Dry Eye

Dry eye happens when the eyes’ various glands don’t produce enough, or the right type, of tears.

Tears are important because they keep the eyes’ surface moist, cleansed, and protected from dust, debris, and bacteria. They are the eyes’ first line of defense against infections. 

Because the clear, dome-shaped surface of the eyes (cornea) receives and bends most of the light rays, tears are vital for the eyes’ overall health and clear vision.

It’s not enough that the lacrimal glands make sufficient tears; equally important is the production of the right type of tears to keep the cornea nourished.

The cornea lacks blood vessels so it depends on the tear film to keep it healthy and functioning optimally.

The tear film has three layers:

1. Outer oily, lipid layer
Produced by the meibomian glands located below the eyes.

2. Middle watery layer
Produced by the lacrimal glands located above the eyes.

3. Innermost mucin layer
Together with the lacrimal glands, the goblet cells of the conjunctiva (the outer lining of the sclera, or the white part of the eye) secrete mucin. Not only does it hydrate and lubricate the cornea, mucin also ensures that the cells of the eye surface don’t stick together when the eyes blink.

Because the cornea is the eyes’ first layer to interact with the external environment, it is critical that it has its own defense system. The mucin layer wards off harmful organisms that may cause diseases.

The rest of the tear components are made in the ciliary body just behind the iris (the colored part of the eye) and in front of the natural lens. They bring essential proteins, electrolytes, vitamins, and growth factors to the eye surface via the pupil, or the opening in the middle of the iris.

Without sufficient tears, your eyes would feel: stinging or burning, gritty or sandy
excessively moist after periods of excessive dryness, painful and red, fatigued, unable to work on any task that requires sustained visual attention etc.

You may also notice your eyes producing stringy discharge, experiencing blurry vision, or feeling heavy in the eyelids. Because of insufficient tears, your eyes may not be able to cry when you experience strong emotions.

Severe dry eyes can cause scarring of the cornea. While some vision loss may result if dry eye is left untreated, permanent blindness due to dry eyes is rare.

Get your eyes checked right away if you experience severe dryness. Our cornea surgeon, Dr. Ghaznawi, specializes in the medical and surgical treatment of severe dry eye. Schedule a consultation with us today to find out if you qualify.

The first line of dry eye treatment is over-the-counter artificial tears. When they don’t work as well, prescription medications to stimulate tear production or control underlying inflammation may be taken.

Conserving tears is another way to treat dry eye. Eye doctors do this by plugging the tear ducts to keep tears from draining too quickly. These tiny inserts (smaller than a grain of rice) are made of silicone or gel, and they can be removed.

Tears extracted from your own blood may also be used as a supplement. A simple blood draw is performed, after which the blood is spun to separate its components. The resulting autologous serum is then enriched with growth factors, albumin, and vitamin A to encourage the healing of the cornea. Autologous serum tears are well-tolerated by the eyes.

For a more permanent solution to dry eye, surgically transplanting the salivary glands from the lower lips to the area around the eyes may be an option. The saliva, in turn, will function as a natural tear substitute.

Dry eyes occur as a result of an imbalance between tear production and drainage. Environmental exposure to smoke, wind, and dry climate are the most common causes of dry eye. But age, female gender, certain medical conditions such as rheumatoid arthritis or Sjogren’s disease, and medications like antihistamines also increase the likelihood of getting dry eye. People who use computers for long periods of time are also prone to develop dry eye as they often forget to blink, which allows tears to evaporate easily.

Studies have found that food rich in vitamins A, B12, and D can be beneficial to both prevent and treat dry eyes. Additionally, fish and flax seeds are also beneficial for dry eyes as they contain Omega-3 fatty acids, which can reduce eye inflammation. Keeping your blood sugar levels in check minimizes the risk of lacrimal gland dysfunction by preventing diabetes-induced nerve damage.

Vitamins A, B12, and D are all important for eye health. Studies have found a deficiency in vitamin D to be responsible for some cases of dry eyes. While vitamin supplements can be used to improve dry eyes, natural sources of these vitamins such as fruits, vegetables, and sunlight are a much better option.

Dry eyes can cause symptoms such as burning sensations, itchiness, redness, excessive tearing, blurring of vision, discomfort, soreness, and foreign body sensation.

Drinking water and keeping yourself hydrated can make tear production more efficient. However, there are many other factors that are responsible for dry eye. Therefore, being hydrated alone may not be able to treat dry eyes, and other treatments may be essential.

In some mild temporary cases of dry eyes caused by environmental exposure to smoke, wind, or dry climates, dry eyes may improve on their own once you avoid these conditions. But dry eyes that are caused by an underlying disorder are often chronic and usually do not go away on their own.

Dry eyes cannot be cured permanently, but their symptoms can be managed using artificial tears, prescription eye drops, or surgery. Prescription eye drops work by either increasing tear production or by decreasing tear outflow. Other treatment options for dry eye include punctal plugs, which is a minimally invasive procedure that blocks the tear outflow tracts located in the inner corner of the eyes.

Symptoms of dry eyes can also be managed with some natural options such as protection of eyes from smoke, wind, or dry environment. Eating a diet rich in vitamin A, B12, and D can also be beneficial for managing dry eye symptoms. Omega-3 fatty acids can decrease inflammation of the eye, and reduce dry eye symptoms as well.

Apart from causing uncomfortable symptoms such as itching, burning, and soreness, dry eye can also impair vision permanently. Tear films have a nourishing and protective barrier function in the eye. Therefore, deficiency of tear film as seen in dry eyes can make your eyes more susceptible to corneal injury and infections.

Rheumatoid arthritis is an autoimmune condition that has systemic effects on the joints, eyes, heart, lungs, blood vessels, nerves, and muscles. In the eyes, the most common clinical manifestation of rheumatoid arthritis is dry eyes.

Dry eyes are commonly caused by environmental exposure to dry or windy climates, staring at computer screens for long durations without blinking, taking certain drugs such as antihistamines, and so on. But, in some patients, dry eyes may be indicative of an underlying systemic condition such as rheumatoid arthritis, thyroid disorders, or Sjogren’s disease.

Exposure to smoke, dry climates, using a computer for long durations, dehydration, wind, and vitamin deficiencies can make dry eye worse. Dry eyes are worse during the day as tears evaporate more easily during the day from your open eyes.

Dry eyes must be treated before cataract surgery is done to attain tear film and ocular surface stability in order to avoid complications after cataract surgery. For mild to moderate cases, artificial tears and environmental modifications are usually adequate. If cataracts and dry eye are present at the same time, cataract surgeries are usually delayed until the dry eye is managed satisfactorily.