What is Dry Eye Disease?
Tears play a crucial role in eye health by providing continuous moisture, nourishment, and protection to the ocular surface, and they also contribute to clear vision. In dry eye disease, the eye’s tear film becomes dysfunctional, leading to damage of the cornea and ocular surface due to friction and inflammation.
There are two primary types of tear dysfunction in dry eye disease: aqueous-deficient dry eye, caused by an insufficient volume of tears, and evaporative dry eye, which results from an inadequate oil (lipid) layer due to meibomian gland dysfunction (MGD). Dry eye disease typically exists on a spectrum, and often involves both types of dysfunction.
Common Symptoms of Dry Eye Disease
The symptoms of dry eye disease can vary in severity and may include one or more of the following:
- Persistent dryness, irritation, or a gritty feeling in the eyes
- Redness and inflammation of the eyes
- Burning, stinging, or a feeling of something foreign in the eyes
- Blurred vision, fluctuating vision, or difficulty with visual tasks
- Sensitivity to light or wind
- Excess tearing or watery eyes (paradoxically, a sign of dry eye)
- Discomfort when wearing contact lenses
These symptoms can significantly impact your quality of life, making it difficult to perform everyday tasks and enjoy activities you once found pleasurable.
Understanding the Causes of Dry Eye Disease
Dry eye disease is a multifactorial condition, meaning that it can be caused by a combination of various factors. Uncovering the root causes is crucial in developing an effective treatment plan. Some of the primary causes of dry eye disease include:
- Decreased Tear Production: The lacrimal glands, responsible for producing tears, may not function properly due to factors such as aging, certain medical conditions, or side effects from medications.
- Tear Film Instability: The tear film, which is composed of water, oil, and mucus, can become imbalanced, leading to rapid evaporation of tears and reduced eye lubrication.
- Meibomian Gland Dysfunction: The meibomian glands, located along the eyelid margins, produce the oil component of the tear film. Dysfunction or blockage of these glands can contribute to dry eye disease.
- Environmental Factors: Exposure to dry, windy, or low-humidity environments, as well as prolonged use of digital devices, can exacerbate dry eye symptoms.
- Hormonal Changes: Fluctuations in hormone levels, such as those experienced during menopause or certain medical conditions, can affect tear production and the overall health of the tear film.
- Autoimmune Disorders: Conditions like Sjögren’s syndrome, rheumatoid arthritis, and lupus can disrupt the normal functioning of the tear-producing glands.
- Medications: Certain prescription and over-the-counter medications, such as antihistamines, antidepressants, and blood pressure medications, can have dry eye as a side effect.
- Cosmetics: Make-up, serums, moisturizers, and anti-aging can contribute to dry eye by disrupting the tear film, causing inflammation, and blocking essential oil glands along the eyelids.
Understanding the specific causes of your dry eye disease is crucial in developing an effective treatment plan tailored to your individual needs. If you suspect you have dry eye disease, schedule an appointment at CLEI. Our team of experts will help uncover the cause of your symptoms and develop a personalized treatment plan to improve your quality of life.
The Role of the Cornea and Conjunctiva in Dry Eye Syndrome
If left untreated, dry eye disease can impact your cornea, the clear, curved front part of the eye, with some potentially devastating consequences. This is because the cornea is responsible for refracting light and providing the majority of the eye’s focusing power. When the tear film is disrupted, the cornea can become dry, irritated, and susceptible to damage. Additionally the cornea has one of the highest density of nerves making it very sensitive to dryness.
Dry eye disease can lead to the following corneal and conjunctival complications:
- Corneal epithelial damage: The outermost layer of the cornea can become damaged, leading to increased sensitivity and discomfort.
- Corneal erosions: Recurring episodes of dry eye can cause the corneal epithelium to break down, creating small, painful abrasions.
- Corneal ulcers: In severe cases, dry eye can lead to the development of corneal ulcers, which are open sores that require prompt medical attention.
- Corneal scarring: Repeated corneal damage from dry eye can result in scarring, which can impair vision.
- Corneal Perforation: In the most severe cases, the corneal tissue deteriorates and thins to such an extent that a hole develops in the cornea. This condition is considered a medical emergency and requires immediate attention.
Also the clear membrane that covers the white of the eye, the conjunctiva, can become damaged in dry eye disease. Increased friction results in more tissue damage, inflammation and can lead to loose conjunctiva which compounds dry eye issues.
Maintaining a healthy tear film is crucial for the overall health and function of the cornea and conjunctiva. Addressing the underlying causes of dry eye disease is essential in preventing these potentially serious corneal complications and conjunctival issues.
Diagnosis and Evaluation of Dry Eye Disease
Diagnosing dry eye disease involves a targeted examination by one of our experienced eye care professionals. During the evaluation, they will:
- Discuss Your Symptoms: They will ask about the severity and duration of your dry eye symptoms, as well as any factors that may contribute to or worsen the condition.
- Perform an Examination: Your eye care provider will examine the surface of your eyes, eyelids, and tear glands to look for signs of inflammation or dysfunction.
- Conduct Diagnostic Tests: Various tests may be performed, such as:
- Tear Film Break-Up Time: This measures the stability of your tear film.
- Schirmer Test: This assesses the production of tears by the lacrimal glands.
- Ocular Surface Staining: Special dyes are used to identify areas of corneal and conjunctival damage.
- Tear Osmolarity Test: This measures the concentration of dissolved particles in your tears, which can indicate the severity of dry eye disease.
- Corneal Topography: This test checks the corneal surface irregularity.
- Tear Meniscus Height: This test measures the baseline level of tears resting on your lower lid.
- Real-time Wavefront Aberrometry: This shows the objective variation in vision due to the tear film.
- Evaluate the Meibomian Glands: Your eye care provider may assess the function and health of the meibomian glands, which play a crucial role in tear film stability.
Based on the results of these evaluations, your eye care professional will be able to determine the underlying causes of your dry eye disease and develop a personalized treatment plan to address your specific needs.
Available Treatments for Dry Eyes
The treatment for dry eye disease is tailored to the individual and aims to address the underlying causes of the condition. Your eye care provider may recommend one or a combination of the following treatments:
- Lifestyle Modifications: Making changes to your environment, such as using a humidifier, limiting digital device use, and avoiding smoke or wind, can help alleviate dry eye symptoms. Changing cosmetics to a line of ocular research formulated, clean cosmetics designed to be gentle on the eyes and support ocular surface health.
- Diet and Nutritional Supplements: Certain foods, vitamins and minerals may help support the health of the tear glands and the overall eye surface.
- Omega-3 Fatty Acid Supplements: Oral supplements containing omega-3 fatty acids may help reduce inflammation and improve tear production.
- Artificial Tears and Lubricating Eye Drops: These over-the-counter or prescription eye drops can provide temporary relief by supplementing the tear film and reducing symptoms.
- Overnight Ointments and Gels: These thick lubricants provide overnight moisture and protection.
- Warm Compresses and Lid Hygiene: Applying warm compresses to the eyes and gently cleaning the eyelids can maintain meibomian gland function and tear film stability.
- Prescription Eye Drops: Medications that are focused on reducing inflammation and improving tear production. These may include Restasis, Cequa, Vevye, Clarity, Eysuvis, or Meibo.
- Medications: In some cases, your eye care provider may prescribe oral medications, such as antihistamines or anti-inflammatory drugs, to address the underlying causes of your dry eye disease.
- Tear Stimulator Device: This device, namely the iTear100, is used twice a day and stimulates the nasolacrimal nerve pathway through mild vibration at a specific point on the outer nose, promoting natural tear production.
- Tear Stimulation Nasal Spray: Tyrvaya nasal spray works on the same pathway as the device above but with medication, not vibration, it stimulates the nasolacrimal nerve pathway promoting natural tear production.
- Autologous Serum Eye Drops: VitalTears are eye drops made from the patient’s own blood, which contains natural growth factors and proteins that can help promote healing and reduce inflammation.
- Punctal Plugs: These small devices are inserted into the tear ducts to help retain tears on the eye surface, providing relief for moderate to severe dry eye.
- Punctal Gel: Similar to plugs, LarciFill is a water based gel that fills the ducts to retain tears.
- High Flow Irrigation: High flow saline irrigation to remove irritants and inflammation from the ocular surface and tear ducts
- Blepharo Exfoliation: This procedure exfoliates the eyelid margins to remove debris, biofilm, and keratinized cells, improving eyelid hygiene and meibomian gland function.It can be performed through Blephex treatment with a handheld device, or ZEST gel treatment.
- Thermal Meibomian Gland Expression: Procedures with iLux, TearCare, or LipiFlow apply heat to the eyelids to soften backed up oils in the meibomian glands then is followed by gland expression to unclog the glands and improve tear film quality.
- Intense Pulsed Light (IPL) Therapy: IPL treatment called Lumenis OptiLight uses pulses of intense light to reduce inflammation and improve meibomian gland function.
- Radiofrequency (RF) Treatment: Lumenis OptiPlus uses controlled heat to tighten skin and stimulate collagen production around the eyelids, improving meibomian gland function and reducing tear evaporation.
- Amniotic Membranes: These biological tissues, applied directly to the ocular surface, promote healing and reduce inflammation in cases of severe dry eye or ocular surface damage.
- Bandage Contact Lenses: These soft lenses are used to protect the cornea, reduce discomfort, and promote healing by acting as a physical barrier.
- Scleral Lenses: These specialized contact lenses are designed to vault over the entire corneal surface, creating a fluid-filled space that helps maintain hydration and protect the cornea.
- PROSE Treatment: The use of a PROSE device to aid in healing the cornea and ocular surface.
- Surgical Procedures: Procedures are typically considered when non-surgical treatments are insufficient, and they are tailored based on the underlying cause of dry eye. These may include:
- Punctal Cautery or Permanent Occlusion: Permanently closes tear ducts to retain tears on the ocular surface.
- Tarsorrhaphy: Partially sews the eyelids together to reduce tear evaporation and protect the ocular surface.
- Conjunctivochalasis Surgery: Removes excess conjunctival tissue to restore normal tear flow and reduce irritation.
Conclusion: Taking Control of Your Dry Eye Health
Dry eye disease is a complex and often frustrating condition, but recognizing the underlying causes, identifying risk factors, and implementing a comprehensive treatment plan, we can effectively manage your dry eye symptoms and maintain the overall health of your eyes. As your team of expert eye care professionals, we perform a comprehensive dry eye evaluation and will develop a personalized strategy that addresses your specific needs. With the right combination of treatments, lifestyle changes, and preventive measures, we can manage your dry eye and you can enjoy a more comfortable, vibrant life. If you’re struggling with persistent dry eye symptoms, don’t hesitate to schedule an appointment with us today.
