Symptoms & Diagnosis

Dry eyes are present when there is a deficiency in the lubrication of the eyes due to an abnormality of the tear film. There may be too few tears produced or there may be an abnormality in the smooth distribution of tears over the eye.
Alternatively the tears may evaporate too rapidly.

Punctal Plug (white) protruding from and blocking entrance to tear duct (punctum) in lower eyelid. See below

What Causes Dry Eyes?

The commonest cause is found in women aged 40-50 and over, in whom the tear gland becomes under active probably because of hormonal changes. In other cases inflammatory diseases of the eye and eyelids together with scarring and trauma lead to inadequate lubrication. Certain general diseases such as Rheumatoid Arthritis and Sjogren’s Disease are associated with dry eyes also. Eyelid problems such as scarring and inadequate closure may lead to over exposure of the eye and excessive tear evaporation.

Certain drugs cause dry eyes such as anti-histamines, anti-depressants, Beta-blockers and the Pill.Sometimes the irritation of dryness causes a reflex watering of the eyes which can confuse the diagnosis. Usually these tears are of poor quality and the underlying dryness still needs to be addressed.

When staring at a computer or reading many people complain of gritty eyes. This is due to an unconscious reduction in the number of times we blink per minute, leading to an increased evaporation of tears. If this is made worse by a strong air conditioner nearby, or late at night when we generally produce less tears, symptoms can be very severe.

What Problems Do Dry Eye Cause?

In most cases dryness of the eyes is no more than a nuisance causing a sandy or foreign body sensation in the eyes. In some cases symptoms may be severe and significantly affect quality of life. Others complain of blurry vision when their eyes dry out, which characteristically improves after a blink. Some patients complain simply of tired or red eyes. Generally there are good days and bad days, with symptoms typically worse at the end of the day and at night.

Only in a small percentage of patients complaining of dryness is the situation severe enough to affect the health of the eyes and vision.

The Treatment of Dry Eyes

It is important to understand the nature of the condition and that in most cases, the underlying cause of the problem may be irreversible. The aim of treatment is to make the eyes more comfortable so that they cease to become a source of constant irritation and do not affect quality of life. In most cases this is possible even though patients will always have a tendency towards dry eye symptoms with occasional exacerbations.

It is important to avoid environments in which symptoms are worse such as when sitting close to an air conditioner, very dry atmospheres and smoky rooms.

Artificial tears in the form of eye drops are the basis of treatment, but not the only treatment. When used frequently it is better to use drops without preservatives in the bottle, which can be a source of irritation and allergy. They can be used regularly several times a day or just when symptoms are present depending on severity, and as recommended by your Eye Doctor. Ointments are helpful at night, although may be sticky and blur vision during the day. Gels are less viscous and often have a longer effect than drops. There are numerous products on the market, and what may not help one patient is often excellent for another. All may be purchased without prescription.

Any superficial inflammation of the eyes or eyelids, or eyelid deformation must be treated sometimes with antibiotics and eye hygiene techniques.

Newer drops on the market include strong anti-inflammatory drops which target an underlying chronic inflammation in the tear gland and eyeball surface. Uniquely these drops have been shown to increase tear production, and improve symptoms in about 70% of patients, irrespective of the source of the dryness.

In addition we now have the ability to block off the entrance to the tear duct (punctum) with tiny plugs (see picture above) thereby restricting the drainage of existing natural tears, and reducing the need for eye drops.

Food supplements including omega 3 and 6, essential fat products, have been shown to help many dry eyed patients, are thought to work by improving the quality and quantity of our tears, and reducing associated inflammation.

Newer treatments are generally not covered by usual public health insurance and therefore can work out more costly.

Useful info and health tips

• Do not use medications more often
  or for longer periods than prescribed.
• Wash your hands before instilling medications.
• Do not touch the medication dropper or tube tip to the eye, eyelid, or any other surface.
• Report any medication side effects (red eye, discharge, pain) or worsening symptoms.
• Bring your medications to the next visit.
• Bring all glasses you currently wear.
• Bring medical records if you have them.