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Dry Eye Syndrome

Dry eye syndrome (DES), also called dry eye or keratoconjunctivitis sicca (KCS), is a common disorder of the tear film that affects a significant percentage of the population, especially those older than 40 years of age. Dry eye syndrome can affect any race, and is more common in women than in men. Dry eye syndrome is a very common and usually benign condition that is characterized by a disturbance of the tear film.

Symptoms

Common symptoms of dry eye disease:

  • grittiness
  • burning
  • foreign body sensation (the feeling that something is in your eye)
  • tearing
  • red eyes
  • blurred vision
  • eye fatigue
  • contact lens discomfort.

These symptoms can be worsened under certain conditions, such as prolonged staring (such as with reading, watching TV, or driving), windy environments, and indoor heating or drafts from nearby air conditioning vents.

Causes

There are several causes of dry eye disease. Most common is when the tear glands do not produce enough tears, but there can also be deficiencies with oil secretion from the Meibomian glands as well as with mucin secretion from the goblet cells. Furthermore, the quality of tears can be poor in chronically dry eyes, containing more inflammatory chemicals and salts that can actually further irritate the eye and worsen the dryness. Having had any eye surgery, including LASIK and cataract surgery, can make the eye more dry. Situational dryness can occur under certain circumstances, as with long periods of computer work or reading, sitting or sleeping under a ceiling fan, and windy environments.

Risk Factors

Many conditions can increase a person’s risk for dry eye disease. Common risk factors include increased age, female gender, post menopause, Sjogren’s Syndrome, autoimmune conditions (e.g. rheumatoid arthritis), chronic use of certain medicines (e.g., antihistamines, antidepressants, diuretics), and eyelid conditions such as blepharitis.

Diagnosis

Several tests are available to evaluate dry eye symptoms. Your eye doctor may detect signs of inflammation even before you become symptomatic. Nevertheless, the risk of ocular complications from untreated inflammation makes early diagnosis imperative.

The tests include:

  • History, including questions about the health of the ocular surface
  • Clinical exam
  • Schirmer test- used determine whether your tear glands produce enough tears to keep your eyes adequately moist.
  • Fluorescein tear breakup time- method of determining the stability of the tear film and checking for how quickly the tears evaporate.

Treatment

In many cases, dry eye disease can be progressive and worsen if not treated adequately. In addition to trying to prevent dry eye symptoms from developing, such as avoiding drafts and windy environments, taking frequent breaks from long periods of computer use or reading, and increasing room humidity, there are several medical options for treating dry eye disease:

Artificial tears: available over-the-counter, these products can include liquids, gels, and ointments placed on the eye to alleviate discomfort and provide more moisture.

Omega-3 supplements: for certain types of dry eye disease, such as those associated with blepharitis, taking omega-3 fatty acid supplements (such as flaxseed oil or fish oil) may help.

Prescription medicines: eye drops and other medications can be used to control the inflammation (and associated discomfort) on the surface of the eye and help increase the production of one’s own tears.

Punctal plugs: these are small, inert inserts that are placed into the punctum (the opening of the tear drainage system) or in the canaliculus (the tear drainage duct) of the lower or upper eyelid. Plugs cause a back-up of tears in your eyes, similar to the buildup of water in a bath tub when the drain is closed shut, therefore making the eye moist and comfortable.