Dry Eye Disease

Do your eyes feel dry & tired? Constant watering & irritation? Consult our Dry eye clinic

Dry Eye Disease

Dry eye disease is a common and often chronic problem especially amongst the elderly. It is a multifactorial condition in which the eye surface is affected due to inadequate quantity or quality of tears being produced, or the inability of tears to adhere to the ocular surface. Tears are required for lubricating the eye surface, they wash away microorganisms & foreign particles, while providing essential nutrients and protective components that maintain a healthy eye. When there is deficiency in tear production, excessive evaporation of tears, lack of certain components that form the tear film or any disruption of the pathway from production to drainage of tears the result is inflammation and damage to the surface of the eye that can even affect one’s vision.

How are tears normally produced?

Our tear film has 3 layers - the outermost is the oily Lipid layer produced by the Meibomian glands in our lids that retards evaporation of tears, the middle is the Aqueous Layer secreted by our Lacrimal glands that contains water, salts and various proteins. The third and innermost is the Mucin Layer produced by the Goblet cells that coats the eye and allows the tear film to adhere to the surface. The tears drain out through tiny pores in our eyelids into the lacrimal sac that opens into the nose via a duct.

  • Decreased tear production.
  • Inflammation, old age, hormonal changes, certain diseases like rheumatoid arthritis, thyroid and diabetes, medications like antidepressants, antihistamines and so on.
  • Increased tear evaporation- Climatic conditions like hot and dry weather, exposure to cold wind and smoke, air conditioning, inadequate blink rate due to excessive screen time, ill fitting mask.
  • Previous eye surgery- LASIK, cataract surgery, glaucoma surgery.
  • Eyelid disease- Blepharitis, meibomitis, abnormal lid margin
  • Decreased tear production.
  • Inflammation, old age, hormonal changes, certain diseases like rheumatoid arthritis, thyroid and diabetes, medications like antidepressants, antihistamines and so on.
  • Increased tear evaporation- Climatic conditions like hot and dry weather, exposure to cold wind and smoke, air conditioning, inadequate blink rate due to excessive screen time, ill fitting mask.
  • Previous eye surgery- LASIK, cataract surgery, glaucoma surgery.
  • Eyelid disease- Blepharitis, meibomitis, abnormal lid margin

How can Dry Eye be treated

Treatment of dry eye depends on the severity and chronicity. Mild cases can have complete relief if treated timely. Chronic cases require prolonged therapy. Along with medications, lifestyle modifications are important. The aim of treatment is to relieve the symptoms, restore the normal tear film and health of the eye surface and improve the vision if affected by Dry eyes. Commonly used treatments for Dry eye includes the following-

Over the counter
medications

Majority of the cases suffering from Dry eyes can be relieved by Artificial tears and Lubricating eye drops. These help in adding tear volume and retaining the moisture in the eyes. They enhance the retention time of natural tears.They are generally safe and without side effects but if you need to use them very frequently and for extended period of time then it is better to consult your eye specialist and preferably switch to Preservative free drops as some preservatives used in eye drops can be harmful to the cornea.You maybe prescribed Gel tear substitutes which have a longer retention time but may cause momentary blurriness.

Anti-inflammatory
Medications

Since dry eye disease is associated with a vicious cycle of inflammation, anti-inflammatory drops such as mild steroids (Loteprednol/ Fluorometholone) or cyclosporine are often prescribed by your eye specialist. Steroid eye drops must be used only under a doctors advice as long term use can sometimes cause cataract and glaucoma.Oral antibiotics like Doxycycline and Azithromycin also have a role as they reduce inflammation.

Nutritional
Supplements

Omega 3 fatty acids and Vitamin D supplements have been shown to be effective in some studies. Natural sources of Omega 3 fatty acids include Fish, flax seeds and walnuts. Vitamin A supplements are recommended for cases of Vitamin A deficiency. Adequate hydration is important especially in hot climates and drinking 6 to 8 glasses of water is helpful.

Procedures

Warm compresses and meibomian gland expression- In case you have Meibomitis or Blepharitis you may be advised to do warm compress over your eyelids and massage or scrub your lid margins with a special medicated eyelid cleanser. The frequency is once or twice daily for a month or two.

Intense Pulsed Light - This is a new therapy for dry eyes that has shown good results. It has been extensively used by Dermatologists to treat certain skin conditions. It helps by reducing the dilated small vessels and inflammation. The IPL with infrared mask therapy takes about 15 min and requires 2 to 3 sittings at monthly intervals. It is well tolerated and cost effective.

Lipiflow -Thermal pulsation for in office treatment for Meibomian gland obstruction

Punctal plugs- These are inserted into the tear duct openings in the lids and help to reduce the outflow of tears. Maybe advised in severe dry eye cases

Lifestyle and home remedies

Reduce digital screen time and blink more frequently, take short breaks 20-20-20 rule

Blinking exercises

Avoid exposure to direct air draft from ACs and heaters

Use protective glasses with side shields outdoors to avoid dryness caused by wind and sun

Use room humidifiers in dry climates

Drink plenty of water, avoid getting dehydrated

Take nutritional supplements like Omega 3 fatty acids, Vitamin A & D

Always remove eye makeup thoroughly and avoid using eyeliner on the waterline as it can block the meibomian glands

Reduce / avoid contact lenses if your eyes feel dry and irritable

Are there any complications if Dry eye is not treated

Prevention and early treatment of dry eyes is important. If neglected, complications such as scarring of your cornea (the transparent layer at the front of your eye), infection of lids and cornea and chronic inflammation can occur affecting your eyesight permanently.