Relief for Stubborn Dry Eye
From redness and gritty discomfort to excessive tearing and blurred vision, chronic dry eye symptoms can take a toll on your quality of life, making it difficult to read a book or even drive.
“Dry eye is a condition that can be frustrating for the patient in terms of chronic symptoms and discomfort,” says Stephanie Marioneaux, M.D., cornea specialist and clinical spokesperson for the American Academy of Ophthalmology. “It may take some trial and error, but relief is within reach for most patients.”
It’s a common affliction in older adults: According to a 2014 study, an estimated 20 percent of women and 10 percent of men are thought to be affected by dry eye disease, which also goes by the names dry eye syndrome, dysfunctional tear syndrome and keratoconjunctivitis sicca. A landmark 2003 study estimates that 3.2 million women ages 50 and older are affected by dry eye.
Dry eye is the result of either a decrease in tear production (called aqueous tear deficiency) or tears that evaporate too quickly because they don’t contain enough oils to keep the eyes lubricated (evaporative dry eye). Dry eye is a syndrome, meaning that a particular collection of signs and symptoms characterizes the condition, but there’s an underlying cause behind poor- or low-quality tear production. One common reason for dry eye is that tear production naturally decreases as we age. What’s more, menopausal hormone therapy makes dry eye a problem for many older women.
Other factors associated with dry eye span a wide range, including:
• Certain medications, such as antihistamines, decongestants, anticholinergics, antidepressants, pain relievers, sleeping pills, tranquilizers, diuretics, beta-blockers, and drugs for glaucoma, benign prostatic hyperplasia (BPH) and Parkinson’s disease
• Certain health conditions, including thyroid disease, skin diseases (psoriasis, eczema and rosacea), diabetes and shingles
• Autoimmune disorders such as rheumatoid arthritis, lupus and especially Sjogren’s syndrome, which affects about one-third of dry-eye patients and is accompanied by dry mouth, joint pain and fatigue
• Regular use of contact lenses
• LASIK surgery (corrective refractive laser surgery to improve vision), although dry eye is temporary in most cases
• Eyelid inflammation (blepharitis)
• Being of Asian descent
• An abnormally low blink rate (normal rate is 12 blinks per minute)—common among people while they look at computer or video screens or who spend prolonged time reading or watching TV—which deprives eyes of adequate lubrication
• Incomplete blinks, which can be a side effect of cosmetic eyelid surgery (blepharoplasty)
• An anatomic eye abnormality, such as eyelids that turn inward or outward
• A diet lacking in adequate consumption of vitamin A or omega-3 fatty acids
Some experts believe that a chronic disorder called meibomian gland dysfunction (MGD) is behind most cases of evaporative dry eye. The eyelid’s meibomian glands produce the oily substance (meibum) in tears that slows their evaporation. When the glands don’t function properly, they secrete low-quality tears that quickly evaporate, depriving the eyes of lubricants.
Regardless of its cause, dry eye can affect your ability to engage in activities you enjoy. In rare cases, chronic dry eye can damage the cornea or lead to infection.
Easing mild to moderate dry eye
Dry eye typically can’t be cured, but it can be controlled. Dry eye triggered by a medication, for instance, may be treated by switching to a similar drug that isn’t as harsh on the eyes. “An important first step is to identify and treat any underlying condition that may be causing your dry eyes. If age or environmental factors are causing dry eye, the goal is to minimize symptoms by employing coping strategies,” Marioneaux says.
Many people find that over-the-counter artificial tears, which come in liquid, gel or ointment form, are an effective solution to dryness because lubricating eyedrops that contain oil or lipids most resemble the human tear. The thicker the lubricant, the longer it stays in your eye. An ointment should be used only at bedtime since it blurs vision. Eyedrops can be used as needed to soothe eyes. However, if you find yourself using drops more than four to six times a day, you should see your ophthalmologist about other alternatives.
Some artificial tears contain preservatives that can irritate eyes and cause stinging or burning. “If your drops are causing stinging or burning, you should try products without preservatives in them,” Marioneaux says. “Just be aware that these tend to be more expensive than traditional artificial tears because they’re packaged as single-use.” Marioneaux also cautions against continued use of drops that promise to “get the red out,” which can actually worsen redness and other symptoms.
Stepping up treatment
If artificial tears and lifestyle modifications don’t relieve your dry eye, your ophthalmologist may recommend one or more of the following treatments, depending on the severity, cause and type of your dry eye:
• Restasis (cyclosporine) is a prescription eyedrop that helps increase tear production diminished by inflammation. However, it can take several months of use before you see an improvement, and it works in only about one-third of people who use it. Restasis can also be costly.
• Omega-3 and omega-6 fatty acid supplements have been shown in some studies to help dry-eye symptoms, although not all experts agree on the benefits.
• Tear duct plugs, or punctal occlusion, is an in-office procedure during which temporary or permanent plugs made from collagen or silicon are inserted into the tear ducts in the eye’s inner corner to block tears from draining.
• Autologous serum tears use your blood serum to create eyedrops. These drops contain compounds found in natural tears that may help heal the eye’s surface. Evidence for recommending them over artificial tears is lacking, however.
• Surgery can correct eyelid abnormalities or reduce the surface area of the eye to help reduce tear evaporation.
“If you’re experiencing symptoms of dry eye, it’s important to seek out a definitive diagnosis,” Marioneaux says. “The proper diagnosis is crucial for proper treatment.”