Say bye bye to dry eye

Dry eye is a condition many people experience for a variety of reasons. However, dryness in the eyes may be aggravated by the lack of moisture in the air during winter and extra heat blasting in our cars, homes and offices.

 

Dr. Michael Henry
Dr. Michael Henry, former Chief of Ophthalmology at NYGH

Itchy and irritated or gritty eyes, as well as stinging and burning, are common symptoms of dry eye. There may be discharge, pain and redness in the eye or a feeling of heavy eyelids and even blurred vision.

“Chronic dry eye is actually a disease caused by low-grade inflammation causing reduced lubrication and moisture on the surface of the eye,” says Dr. Michael Henry, former Chief of Ophthalmology at North York General Hospital's Cataract High Volume Centre, who also has a private practice. "Dry eye relates to the quality of the tear film on the surface of the eye. In fact, it's ironic, but excess tearing is also a symptom of dry eye. A lot of people complain that their eyes are tearing too much, but if the eyes are dry and sore this can result in reflex tearing leading to an overabundance of tears.”

Two major factors contribute to dry eye

When you blink, a film of tears spreads over the eye, making the surface of the eye smooth and clear. Without this tear film, great vision is not possible. We can think of the tear film consisting of three layers, each with its own purpose: a watery layer, an oily layer and a mucus layer. 

There are two major factors contributing to dry eye disease:

1) reduced tear production from the lacrimal glands, and 2) too rapid evaporation of those tears when not enough oil is produced by the meibomian glands (30-40 glands in the upper lid and 20-30 glands in the lower lid), which normally coat the surface of the tear film. A lack of mucous production can also be a contributing factor to dryness.

Many causes for dry eye 

While winter dryness and excess heat may cause dry eye symptoms, they can also occur because of several environmental conditions and health-related issues such as:

  • Windy, smoky, or dry environments which increase tear evaporation
  • Side effects of many eye drops and systemic medications
  • Seasonal allergies
  • Autoimmune disorders, such as rheumatoid arthritis and Sjögren's syndrome, thyroid disorders, and diabetes
  • Conditions that cause an irregular surface of the cornea
  • Hormonal fluctuations during pregnancy and menopause
  • Laser eye surgery that may cause temporary dry eye symptoms.

Although people of all ages may complain of dry eye, it is even more prevalent in older populations. Age is associated with a decline in tear production. Dr. Henry says that as people get older, the meibomian glands tend to atrophy and are not able to produce as much oily secretions, thus leading to excessive tear evaporation.

“Additionally, when people are talking, they can blink up to 14 times per minute,” says Dr. Henry. “But when using a computer or any other digital device, we tend to blink a lot less — maybe only three to four times per minute —  and there is more opportunity for tears to evaporate. Remember to glance around to give your eyes a rest and blink to moisten them.”

woman with hand on eye
Itchy and irritated or gritty eyes, as well as stinging and burning, are common symptoms of dry eye.

How to ease the discomfort

There are a number solutions that reduce the discomfort of dry eye and ease symptoms.

Topical treatments and medications

  • Artificial replacement tears such as those with hyaluronic acid are very soothing.
  • Microbead masks (warmed in the microwave for a few seconds) and placed to warm the eyelids for five to seven minutes help loosen up oily secretions from the meibomian glands.
  • Restasis and Xiidra are topical medications (drops) that increase the production of natural tears. Restasis can take between three to four months to start relieving symptoms; however if started early enough before the winter months, dry eye sufferers have significantly less discomfort when winter arrives. Xiidra is faster acting and may give relief of symptoms in just a few weeks.

Oral treatments

  • Take certain Omega 3 fatty acid supplements (not alcohol-based capsules). 
  • Eating fatty fish like salmon, mackerel, herring, trout and sea bass a few times per week is just as good or better than the Omega 3 supplements.

Surgery

  • Generally, surgery is not a treatment for dry eye sufferers. However, punctal occlusion with punctal plugs can be used to temporarily or more permanently close off your tear drainage channels and allow for better retention of your natural tears. There are lid surgeries to tighten up loose lids that can be associated with dry eye symptoms as well.

New diagnostic techniques and treatment

New diagnostic techniques for dry eye include checking tear osmolarity (or level of tear saltiness) and infrared technology that takes pictures of the meibomian glands to assess their quality and quantity. Such tests are able to identify the cause of the dry eye and thus help better target treatments. Novel treatments are making their way onto the market, such as True Tear, a neuro stimulator inserted two to three times per day into the nose to produce more tears (currently not available in Canada). Intense pulsed light (IPL) therapy and Lipoflow are available products used to heat and massage the eyelids to improve meibomium gland secretions into the tear film.

“For any issues with your eyes, it's best to see a doctor as soon as possible for a diagnosis,” says Dr. Henry. Find out when you should see an ophthalmologist on the Canadian Ophthalmological Society website.

This article first appeared in the March 2018 issue of The Pulse. 

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