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What is Dry Eye Syndrome?

Below, we’ll take a look at what dry eye is, what causes it, how it’s diagnosed and how it can be treated. And along the way, we’ll also answer some frequently asked questions you may have.

What is Dry Eye Syndrome?

Dry eye syndrome takes on a number of different names – its medical name is keratoconjunctivitis sicca, but you’ll more often hear it referred to as dry eye disease or even “dry eyes”. This condition occurs when your eyes aren’t producing tears correctly, or the tears that are being produced aren’t the right consistency, which causes them to evaporate too rapidly. Along with dry eye, you may find that the surface of the eye also becomes inflamed. And, if left untreated, this can lead to scarring on the cornea, ulcers, painful eyes and partial vision loss. However, the permanent loss of sight is incredibly rare with dry eye syndrome. Sometimes, you may find certain activities are difficult when you’re suffering from dry eyes, including reading or using a computer for long periods of time. You may also find your eyes aren’t as tolerant of dry environments as they used to be, such as being on an aeroplane.

The Types of Dry Eye Syndrome and Their Symptoms

There are two types of dry eye syndrome: Aqueous Tear-Deficient Dry Eye Syndrome – A disorder whereby the lacrimal glands (where tears are produced) don’t produce enough water in order to help retain a healthy surface on your eyes. Evaporative Dry Eye Syndrome – This can result when your meibomian glands (the glands responsible for producing the oily or lipid parts of your tears) become inflamed. The oil in your tears helps to keep them stable and slows down the evaporation process. Dry eye syndrome can be associated with a number of conditions, including:
  • Any disease that affects the components that make up your tears
  • Inflammation of the conjunctiva, lacrimal gland or the surface of the eye
  • Cosmetic surgery – when the eyelids are opened too far
  • When the surface of the eye is increased, e.g. in thyroid disease, the eye starts to protrude forwards

What Are the Symptoms of Dry Eye Syndrome?

For the majority of people, the symptoms of dry eyes are relatively mild, but, in more severe cases, it can be painful and may lead to further complications. Symptoms tend to affect both eyes, and can include:
  • Burning and red eyes
  • Feelings of soreness, grittiness or dryness, which get worse as the day goes on
  • Eyelids that are often stuck together when you wake up in a morning
  • Blurred vision, which is better after you’ve blinked
  • Periods of excess tears, which follows a dry spell
  • Heavy eyelids
  • Uncomfortable sensations when wearing your contact lenses
  • Struggling to read or carry out tasks that require extended periods of concentration with your eyes
  • Stringy discharge
If you are experiencing mild symptoms on a regular basis, you should seek the advice of your optician. They will be able to check for the condition and may refer you to an ophthalmologist. However, if you have any severe symptoms, you should seek urgent medical attention.

What Causes Dry Eye Syndrome and Who’s at Risk of It?

Dry eye syndrome can occur if the quality of your tears is affected or a process within your tear production is disrupted. There is a whole host of reasons as to why this can happen, but a single cause may not be found. Some of the potential causes are as follows:

Hormonal Changes

Hormones are chemicals that are produced by your body, and they can have a powerful influence on the body’s processes, including tear production. The production of your tears is stimulated by hormones. Therefore, when these hormone levels change in women, it can increase their risk of developing dry eyes. These hormonal changes can occur when they’re taking the contraceptive pill, are going through menopause or they’re pregnant.

Ageing

Older people are more likely to suffer from dry eye syndrome, and this may be due to the fact they’re producing fewer tears. Their eyelids may also start to ineffectively spread tears over the eyes’ surfaces.

Activities and the Environment

A drying effect that causes your tears to evaporate can be caused by a number of different environmental factors, including high altitude, hot blowing air, a dry climate, the wind and the sun. Several activities can also contribute to the condition, including working with a computer, writing, and reading. This is because, when people are doing something that requires visual concentration, they tend to blink less. As a result, the tear film drains away or evaporates more quickly than it’s restored.

Medications

Certain medications are also thought to include the side effect of dry eye syndrome, including diuretics, beta-blockers, antidepressants, and antihistamines.

Laser Eye Surgery

Following certain types of laser eye surgery, some people have developed dry eye syndrome in the weeks that follow their surgery. However, most cases do tend to clear up after a few months.

Contact Lenses

The eye can sometimes become irritated by contact lenses. But these symptoms can often be resolved if you limit how often you wear them or change to a different lens. You may also want to try using preservative-free eye drops or changing your cleaning solution.

Medical Conditions

Your risk of developing dry eye syndrome may also be increased by an underlying medical condition. A lot of people who have the condition also have meibomian gland dysfunction (MGD) or blepharitis. These result in an inflammation of the eyelid margins, which can block the meibomian glands from producing enough oil for the tear film. Blepharitis can occur in healthy people and at any age, but it may also be as a result of a bacterial infection or condition such as rosacea (a skin condition that makes the face appear blotchy and red). Those who suffer from the following may also be at an increased risk of developing dry eyes:
  • Allergic Conjunctivitis
  • Contact Dermatitis
  • Sjӧgren’s Syndrome
  • Rheumatoid Arthritis
  • Lupus
  • Scleroderma
  • Bell’s Palsy
  • HIV
  • A previous serious trauma to the eye – e.g. exposure to radiation or burns

How is Dry Eye Syndrome Diagnosed?

Your local GP or optician can carry out an eye examination which will confirm whether or not you have dry eyes, and will then be able to advise you on the appropriate treatments. Sometimes, the diagnosis may be uncertain, or you may require specialised tests and treatment plans. If this is the case, you will be referred to an ophthalmologist – a specialist eye surgeon. They may conduct a number of tests, which will establish the quantity and quality of your tears. These include:

Fluorescein Dye Test

The specialist will use specialist yellow-orange dye eye drops so they can see your tears clearly. This helps them establish how long it is before your eye dries out. This test will also show up any damage to the surface of your eye. But the dye is only temporary, so it won’t transform the colour of your eye for good!

Schirmer’s Test

Some tiny strips of blotting paper are placed over your lower eye. They’re left in this position for five minutes before they’re removed and examined. If during the five minutes, the paper has wetted no more than 10mm, this demonstrates you have dry eye syndrome.

Lissamine Green Test

This uses a paper strip which has special dye on it – lissamine green. Before it is placed onto the surface of your eye it’s diluted in a saline solution. As it makes your eye go green, it allows the ophthalmologist to see whether there is any damage to your eye’s surface.

How Can Dry Eye Syndrome Be Treated?

Unfortunately, there isn’t a cure for dry eye syndrome, but the symptoms can be controlled through effective treatments. During your life, you may experience recurring episodes of dry eye syndrome. The treatment you receive will depend on what’s causing it – an underlying condition, tears that are evaporating too quickly or a decreased production of tears. The first thing to consider will be whether any of the aforementioned factors, e.g. medication, could be causing the symptoms. If it’s being caused by an underlying condition, your doctor will prescribe the best treatment for this, or they may refer you to the required specialist. Sometimes, dry eye syndrome can be prevented or eased by improving your diet, keeping your eyes clean and changing your environment.

Lubricant Treatments for Dry Eye Syndrome

Cases of dry eyes that are described as being mild to moderate can often be treated with a number of lubricant eye treatments, including ointments, gels, and drops. These treatments are often described as ‘artificial tears’ because they help to replace water that’s missing from your tears. However, these treatments don’t contain the nutrients, vitamins, and antibodies that are contained in your natural tears and are paramount to your eye health. A lot of these lubricants are available as over-the-counter medications from your chemist. You may find that you need to try various different gels and drops to find the one that’s most suitable for you. And sometimes, you may need to use a few different types at the same time to achieve the best effect. However, if you do wish to make changes to your treatment, you should discuss this with your doctor or optician.

Preservative-Free Eye Drops for Dry Eye Syndrome

To prevent harmful bacteria from reproducing inside a bottle, some eye drops will contain preservatives. However, if it’s necessary for you to use eye drops over six times a day, you should opt for eye drops that are free from these preservatives. This is particularly crucial if you’ve been described as having ‘severe dry eye disease’ by your ophthalmologist. Over a long period of time or in large quantities, these preservatives can start to damage the delicate cells that are found on the eye’s surface, and this can also lead to inflammation. Preservative-free eye drops may also be necessary if you wear soft contact lenses because the preservatives can damage your eyes as they attach to the contact lenses. These types of drops can be more expensive than others. And if you do struggle to administer them correctly, there are certain devices available that can help, including single dose containers and squeeze bottles.

Oily Tear Eye Drops for Dry Eye Syndrome

An increasing amount of eye drops that help reduce evaporation from your eye’s surface and replenish the oily component of your tears are being used. These include liposomal sprays and synthetic guar gums. Available over the counter or by prescription, liposomal sprays are sprayed onto the edge of your eyelids when they’re shut. Then, when you open your eyes, a new oily film is created as it spreads across the surface of your eyes. These types of drops are especially useful if your dry eyes are as a result of your tears evaporating too quickly or you have blepharitis.

Eye Ointments for Dry Eye Syndrome

These types of treatments can also be used to keep your eyes moist and lubricated during the night. Even while you’re asleep your tears can still evaporate if your eyelids aren’t closed fully. However, these ointments are normally only recommended for night use due to the blurred vision they often cause. You shouldn’t use them when you’re wearing contact lenses either and may need to seek an alternative treatment.

Anti-Inflammatory Treatments for Dry Eye Syndrome

For many, long-term dry eyes are caused because the areas in and around the eye have become inflamed. Therefore, one of the below treatments may be recommended, but your ophthalmologist will be able to advise of this after your appointment.

Corticosteroid Eye Drops and Ointments for Dry Eye Syndrome

These medications boast powerful anti-inflammatory properties that can be administered as ointments or eye drops when dry eye syndrome cases are more severe. However, a third of people who use these do have side effects, which include increased pressure in the eye and cataracts. Therefore, this group of treatments should only be offered if you’re being seen regularly by an ophthalmologist at your local hospital. If you aren’t going to follow-up appointments at the clinic, you shouldn’t use them.

Oral Tetracyclines for Dry Eye Syndrome

Tetracyclines in low doses can be used to reduce inflammation for a minimum of three months but can be used for much longer. The most common form is doxycycline, but there are others (e.g. lymecycline and oxytetracycline) that can be prescribed.

Ciclosporin Eye Drops for Dry Eye Syndrome

This is a medication that can be used for severe dry eyes that aren’t responding to other treatments, as it suppresses your immune system. You will only be able to receive this treatment from an ophthalmologist in a hospital eye department.

Serum Eye Drops for Dry Eye Syndrome

In very rare cases where nothing else has worked, serum eye drops may be needed. These are incredibly specialist eye drops as they’re made from your blood or that of a donor. To make these drops, a unit of blood is taken before the blood cells are removed from it. The serum that’s remaining is then placed into eye drop bottles.

Surgery for Dry Eye Syndrome

If you have failed to respond to any of the above treatments, surgery may be considered. There are two types that can be used to treat dry eye syndrome:

Punctal Occlusion

This involves using small punctal plugs to prevent your tears from draining out of your tear ducts by sealing them. This should keep your eyes moist. At first, temporary silicone plugs are used to make sure the procedure is working. If it is, these can be replaced with permanent plugs. In severer cases, the tear ducts may be cauterised (sealed with heat). This permanently seals the hole where your tears drain from to increase how many tears are on the surface of your eyes.

Salivary Gland Autotransplantation

Often used as a last resort, this is an incredibly uncommon procedure. It involves removing some of the glands from your lower lip that are responsible for producing saliva, before placing these around your eyes under the skin. The saliva these glands produce acts as a substitute for your tears.

Conclusion

If you think you’ve developed dry eye syndrome, you should seek the advice of your optician straight away. They may refer you for treatment, but, in a lot of cases, making some simple changes to your lifestyle can help ease the symptoms you’re experiencing. Even if you haven’t got dry eye syndrome, being aware of the factors that can cause dry eyes will enable you to take the necessary steps in preventing this from developing.

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