Dry Eye: Frequently Asked Questions
This article is for people who either suspect they have dry eye, or are newly diagnosed with chronic dry eye, or have suffered from dry eye for some time and are just starting their quest to learn more about it and search for better solutions.
What is dry eye?
A: Dry eye is a catch-all term referring to abnormalities of the tear layer which normally coats the surfaces of the eyes, providing clear vision and protecting sensitive surface tissues. Other names for dry eye include dry eye syndrome, chronic dry eye, dry eye disease, and keratoconjunctivitis sicca.
Dry eye does not mean your eyes are “dry” – in fact, many people who suffer from dry eye have chronically watery eyes. Dry eye means there is something wrong with your tear film.
The human tear film is complex, consisting of an aqueous (watery) layer with a thin lipid (oily) layer on top to retard evaporation and a thin mucous (sticky) layer underneath to help it adhere properly to the surface of the eye. Each of the three layers has a different source, and disruption to any one or more of the three tear film layers may interfere with the process of routine lubrication of the eye surface. These disruptions, if prolonged, may cause one of the conditions that fall into the “dry eye” bucket.
What can cause dry eye?
A: There are many different causes of the conditions collectively referred to as dry eye syndrome, including:
Environment (dry climates, air conditioning, pollution, wind)
Auto-immune diseases (e.g. Sjögrens Syndrome, rheumatoid arthritis, lupus)
Surgeries on the eyes or eyelids (e.g. blepharoplasty, LASIK, LASEK, PRK, corneal transplants, etc.)
Medication side effects
Other medical treatments
What are typical symptoms of dry eye?
A: Symptoms vary greatly. Some symptoms, such as watery eyes, are surprising. Some of the most common symptoms experienced by dry eye patients:
Feeling like there is something in your eye (foreign body sensation)
Scratchy, gritty eyes
Aching or sore eyes
Smarting or burning eyes
Sensitivity to light (photophobia)
Eyes tire easily, particularly noticeable from reading, watching TV or using a computer
Contact lens discomfort or intolerance
Excessive mucus discharge
Eyes easily irritated by smoke, allergans, fragrances, etc.
Blurred vision, particularly first thing in the morning, and/or late in the day
Eyelids “stick shut” at night
Eyelids feel “heavy”
How are dry eyes tested and diagnosed?
A: The most frequently used tests for dry eye are the Schirmer lacrimation test (where a small strip of paper is placed in the eye), which is intended to measure aqueous tear production, and the tear break-up time test, which can help doctors identify tear film instability. Corneal staining is also increasingly used. No other tests are as standardized and widely employed, but there are some emerging technologies attempting to change this, and there are some valuable but infrequently employed existing technologies such as meibography which can yield very important diagnostic information about meibomian gland function.
It is widely acknowledged at least at academic levels that there is a poor correlation between clinical testing for dry eye and the symptoms patients experience. In other words, you may truly be suffering from dry eye disease without having test results that seem to back this up. For this reason, we at The Dry Eyey Zone are strong advocates for the use of an excellent self-diagnostic survey called the Ocular Surface Disease Index, a scientifically validated 20-question survey which produces a score based upon commonly recognised symptoms and their severity and helps patients communicate more effectively with their doctors.
What treatments are available for dry eye?
A: Treatments need to be tailored for the type of dry eye. While some treatments attempt to treat the source, with moderate to severe dry eye it is almost always necessary to use treatments and products which reduce the symptoms so that the life-impact is lessened.
Some of the best-known treatments are:
Lubricants (artificial tears, gels and ointments)
Restasis (prescription eyedrop to treat inflammation)
Protective eyewear and other environmental controls
In addition, there are many lesser-known treatments ranging from autologous serum eyedrops to the Boston Scleral prosthetic lens, and there are many drugs in some stage of development which may eventually be available for dry eye treatment.
What is the role of artificial tears (and gels and ointments)?
A: It is essential to the health of the eye that the eye surfaces remain lubricated. A dry eye ocular surface results in eye injuries (erosions and abrasions) which can progress to ulceration in severe cases, and can seriously compromise vision.
Nearly all dry eye patients, irrespective of what other treatment(s) they may be using, need to use eye lubricants to protect their eyes and to reduce discomfort. For daytime use, this means artificial tear supplement. Some patients use thicker products, such as gels or ointments, at night.
What are punctal plugs and cautery?
A: The eyes have four drains, called puncta, through which tears (which are constantly renewed) exit. These are in the lower and upper corners of the eyelids nearest the nose.
For patients whose dry eye symptoms are caused primarily by a deficiency in the water (aqueous) part of their tears, stopping the drains (called punctal occlusion) can sometimes help improve the symptoms. There are two ways to do this: using small plugs, or permanently sealing the openings with cautery. There are also temporary collagen plugs, which dissolve by themselves, which can be placed in order to test the likelihood that silicone plugs or cautery will be helpful and will not result in tear overflow (epiphora).
What is lid therapy and how can it help me?
A: For many patients, part or all of the problem causing their dry eye conditions may be meibomian gland dysfunction – a deficiency in the oily part of their tears which is supposed to slow evaporation of the tears. This can be treated by improving the secretions from the meibomian glands. Oral antibiotics and/or flaxseed or fish oil supplements may help. For many patients lid treatments may be a more acceptable or more immediately effective method. Lid therapy involves improving eyelid hygiene to reduce inflammation and heat treatment as well as (sometimes) massage to get the meibomian gland secretions liquefied and moving.
I’m just in so much pain I don’t know what to do. Help!
A: Getting pain under control so you can function is, for some patients, one of the hardest tasks. Participating in internet forums like Dry Eye Talk is a great way to share ideas about what to do when things get really rough. Check out our pain management page for some specific tips and then come to the forum to see what other things patients have come up with to manage pain.
I’ve experienced depression since the onset of dry eye syndrome. Is that unusual?
A: There are several reasons chronic dry eye can lead to clinical depression. Dry eye patients need to be on the alert, understand why they may be susceptible to depression and why this is normal, and speak with both their eye doctor and their GP about their concerns.
First, the pain can be constant and severe. Most people who have never had dry eye or a serious eye injury have no conception how much pain the eyes are capable of producing. It can drive one to distraction. When chronic, it is a constant drain on one’s coping resources. Second, there is a direct and sometimes dramatic impact on lifestyle. Outdoor activities, for example, may become impossible, because of irritation from air/wind and/or because of extreme light sensitivity. Work, especially in air-conditioned or heated offices and with fluorescent lighting, not to mention working on a computer, can be far more difficult to get through. Third, appearance can be affected. Chronically red eyes are unsightly. Women may find they can no longer tolerate cosmetics near their eyes. Fourth, and perhaps most stressful of all, good medical care is so very difficult to get! Finally, there may be special factors at play depending on the individual cause of dry eye syndrome; for example, patients who got dry eye from LASIK surgery or as a side effect from a drug may struggle with the suddenness of the change, with self-blame, or with resentment over not being informed of the risks.
If you are struggling with depression and/or anxiety, this is normal even if prolonged but it does get better. Joining a support group is a good idea so that you can spend time with others who truly understand what you are going through.