Dry eyes came into the spotlight in the eye care world several years ago. Although everyone experiences a mildly dry eye every now and then, persistent and problematic dry eyes are now recognised as real eye disease, termed dry eye syndrome or dry eye disease.
Dry Eye Symptoms
It may sound like it should be straightforward, but identifying dry eye disease is not always that simple. Many patients with dry eyes don’t present with any noticeable symptoms or may put their problems down to something else. In addition to the sensation of dry eyes, here are some other dry eye symptoms to look out for.
- The eyes feeling gritty or like there is a foreign particle lodged in the eye
- A red or pink tinge to the rims of the eyelids or the whites of the eye (sclera)
- Disturbances to the vision, often in the form of visual clarity that fluctuates with each blink; there may also be a filmy sensation to the vision
- Sore and tired eyes, often more pronounced later in the evening or when doing a visually demanding task, such as reading or computer work
- Watery eyes, due to the reflexive overproduction of tears in an attempt to lubricate a dry eye
- A sticky sensation of the eyelids
Types of Dry Eyes
For your eye care professional to be able to recommend the most effective dry eye treatment, it’s important to first identify which type of dry eyes is predominantly present.
There are two general categories of dry eye disease – aqueous deficiency dry eye and evaporative dry eyes. The distinction between the two is not always clear and in fact, most people with dry eyes will have some combination of the two types.
Aqueous deficiency dry eye occurs when the aqueous component of the tear film is inadequate. The tear film covers the surface of the eye and is predominantly aqueous, produced by the lacrimal (tear) gland. The most common cause of aqueous deficiency dry eye is an autoimmune disease known as Sjogren’s syndrome, which, amongst other things, can affect the production of saliva and tears. Other factors which may cause aqueous deficiency dry eye include:
- Contact lens wear
- Refractive surgery, such as LASIK
- Ageing
- Obstruction, trauma, or tumours of the lacrimal gland or ducts
- Certain medications, including antihistamines, chemotherapy, and antidepressants
Evaporative dry eye occurs when the tear film dissipates too quickly between blinks, leaving the corneal surface exposed. This happens because the superficial lipid layer of the tear film is inadequate. The vast majority of evaporative dry eye cases are due to a dysfunction of the oil-producing glands of the eyelid, called the meibomian glands. Other causes of evaporative dry eye include: 
- Contact lens wear
- Vitamin A deficiency
- Poor eyelid position and function
- Eye drop medications or their preservatives
- Allergies
Once the main contributing factors to your dry eyes have been identified, an appropriate dry eye treatment plan can be formulated.
Dry Eye Treatment Strategies
Remove exacerbating factors
Needless to say, an important part of managing your dry eyes is to remove any causative factors, where possible. This may mean changing your eye drop medications to one without preservatives, or modifying your environment. Air conditioners and heaters may need to be redirected away from your face, or perhaps you may need to use a humidifier. Poorly fitted contact lenses or lenses made from a material that is not biocompatible with your eye may need to be reviewed. Although contact lens technology has come a long way in developing high water content materials, there is a proportion of patients who are simply not suitable for long periods of contact lens wear.
Lubricant eye drops
Lubricating eye drops, also known as artificial tears or tear supplements, still deserve a mention in dry eye treatment. Lubricant drops are easily accessible, relatively inexpensive, and easy to self-administer. These eye drops are not medicated and are designed to restore moisture to the surface of the eye and stabilise the tear film. There are a staggering variety of artificial tears available – multidose bottles and one-use preservative-free units, gels and ointments, and not to mention all the different brands. As a general rule, multidose bottles are fine as long as you are not allergic or sensitive to preservatives. Viscous lubricants such as gels and ointments are most useful for moderate to severe dry eye or if you need to protect your eye’s surface overnight.
Lid hygiene
Keeping your eyelids clean and the oil glands unclogged can go a long way in soothing any dry eye. You may want to use a warm compress over the eyelids, followed by a gentle lid massage to encourage the glands to express their oils. Try to ensure you fully remove any eye makeup at the end of the day and avoid eyeliner on your lid margins.
Other therapies
Optometrists and ophthalmologists are offering in-office dry eye treatments in increasing numbers. These include the use of technologies such as IPL (intense pulsed light) and devices to aid meibomian gland expression. There are also prescription medications that are shown to be effective at treating dry eyes, such as an eye drop made from a patient’s own blood serum or immunosuppressant drops.
Dry eye disease remains an area of interest for many eyecare practitioners, so we’re sure to see further developments in its treatment in the near future.
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