| Dry eye or Dry eye Syndrome is a very common condition that increases with age and probably affects 2 million Britons – usually more women than men. Dry eye occurs when people don’t have either enough tears, or the correct composition of tears, on the surface of their eyes to lubricate the eyes and keep them comfortable.
The TEAR FILM is composed of THREE layers. Each component layer is dependent on the other for proper function. The outer, oily layer of the tear film is produced by the meibomian glands in the eyelids and reduces evaporation of the tears. The thick, middle, watery layer is made by the lacrimal gland above the upper eyelid and washes away irritants. The inner, mucus layer is secreted by the goblet cells in the conjunctiva (mucous lining) of the eyelids and helps the tear film stick to the cornea.
Symptoms and Signs
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persistently gritty |
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itchy |
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burning |
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pain |
These symptoms worsen as the day goes on. Stringy mucus may appear in or around the eyes. Usually patients who have dry eye, already know. Patients with the most severe disease are at increased risk of developing corneal infection, scarring or ulceration. These conditions can cause permanent vision loss, so it is important to seek professional help if you have severe symptoms of dry eye.
Dry eye does not frequently casue blindness, but as it is such an uncomfortable condition, it is a common reason for seeking assistance.. Furthermore, dry eye syndrome is associated with a decreased ability to perform activities that require visual attention, such as reading and driving a car.
Sjogren’s syndrome
Severe dry eye is sometimes caused by Sjögren's syndrome, which is an uncommon chronic, multi-organ, autoimmune disorder that also results in dry mouth and often arthritis. More information about this disease is available at: www.sjogrens.org. You should be seen regularly by your doctor and ophthalmologist if you have Sjogren’s syndrome.
Tests for Dry Eye
Several tests for Dry eye are used by your doctor. The meniscus of tears, lid wiper action and distribution along with objective tests below provide information. Not all tests are always performed and are done where appropriate depending on a) Symptoms and b) cinical findings.
Objective tests:
Tear Break Up Time (TBUT)
The speed at which tears break up reflects evaporation
Schirmer’s Test
Strips of sterile blotting paper are placed at the corner of the eyelids for 5 mins. The length of wetting reflects the level of tear production. Three types of Schirmer’s tests can be performed and will be used depending on severity.
Treating Dry Eye
AVOID anything that can aggravate dryness, such as:
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very warm rooms (a humidifier may help) |
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hair driers |
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smoke |
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wind |
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contact lenses |
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Hormone Replacement Therapy (HRT) can aggravate dry eye. There is some evidence that, in older women, hormone replacment therapy makes dry eye worse; if you are using HRT, talk to your doctor about this. |
Medical Treatment
First line of treatment is usually Lubricating eye drops or gels. These can be bought over the counter. Best to try out different types to see what suits your best. Note that if the drops aggravate your eye, this might be due to the preservatives in the drops. Try using non-preserved drops instead. These do provide relief but do not address the underlying problem.
Some people with dry eye complain of scratchy eyes when they wake up; this symptom can be treated by using an artificial tear ointment at bedtime.
Some newer prepartions that normalize the electrolyte balance on the ocular surface have been shown to be of benefit and newer preparations are being researched.
In more severe cases of dry eye, the eye might become inflamed and anti-inflammatory medications including steroid eye drops may be presecribed. These are safe for short term use, but during their use you must be monitored by your ophthalmologist.
Punctal Occlusion may be an option offered by your ophthalmologist in severe cases. This involves blocking ducts within your eyelid. The ducts carry tears away from the eye to the nose (the reason why the nose gets stuffy when one cries). Again this is an option best advised by your doctor after careful analysis.
Blepharitis is one of several conditions that can contribute to dry eye. Your doctor will be able to advise the best approach to your dry eye. Treating Blepharitis may be an option.
Laser eye surgery and dry eye
Laser eye surgery, especially traditional Lasik can aggravate dry eye. Although Centre for Sight uses IntraLASE and IntraLASIK which reduces the duration and severity of dry eye, patients with dry eye are first treated for their specific cause. Once corrected they undergo laser vision correction. If they cannot be corrected, Laser eye surgery will not be recommended and other options may be considered.
Centre for Sight doctors are all fellowship trained in Cornea and the Anterior Segment. In the course of their usual practice, they are often asked to see patients in second opinion and to manage dry eye. You can be confident that you will be evaluated by doctors with expertise in this area at the time of your consultation.
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