Dry Eye Disease

Dry eye is a condition in which a person doesn't have enough quality tears to lubricate and nourish the eye. Tears are necessary for maintaining the health of the front surface of the eye and for providing clear vision.

Dry eye is a common and often chronic problem, particularly in older adults. With each blink of the eyelids, tears spread across the front surface of the eye, known as the cornea. Tears provide lubrication, reduce the risk of eye infection, wash away foreign matter in the eye and keep the surface of the eyes smooth and clear. Excess tears in the eyes flow into small drainage ducts in the inner corners of the eyelids, which drain into the back of the nose. Dry eyes can occur when tear production and drainage is not in balance.

Dry eyes can occur when tear production and drainage are not in balance. People with dry eyes either do not produce enough tears or their tears are of a poor quality:  

• Inadequate amount of tears. Tears are produced by several glands in and around the eyelids. Tear production tends to diminish with age, with various medical conditions or as a side effect of certain medicines. Environmental conditions, such as wind and dry climates, can also decrease tear volume due to increased tear evaporation. When the normal amount of tear production decreases or tears evaporate too quickly from the eyes, symptoms of dry eye can develop. 
• Poor quality of tears. Tears are made up of three layers: oil, water, and mucus. Each component protects and nourishes the front surface of the eye. A smooth oil layer helps prevent evaporation of the water layer, while the mucin layer spreads the tears evenly over the surface of the eye. If the tears evaporate too quickly or do not spread evenly over the cornea due to deficiencies with any of the three tear layers, dry eye symptoms can develop.

Dry eyes can develop for many reasons, including:  

• Age. Dry eyes are a part of the natural aging process. The majority of people over age 65 experience some symptoms of dry eyes. 
• Gender. Women are more likely to develop dry eyes due to hormonal changes caused by pregnancy, the use of oral contraceptives and menopause. 
• Medications. Certain medicines, including antihistamines, decongestants, blood pressure medications, and antidepressants, can reduce tear production. 
• Medical conditions. People with rheumatoid arthritis, diabetes, and thyroid problems are more likely to have symptoms of dry eyes. Also, problems with inflammation of the eyelids (blepharitis), inflammation of the surfaces of the eye, or the inward or outward turning of eyelids can cause dry eyes to develop. 
• Environmental conditions. Exposure to smoke, wind and dry climates can increase tear evaporation resulting in dry eye symptoms. Failure to blink regularly, such as when staring at a computer screen for long periods of time, can also contribute to drying of the eyes. 
• Other factors. Long-term use of contact lenses can be a factor in the development of dry eyes. Refractive eye surgeries, such as LASIK, can decrease tear production and contribute to dry eyes. Advanced dry eyes may damage the front surface of the eye and impair vision.

People with dry eyes may experience irritated, gritty, scratchy or burning eyes; a feeling of something in their eyes; excess watering; and blurred vision. Symptoms include:  

• Redness. 
• Stinging, scratching, or burning sensations. 
• Light Sensitivity. 
• Watery eyes. 
• Stringy mucus near the eye. 
• Blurry Vision.
• Night vision changes.
• Gritty sensation in eyes.
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Dry eyes can be diagnosed through a comprehensive eye examination. Testing with emphasis on the evaluation of the quantity and quality of tears produced by the eyes may include:  

• Patient history to determine the patient's symptoms and to note any general health problems, medications or environmental factors that may be contributing to the dry eye problem. 
• External examination of the eye, including lid structure and blink dynamics. 
• Evaluation of the eyelids and cornea using bright light and magnification. Measurement of the quantity and quality of tears for any abnormalities. 
• Special dyes may be put in the eyes to better observe tear flow and to highlight any changes to the outer surface of the eye caused by insufficient tears. 
• Special imaging of Meibomian glands and tears with Keratograph. 
• With the information obtained from testing, we at Eyecare Experts can determine if you have dry eyes and advise you on treatment options.

What causes Dry Eye?  Dry eye can be influenced by a number of factors related to environment and health that determine tear quality.  

Tears have 3 layers: 

1. A mucus layer, 
2. An aqueous (watery) layer, and 
3. A lipid (oily) layer.  

If there’s an imbalance in these layers, your vision and comfort of your eyes may be affected. For example, if not enough lipid layer is being produced, tears may evaporate too quickly and cause symptoms ranging from discomfort to extra tear production and poor quality of vision.  Poor tear quality is often caused by Meibomian Gland Dysfunction (MGD), a condition that impacts the production of oils in your tears.  The most common form of MGD is obstruction of the oil producing glands in the eyelids. At Eyecare Experts, we will test your tear quality to determine whether MGD is contributing to or causing your dry eye symptoms and create a customized treatment plan to address it.

Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017;15(3):276-283. doi:10.1016/j.jtos.2017.05.008