Dry Eye

What is Dry Eye?

Dry eye, or dry eye syndrome, is a condition where the eyes are not adequately lubricated due to insufficient tear production. It is estimated that around 77% of the population experiences this issue. In individuals with dry eye, there is an inability to generate enough tears to keep the eyes moist, or the tears evaporate too quickly, causing discomfort. The tear film that covers the eye is composed of three distinct layers:

• An outer oily (lipid) layer
• A middle watery (aqueous) layer
• An inner mucus layer

This tear film plays a crucial role in maintaining the moisture and health of the eyes, and it must remain intact between blinks to avoid dryness and irritation. Dry eye can be a highly uncomfortable condition that can affect your overall quality of life. However, symptoms can often be managed with treatment, including guidance from your pharmacist.

Types of Dry Eye Syndrome

There are two primary types of dry eye syndrome: 1. Aqueous deficiency: This occurs when the eyes do not produce enough tears. 2. Evaporative dry eye: This happens when tears evaporate too quickly.

In some cases, individuals may experience a combination of both types.

What Causes Dry Eye?

Dry eye can result from several factors, including3,4:

• Ageing: As people get older, tear production naturally decreases.
• Menopause: Hormonal changes can affect tear production.
• Medical conditions: Conditions such as Sjogren’s syndrome, allergic eye disease, rheumatoid arthritis, lupus, scleroderma, and vitamin A deficiency can contribute to dry eye.
• Medications: Certain medications, such as antihistamines, antidepressants, hormone replacement therapy (HRT), diuretics, and drugs for high blood pressure, acne, and Parkinson’s disease, may reduce tear production.
• Eyelid issues: Problems such as the eyelid turning inward or outward can affect tear distribution.
• Eye trauma: Injury to the eye can lead to dry eye symptoms.
• Environmental factors: Wind, dry air (especially during the winter months), and irritants like cigarette smoke and dust can increase the risk.
• Eye surgeries: Procedures like laser eye surgery or cataract surgery may trigger dry eye.
• Prolonged use of contact lenses: Extended wear of contact lenses can contribute to dryness.
• Screen time: Excessive time spent on electronic devices can result in reduced blinking, exacerbating dry eye.

Managing the condition involves understanding its causes and finding appropriate treatments tailored to individual needs.

Who is Affected by Dry Eye Syndrome?

While dry eye syndrome can affect anyone, it is more prevalent among women, with nearly twice as many women experiencing the condition as men. The condition is also more common in individuals over the age of 50, as tear production naturally decreases with age. Postmenopausal women are particularly susceptible to dry eye due to hormonal fluctuations. Additionally, individuals with rheumatoid arthritis (RA) often experience dry eye, as inflammation caused by RA can affect the tear glands, leading to reduced tear secretion. People of Asian descent are also more likely to develop dry eye.

What Are the Symptoms of Dry Eye?

The typical symptoms of dry eye, include:

• Stinging or burning sensations
• Watery eyes, despite the dryness
• Redness in the eyes
• Itchy eyes, particularly at the corners
• A feeling of something in the eyes, such as an eyelash or grit
• Eyes that feel tired or need to be closed, or become fatigued more easily than before
• Stringy mucus around the eyes, especially upon waking
• Sensitivity to light
• Blurred vision
• Difficulty wearing contact lenses
• Challenges with driving at night due to visual discomfort

These symptoms can significantly impact daily activities and comfort, but they can often be managed with the right treatment.

What is the Treatment for Dry Eye?

Although there is no permanent cure for dry eye, treatments focus on alleviating and managing the symptoms. These methods generally work by either boosting tear production, preserving the tear film, or reducing tear evaporation. Common treatments include:

• Artificial tears (eye drops), These are one of the most frequently recommended treatments by pharmacists and doctors to add moisture to your eyes. Some types work by enhancing the oily layer of the tear film, others improve the watery layer, and some help reduce the discomfort associated with the condition.
• Medications, These are prescribed to help stimulate tear production.
• Lacrimal plugs, These are tiny plugs inserted into the tear ducts to prevent the loss of tears. This procedure is generally painless and reversible.
• Surgery, In severe cases that do not respond to other treatments, surgical intervention may be necessary. This involves permanently blocking the drainage holes in the corners of the eyes, ensuring the eyes retain adequate moisture. Surgery is typically considered only after other treatment options have been exhausted and will require a referral from a general practitioner (GP).

Can Dry Eye Be Prevented?

Dry eye is a chronic condition that does not resolve on its own, and symptoms often worsen with age. However, there are several steps you can take to manage and reduce the symptoms:

• Blink more frequently
• Avoid wind exposure by steering clear of direct airflow from hair dryers, car heaters, air conditioners, and fans.
• Wear sunglasses when outdoors, particularly on windy days.
• Use a humidifier to keep the air moist, especially during the winter months when indoor heating is common.
• Take regular breaks while working on a computer, and position your screen just below eye level. This reduces the wide opening of the eyes and slows down the evaporation of tears.
• If you smoke, make efforts to quit, and avoid being around others who smoke.
• Consult your doctor or pharmacist if any of the medications you are taking could be contributing to your dry eye symptoms.

When Should You Visit Your Doctor?

Dry eye can severely affect your quality of life, making daily activities such as working, reading, or driving challenging. If left untreated, it can lead to complications like eye infections or damage to the surface of the eyes. If your symptoms do not improve with over-the-counter eye drops and lifestyle adjustments, it’s a good idea to visit your doctor. They may suggest additional treatments or therapies to help manage the condition effectively.