The Facts

Dry eye disease (DED), also known as dry eye syndrome or dysfunctional tear syndrome, is a condition that involves the tears and the surface of your eyes. Your eye constantly produces tears which move across the surface of your eye, keeping it moist. People with DED either don't produce enough tears or the tears they do produce evaporate off the eye surface too quickly to keep the eye moist. Some people with DED have both issues. Because of this, your eyes can feel dry and irritated.   

DED is one of the most common conditions seen by optometrists. It affects up to 30% of those over the age of 50. Unfortunately, it is often underdiagnosed because many people believe that having dry eyes is a normal part of aging and that nothing can be done to prevent or treat it.

Causes

DED can result from not enough tear production, poor quality of tears causing evaporation from the eye surface, or a combination of both. If any part of the complex system that produces tears is not working properly, DED can result. As your eye dries, it can lead to inflammation on the surface of eye, making the symptoms of DED worse.

You may have a higher risk of having DED if you are: female, older than 40 years old, wear contact lenses, and have had eye surgery (including LASIK).

DED can also be caused by a variety of diseases, medications, and environmental factors.

Diseases that can cause DED include:

• Sjögren syndrome
• Parkinson's
• diabetes
• psoriasis
• rosacea
• thyroid disease

Certain medications such as some antidepressants, diuretics, beta blockers, anti-histamines, hormone replacement therapy, and retinoids can cause or worsen DED. Additionally, dry, windy, smoky, or cold air can cause eye dryness. Looking at a computer or other electronic device for long periods of time can also lead to DED.

Symptoms and Complications

People with DED often feel like something is in their eye – this is called foreign body sensation. The eye may feel scratchy, gritty, or sandy. Other common symptoms of DED include eyes that burn or look red. Sometimes people are bothered by light (photophobia) and have blurry vision. People with DED can actually have watery eyes. This is the body trying to respond to discomfort in the eye. Unfortunately, these extra tears don't add moisture to the eye.

DED worsens throughout the day. It can come and go for some people, while others have some symptoms all the time.

When not treated, DED can lead to complications that scar the surface of eye, leading to impaired vision.

Making the Diagnosis

Your doctor/optometrist usually diagnoses DED based off your symptoms, an examination, and possibly a few simple tests. Your doctor/optometrist may perform a slit lamp exam which is used to look at different parts of your eye. They may also ask you to answer a questionnaire about your symptoms. Some clinicians may perform more tests including the Schirmer tear test that can measure your tear production or put drops in your eye to check the eye's surface.

Symptoms don't always line up with how dry the eye is. Some people have very dry eyes and no symptoms at all, while others have very bothersome symptoms and tests not show their eye is dry.

Treatment and Prevention

Artificial tears, also called lubricants, are the main treatment for DED. They help to keep the eye moist and relieve the symptoms of DED, but they do not cure the condition. Artificial tears can also help to keep your tears from evaporating off the eye. For more severe symptoms of DED, you may need to use an ointment or gel, which can stay in your eyes longer. They can be purchased without a prescription from your local pharmacy. If you are using the eye drops more than 4 times a day, you should ask your doctor or pharmacist for a preservative-free artificial tear to reduce the risk of side effects that can happen with excessive use.

If over-the-counter options are not enough to help with your DED symptoms, prescription medications may be needed. Anti-inflammatory and cyclosporine eye drops can be used to help reduce inflammation and help with the symptoms of DED. You should continue to use artificial tears while using these eye drops. Treatment and control of DED is important to prevent complications and worsening of the disease as people age.

To help relieve your dry eyes:

• Ensure you are blinking regularly, especially when using a computer or other electronic device.
• Use a humidifier in your bedroom, at your desk, or any space you spend lots of time.
• Avoid sitting in the stream of air from air conditioners or heaters.
• Wear sunglasses outside to protect your eyes from wind and dust.
• Wear moisture chamber glasses to keep the air around your eyes moist.
• Avoid cigarette smoke exposure.
• Take proper care of contact lenses, or switch to daily, disposable contact lenses.