It’s important to learn about the possible causes of dry eyes, its treatment options, and what can be done to prevent mild symptoms from turning into severe cases. One may not be aware of this all the time, but consistent and adequate production of tears keeps your eyes comfortable and functioning. By keeping your eyes consistently moist, your tears wash away dust, debris, and microorganisms. Normally, tears are made up of three crucial components: oil, water, and mucus. The oily component (produced by the meibomian glands) is the outermost layer and slows down the evaporation of tears from the eye’s surface. The watery component (produced by the lacrimal glands) makes sure that your eyes are sufficiently moistened. The mucus layer (produced by the cells lining the cornea and conjunctiva) helps anchor tears to the surface of the eye for it to spread evenly.

What causes dry eye?

Before creating a dry eye management plan, identifying the root cause of the problem is imperative. Ideally, the proper balance of water, oil, and mucus must be maintained for tears to lubricate and consequently protect your eyes. Deficiency in any one or more of these components, both in quality and quantity, leads to dry eyes.
Briefly speaking, dry eye disease can be categorized into the following subtypes:
• Evaporative dry eye – which is attributed to meibomian gland dysfunction.
• Aqueous tear-deficient – This subtype is a result of your lacrimal glands’ failure to produce the watery component in your tears to keep the eyes sufficiently moistened.

THIS DYSFUNCTION MAY RESULT FROM ONE OR A COMBINATION OF THE FOLLOWING FACTORS

• Natural process of aging
• Hormonal imbalance (which explains why the dry eye is common in women, particularly those who are menopausal, pregnant, or taking oral contraceptives)
• A side effect of certain medications such as antidepressants, decongestants, antihistamines, and anti-hypertensive drugs
• Medical conditions such as autoimmune disorders (Sjögren’s syndrome, rheumatoid arthritis, diabetes, and thyroid problems)
• Inflammation of the eyelids
• Chronic exposure to dry climates, smoke, and dry wind
• Long-term use of contact lenses
• Staring at digital screens for long periods of time
• Post-refractive eye surgeries such as LASIK

Dry Eye Diagnosis

Dry eye syndrome is usually diagnosed with a thorough evaluation of the patient’s history, careful physical assessment, comprehensive eye examination, and ocular surface tests. Therefore, accurate diagnosis and appropriate evaluation are critical to helping initiate the right management and treatment pathways. Using the right diagnostic tools makes a huge difference in the relief of symptoms.
There are several tests available to help with the diagnosis of dry eye disease, including epithelial staining, meibomian gland evaluation, tear osmolarity, the Schirmer test, and tear film break-up time (TBUT):

• Epithelial staining is used to determine how quickly your tears dry out, as well as assess the condition of your eyes’ surface.
• A meibomian gland evaluation is performed to determine if this gland is responsible for your condition.
• Tear osmolarity helps doctors classify the type of dry eye and understand the severity of the disease.
• The Schirmer test is used to determine if your eyes produce enough tears to keep adequately moist.
• And TBUT is used to test for evaporative dry eye, a subtype of the disease.

Dry Eye Symptoms

The following symptoms can appear abruptly or gradually, lasting from hours to days to all the time.

• Redness
• Eye pain
• Feeling of “something foreign” in the eyes
• Episodes of excessive tearing (this is often a result of the eyes’ attempts to lubricate the eyes)
• Gritty or sandy feeling in the eyes
• Eyelids that tend to stick together when you wake up

In rare cases, untreated dry eye can potentially lead to keratitis (inflammation of the cornea). This could further progress to corneal ulceration and eventually vision loss. Sharp pain, extreme sensitivity to light, and sudden deterioration of vision are symptoms indicating severe dry eye requiring immediate and serious medical help. Most dry eye sufferers have multiple symptoms but only one or two of these may be reasons for visiting an eye doctor for the first time. Often, it’s not until they’re asked about the other symptoms that they are aware of its occurrence

Options for Dry Eyes Treatment
If your dry eye symptoms are caused by an underlying condition, recommended treatments will be focused on the condition itself. Other treatment modalities include medications, surgical procedures, and non-surgical methods.

Dry Eye Medications
There are a few basic medications that can be used in mild cases of dry eye.
These include:
•Lubricating eye drops: These are popularly known as artificial tears. Different medications have different sets of ingredients, depending on what is missing in the layers of your tear film. Eye drops range from oil-based drops to hypotonic drops.
• Nonsteroidal and Steroidal prescription drops: These eye drops are the treatment of choice for dry eyes caused by inflammation of the ocular surface.
• Serum tears: This formulated teardrop is typically used in moderate to severe cases and contains the clear portion, or serum, of the patient’s blood. The formula contains saline, as well as other nutrients and growth factors.

Dry Eye: Non-surgical Approach
• Warm Moist Compresses: When applied to your eyelids, this approach helps stimulate the meibomian glands of the eyelids to produce more lipids, a component of our tears.
• Punctal Plugs: Punctal plugs are often made of silicone, acrylic, or hydrogel. They are inserted into the tiny ducts where tears drain. These plugs help keep the tears on your eye’s surface and prevent them from evaporating quickly.
• Blinking: Frequent blinking while reading or working on computers helps sufferers of mild dry eye cases. This can be hard to remember to do while performing focused tasks.
• Intense Pulsed Light Therapy (IPL): IPL is recommended for dry eye caused by ocular rosacea, a condition where tiny blood vessels along the eyelid margin are unusually dilated. IPL helps return the blood vessels to their regular size decreasing the appearance of redness. It also heats the eyelids, allowing the meibomian glands to open and release lipids.
• Meibomian Gland Expression: This is recommended for dry eyes caused by meibomian gland disease. A forceps-type device is used to gently squeeze out the clogged contents from the meibomian glands. Once the clogged contents are out, natural oil production will return to normal and will keep tears from evaporating as quickly.
• LipiFlow Thermal Pulsation System: This patented device combines the results of warm compress and meibomian gland expression.

Dry Eye: Surgical Approach
Often, surgery is the last resort to treat dry eye syndrome.
Punctal cautery is a quick procedure that permanently closes the tear duct opening to keep tears within the eye’s surface for a longer period of time.

Preventing Dry Eye Syndrome
While there are cases when dry eye syndrome is a secondary condition to an underlying cause, there are also things most people can do to prevent it from happening:
• Take frequent breaks when working for long periods in front of the screen.
• Wear sunglasses with wraparound frames when going outdoors, particularly in dry climates
• Use a humidifier during winter to help moisten the air
• Avoid smoking or going near people who smoke
• Focus on a diet rich in omega-3s (e.g. flaxseed oil, chia seeds, fish, cod liver oil)

Ignoring dry eye symptoms can potentially lead to inflammation of the cornea, conjunctiva, and permanent vision loss in extreme cases. It is crucial to get in touch with your eye doctor immediately once you notice early signs of dry eye symptoms.