Symptoms: Burning sensation, dry or scratchy feeling, red eyes, blurry vision.

Causes: Ageing, medications, medical conditions, increased evaporation of tears, wearing contact lenses, climatic conditions, inflammation.

Risk Factors: Age, wearing contact lenses, medications and medical conditions.

Prevalence: 5 to 50%

Severity: Mild to severe

Which doctor to consult: Ophthalmologist

OVERVIEW:

Dry eye, also known as dry eye disease, dry eye syndrome, and keratoconjunctivitis sicca, is a condition that occurs when the eyes do not produce enough quality tears to lubricate and nourish them. Symptoms include dryness, irritation, stinging or burning sensation. 

Dry eye is caused by various factors, including ocular, anatomical and systemic issues. It's crucial to thoroughly assess patients with signs and symptoms of dry eyes, as prompt treatment can significantly provide relief from dry eyes and improve their long-term quality of life. 

While some people may only experience mild discomfort, others may have more serious problems, and in some cases, it can cause permanent damage to the eye's surface. Treatment options for dry eyes include medication (eye drops/ointment), lifestyle changes, and surgery.

SYMPTOMS:

The symptoms of dry eyes include:

• A scratchy feeling (a feeling like there is something in the eye)

• Red eyes

• Blurry vision

• Sensitivity to light

• Stinging or burning sensation

• Irritation

• Feeling uncomfortable while wearing contact lens

CAUSES:

The causes of dry eyes are:

• Age & Gender: As people age, they tend to produce fewer tears. This may lead to dry eyes. Women often experience dry eyes after menopause.

• Medication: Certain medications like diuretics, antidepressants, antihistamines, acne and cough medicines may cause dry eyes as a side effect.

• Medical conditions: Few people develop dry eyes as a symptom of another medical condition, like rheumatoid arthritis, systemic lupus erythematosus (SLE), Bell’s palsy and blepharitis.

• Evaporation of tears: If the tears do not spread evenly over the cornea or evaporate too quickly, dry eye symptoms can develop.

• Wearing contact lenses: Contact lenses can result in dry eyes due to reduced oxygen flow into the eyes, which is necessary for the production of natural tears.

• Environmental factors: Dry, warm air, solar radiation, and wind can cause the eyes to dry out. Low humidity resulting from central heating or air conditioning or living in a hot and dry climate are common environmental causes of dry eyes. Windy conditions can also cause tears to evaporate more quickly, leading to dry eyes.

• Screen time: Not blinking regularly, such as when staring at a computer screen for long periods of time, can contribute to the drying of the eyes.

• Damage to the eye: Damage to the outer part of the eye or eyelid due to injury, disease, or surgery can affect the natural tear production and damage the overall function of the eye.

• Skin conditions: Meibomian gland dysfunction can be aggravated by skin conditions such as seborrhoeic dermatitis and ocular rosacea, resulting in the aggravation of dry eye disease symptoms.

RISK FACTORS: 

Dry eyes can develop due to many reasons, including:

• Age: Dry eyes are a common age-related issue. Most people over the age of 65 experience some dry eye symptoms.

• Gender: Hormonal changes caused by pregnancy, oral contraceptives, and menopause make women more susceptible to dry eyes. 

• Medicines: Certain medications, including blood pressure medications, decongestants, antihistamines, and antidepressants, can decrease tear production. 

• Medical conditions: Medical conditions such as thyroid, diabetes, rheumatoid arthritis, blepharitis (eyelid inflammation), and Bell’s palsy can lead to dry eyes. 

• Environmental conditions: Dry eye symptoms can be caused by exposure to smoke, wind, and dry climates, which increase tear evaporation. Prolonged staring at a computer screen, leading to a failure to blink, can also contribute to dry eyes. 

• Other factors: Long-term use of contact lenses can lead to the development of dry eyes. Refractive eye surgeries like LASIK can decrease tear production and contribute to dry eyes. Prolonged use of digital screens also increases the risk of dry eyes.

POSSIBLE COMPLICATIONS:

Complications are rare but may occur if you have an underlying medical condition and are exposed to a dry environment, which can cause extremely dry eyes. The possible complications include:

• Eye strain

• Sensitivity to light

• Difficulty wearing contact lens

• Corneal ulcers

• Redness, stinging sensation

• Corneal damage and infections

• Conjunctivitis (inflammation of the conjunctiva)

• Keratitis (inflammation of the cornea)

• Corneal perforation

• Impaired vision

PREVENTION:

The following steps aid in reducing the symptoms of dry eyes:

• Do not forget to blink regularly if you are reading or staring at a computer screen for a long time.

• Increasing humidity levels at work and home can help prevent dry eyes.

• When spending time outdoors, especially in windy or sunny conditions, wearing sunglasses with wraparound frames can help protect your eyes from dryness.

• For some people, nutritional supplements that contain essential fatty acids can reduce dry eye symptoms. Consult your doctor to see if dietary supplements could help with your dry eye problems.

• Staying hydrated is important to prevent dry eyes. Drinking 8 to 10 glasses of water each day can help.

• Refrain from smoking or consuming excessive amounts of alcohol.

• Direct the flow of car heaters away from your face to prevent air from blowing into your eyes.

• Stay away from environments that are drier than usual, such as deserts, aeroplanes, and high-altitude locations.

WHEN TO SEE A DOCTOR:

If you experience redness in your eye or if dryness affects your vision, it is recommended to consult a doctor or optician. Additionally, if you have dry eyes and feel severe pain or discomfort that goes beyond the usual scratchiness or irritation, it is advisable to seek medical attention. Unusual pain and changes in vision are not typical symptoms of dry eyes and may indicate other eye problems or complications associated with dry eyes.

DIAGNOSIS:

A thorough eye examination is required to diagnose dry eyes. Based on the test results, an optometrist can determine if you have dry eyes and suggest appropriate treatment options.

• Patient history is evaluated to identify any contributing factors.

• The examination may focus on evaluating the amount and quality of tears produced by the eyes. 

• The external eye structure, eyelids, and cornea may also be examined using bright light and magnification, and special dyes may be used to detect any abnormalities.

TREATMENT:

The treatment for dry eyes includes:

Medications: The most common treatment for dry eye is a type of eye drops called artificial tears and eye ointments which help your eyes make more tears. These include:

• Carboxymethylcellulose/Sodium carboxymethylcellulose

• Propylene glycol

• Hypromellose

• Sodium hyaluronate 

• Povidone

• Ciclosporin
• Polyethylene glycol+propylene glycol

Lifestyle changes: If you are experiencing dry eye due to any factor in your life or surroundings, your doctor may recommend some changes to alleviate the symptoms. To ease the discomfort, you can try:

• Avoiding exposure to smoke, wind, and air conditioning

• Using a humidifier to keep the air moist

• Taking breaks from staring at screens

• Wearing wraparound sunglasses while outside, drinking enough water

• Getting adequate sleep every night.

Tear duct plugs: If your eyes are producing tears too quickly and they are not staying in your eyes, your doctor may recommend using tear duct plugs. These are special devices that are inserted into the small holes in the inner corners of your eyes to help retain the tears.

Surgery: A dry eye may occur due to loose lower eyelids, which may lead to quick drainage of tears from the eye. In such cases, the eye doctor may recommend a surgical procedure to correct the eyelids and prevent tears from leaving the eyes too quickly. However, this treatment option is not frequently used.