings that drain tear fluid from your eyes. They slow or stop tear fluid drainage to reduce or prevent dry eye.
— Thermal pulsation therapy. Dry eye can be treated by unblocking meibomian glands. In this procedure, a doctor applies controlled heat and gentle pressure to both your inner eyelids using disposable eye pieces.
— Intense pulsated light (IPL) therapy. IPL therapy, also administered by a doctor, treats the underlying meibomian gland dysfunction, one of the most common causes of dry eye disease. It works by applying bright light to the skin surrounding the eyes in a recurrent, pulsating rhythm to release the buildup of oil and unclog the meibomian glands.
— Microblepharoexfoliation. Your doctor may use a tiny spinning sponge to clean your eyelids and lashes of debris, bacteria toxins, biofilm and mites that can infect the eyelids and cause symptoms of dry eye.
— Meibomian gland probing. This treatment clears any internal blockage in the glands that are causing dry eye. A fine wire or probe is inserted into the glands to manually unblock them.
— Special contact lenses. Special contact lenses are available to help people with dry eye disease. They trap moisture and protect the surface of the eyes.
— Underlying cause treatment. Some medications like antihistamines and antidepressants may be the cause of dry eye, so your doctor may recommend substitutes. Other serious conditions like Carolyn Adelsten’s underlying Sjogren’s syndrome, need to be treated to improve symptoms of dry eye.
Home remedies:
— Warm compresses and eyelid massage. By gently massaging your eyelids after applying warm compresses for 5-10 minutes, the oil in the meibomian gland becomes more fluid.
“It used to be that there were only one or two options for treating dry eye, but now we have many treatments available that target different aspects of the condition,” says Karakus.
It’s important, she adds, to get a comprehensive assessment to identify the root cause of dry eye and determine if there’s underlying disease that needs to be addressed. Based on the findings, treatments should be tailored to each patient.
How Can Lifestyle Changes Manage Dry Eye Disease?
Dry eye is a chronic disease, but its symptoms can be managed. Dr. Beeran Meghpara, co-director of refractive surgery at Wills Eye Hospital in Philadelphia, says that adopting some of the following lifestyle changes can help alleviate your symptoms:
— Apply warm compresses. At the earliest signs of dry eye, apply warm compresses to your eyelids to help maintain oil levels in the tear film. Masks that can be heated are readily available at pharmacies online and in doctors’ offices.
— Avoid environmental triggers. Cigarette smoke, blowing air vents, wind and allergens can worsen dry eye symptoms. When outdoors, consider wearing wrap-around eyeglasses or sunglasses. In winter, when indoor heat can decrease humidity, use a room humidifier. In summer, be aware that air from ceiling fans can worsen dry eye.
— Use artificial ointment or thick eye drops. If you wake up with dry, scratchy eyes, apply artificial ointment or gel lubricating drops before bed.
— Take screen breaks. When using a computer or tablet for extended periods, periodically rest your eyes. A good rule of thumb: Every 20 minutes look at something at least 20 feet away for 20 seconds.
— Try vitamins and supplements. Ensure you are getting enough vitamin A and omega-3 fatty acids, either from your diet or through supplements. Consult with your healthcare provider about your nutritional needs.
“If you’ve tried home remedies or you’re using more than three to four over-the-counter eye drops a day without relief, make an appointment to have your eyes examined by an eye care professional,” advises Meghpapra.
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Dry Eyes: Causes, Symptoms and Treatments originally appeared on usnews.com
