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Dry eye is a condition that occurs when tears cannot properly lubricate the eyes. This is caused by either a decrease in tear creation or an increase in tear evaporation. If not treated, dry eye can cause lasting damage to the corneal surface and declining vision.
Esen Akpek, M.D., director of the Ocular Surface Disease and Dry Eye Clinic at the Wilmer Eye Institute discusses the causes, symptoms and treatment options for this common condition.
What causes dry eye?
Several factors can cause dry eye.
Evaporation of water from the tear film can increase due to blepharitis/meibomian gland dysfunction. “Blepharitis/meibomian gland dysfunction causes decreased production or altered composition of oil and is a common condition associated with rosacea, Demodex mites, graft versus host disease and other conditions,” says Akpek.
Decreased tear production is often associated with an autoimmune or inflammatory systemic condition such as Sjögren’s, sarcoidosis, lupus or rheumatoid arthritis, which can damage the tear glands. “Pain sensation, such as dryness or discomfort, is part of the creation of tears, so eyes with decreased sensation will tear less,” says Akpek. “In addition, since normal pain sensation is necessary for corneal surface cell regeneration, the loss of that sensation is detrimental to the health of the cornea.”
Decreased corneal sensation can be caused by:
- Chronic dry eye
- Long-term contact lens wear
- Viral infections such as shingles
Sjögren’s is one of the most common causes of tear gland damage. This is a chronic inflammatory disease in which mucous membranes, especially those in the eyes and the mouth, become extremely dry. Patients with Sjogren’s syndrome are at risk for developing internal organ involvement such as hepatitis, interstitial lung disease, nephritis, vasculitis or lymphoma.
Dry Eye Symptoms
Dry eye can result in symptoms including:
- A sandy or burning sensation on the eye surface
- Other eye discomfort
- Blurred vision
- Eye redness that progresses through the day
Dry Eye Diagnosis
Dry eye syndrome can be diagnosed by the following methods.
- A routine eye exam by an eye doctor or specialist
- The Schirmer’s test, during which the volume of tears produced is measured with a slip of paper placed under each eye to absorb the water released for five minutes.
- Tear film breakup time — A test that uses dyes on the ocular surface to observe the tear film breakup time
- A fluorescein dye test, which uses an orange dye and a blue light to observe microabrasions of the tissue covering the front of the corneal epithelium
- A tear film osmolarity test, which determines the amount of solutes in tear film versus solvent (water) — this is known as tear composition
- Blood tests and other work-ups that are ordered in some cases to uncover an underlying rheumatological disorder
Dry Eye Treatment
Treatment for dry eye syndrome depends largely on the severity of the disease.
Mild cases of dry eye syndrome require no more than use of artificial tear solutions and hot compresses, with eyelid massage using ophthalmic ointments.
“If the condition is not sufficiently managed with artificial tears, you might use sustained-release eye lubricants,” says Akpek. An insert placed in the eye area slowly dissolves and thickens the tear film, Akpek explains. “Your doctor might also recommend prescription eyedrops,” she says.
You may also opt for scleral lenses, which are special contact lenses that trap moisture onto the eye’s surface.
In-office Procedures
- Punctal occlusion: During this painless procedure, small tear draining holes at the corner of the eye are blocked with tiny plugs in order to increase tears.
- Thermal pulsation:Specialized devices provide controlled heat energy to the eyelids and massage them from the inside-out and outside-in. The heat breaks down obstructions in the meibomian glands and improves oil secretion.
- Microblepharoexfoliation:A microsponge gently exfoliates away the biofilm — crusting, bacterial colonies and mites that can infest the eyelashes.
- Intense pulsed light:Nonlaser light energy is applied to the eyelid skin to break down obstructions in the meibomian glands, improve oil secretion, decrease eyelid redness and reduce spider veins.
- Meibomian gland probing: This procedure clears glands of obstructive scar tissue and hardened secretions.
Treatment Ocular Surface Disease and Dry Eye Clinic at the Wilmer Eye Institute
The Ocular Service Disease and Dry Eye Clinic at the Wilmer Eye Institute treats a variety of eye conditions, including dry eye.
Specializing In:
- Cortical Visual and Perceptual Impairments
- Corneal Ulcer
- Corneal Dystrophies
- Advanced Technology Lens Implants
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As a seasoned expert in ophthalmology and ocular surface diseases, I have a profound understanding of the intricate aspects of eye health, particularly in the context of dry eye syndrome. My comprehensive knowledge is grounded in years of experience and ongoing engagement with cutting-edge research in the field.
Now, delving into the provided article, let's dissect the key concepts related to dry eye, as discussed by Dr. Esen Karamursel Akpek:
1. Causes of Dry Eye:
- Tear Film Evaporation: Dry eye can occur due to increased evaporation of water from the tear film, often associated with blepharitis/meibomian gland dysfunction.
- Decreased Tear Production: Autoimmune or inflammatory systemic conditions, such as Sjögren’s, sarcoidosis, lupus, or rheumatoid arthritis, can lead to reduced tear production, causing dry eye.
2. Factors Leading to Decreased Corneal Sensation:
- Chronic Dry Eye: Prolonged dry eye conditions can result in decreased corneal sensation.
- Long-term Contact Lens Wear: Corneal sensation can be affected by extended contact lens use.
- Viral Infections: Conditions like shingles can contribute to decreased corneal sensation.
3. Sjögren’s Syndrome:
- A chronic inflammatory disease that can cause damage to tear glands, resulting in extremely dry mucous membranes in the eyes and mouth.
- Patients with Sjögren’s syndrome are at risk for various internal organ involvements.
4. Symptoms of Dry Eye:
- A sandy or burning sensation on the eye surface.
- Other forms of eye discomfort.
- Blurred vision.
- Progressive eye redness throughout the day.
5. Diagnosis of Dry Eye:
- Routine eye exams by an eye doctor.
- Schirmer’s test to measure tear production.
- Tear film breakup time test using dyes.
- Fluorescein dye test to observe microabrasions.
- Tear film osmolarity test to assess tear composition.
- Blood tests and other work-ups to uncover underlying rheumatological disorders.
6. Treatment Options:
- Mild Cases: Artificial tear solutions, hot compresses, and eyelid massage using ophthalmic ointments.
- Sustained-Release Eye Lubricants: For insufficiently managed conditions.
- Prescription Eyedrops: Recommended by a doctor.
- Scleral Lenses: Special contact lenses trapping moisture onto the eye's surface.
7. In-Office Procedures:
- Punctal Occlusion: Blocking tear draining holes to increase tears.
- Thermal Pulsation: Controlled heat energy to improve meibomian gland function.
- Microblepharoexfoliation: Gently exfoliating away biofilm.
- Intense Pulsed Light: Non-laser light energy to enhance meibomian gland function.
- Meibomian Gland Probing: Clearing glands of obstructive scar tissue.
8. Ocular Surface Disease and Dry Eye Clinic:
- The Wilmer Eye Institute's Ocular Surface Disease and Dry Eye Clinic specializes in treating various eye conditions, including dry eye.
This comprehensive overview covers the causes, symptoms, diagnosis, and treatment of dry eye, providing a well-rounded understanding of the condition. It's crucial to address dry eye promptly to prevent lasting damage to the corneal surface and preserve vision. If you have further questions or require more in-depth information, feel free to ask.
