Dry Eye Introduction

Dry eye is an extremely common condition characterised by the lack of adequate lubrication of the eyes. Tears play an integral role in lubricating and nourishing the outer surface and clear window of the eye known as the cornea. Tears are composed of water, fatty oils and mucus that keep the eye surface smooth and clear, wash away foreign matter, and prevent infection. Dry eyes can result from either poor quality or quantity of tear production. Besides causing discomfort which can range from mild to debilitating, dry eye syndrome is usually benign and serious complications are rare. However, advanced dry eye syndrome can increase the risk of eye infections and inflammation as well as corneal scarring.

Symptoms

The symptoms of dry eye syndrome are often chronic and can be very frustrating for the patient. Patients often complain of –

• Grittiness
• Burning
• Blurry or fluctuating vision
• Red and irritated eyes

Reduced blinking frequency which occurs with reading, driving or prolonged screen time can exacerbate the effects.

Causes

Dry eye syndrome is a complex and multifactorial condition with many elements contributing to the overall picture. Predisposing causes include:

1. Insufficient tear production– which is typically seen in patients over 50 years of age, post-menopausal women, those with previous eye or refractive laser surgery, medical conditions such as diabetes, thyroid disorders, and autoimmune conditions including Lupus and Rheumatoid Arthritis.
2. Poor quality of tears– which can be due to conditions such as blepharitis, a chronic low-grade inflammation of the eyelid margins
3. Reduced blink rate– which usually occurs during periods of concentration such as reading, driving, and prolonged screen time. Less commonly it can be caused by neurological disorders such as Parkinson’s disease.
4. Medications – some medications such as antidepressants can reduce tear production or tear quality.
5. Environmental factors including exposure to hot, dry or windy outdoor conditions as well as air-conditioned and de-humidified offices or planes are known to exacerbate symptoms.
6. Abnormal eyelid anatomy may contribute by causing poor tear production or improper tear flow.

Treatment

Treatment of dry eye may include a combination of the following:

1. Optimise the quality and quantity of tear production.
2. Reduce predisposing factors – these may include lifestyle modifications such as reducing air-conditioning, maintaining adequate humidity, wearing protective goggles in windy conditions or changing medications appropriately under the guidance of your physician.
3. Use of artificial tear supplements (lubricants) – these offer relief by acting as an alternative to tears. They usually come in 3 consistencies – drops, gels and ointments. The thicker the preparation, the longer the lubricating effect but also the longer your vision is disrupted. Drops and gels are recommended for use during the day and ointments before bedtime.
4. Conserving tears – by inserting plugs into the tear ducts, tears are prevented from being drained too quickly, allowing them to lubricate your eye surface for longer.
5. Anti-inflammatory drops – some forms of severe dry eye syndrome are associated with inflammation. A short course of anti-inflammatory drops can sometimes be helpful
6. Dietary supplements – various supplements including Fish Oil and Flaxseed Oil have been shown to improve tear production in some patients

Key Points

Dry eye syndrome is extremely common and can be caused by a variety of underlying factors. Symptoms can vary from mild to severe however dry eyes rarely cause serious ocular complications. Several treatment options are available and the doctor may employ a combination of measures to get the best results. Compliance is important as the condition is typically chronic.

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