Understanding Dry Eye Conditions and How to Manage Them

Understanding Dry Eye Conditions and How to Manage Them

Introduction

Dry eye is an increasingly common condition, affecting approximately 1 in 4 people globally. It occurs when the eyes do not produce enough tears or when the tears evaporate too quickly, leading to dryness, inflammation, redness, and swelling. Factors such as hot, windy environments, contact lenses, and certain medical conditions or medications can contribute to this issue.

At Zenith Pharmacy, we understand how uncomfortable and frustrating dry eye can be. It's a condition that we see quite frequently among our patients, especially those who spend long hours in front of screens, wear contact lenses, or are experiencing hormonal changes, such as menopause. Many of our patients are women over the age of 45, who are particularly susceptible to dry eye due to these hormonal shifts. Our goal is to provide you with the knowledge and tools needed to manage this condition effectively. In this article, we will explore the causes, symptoms, and treatments for dry eye, and share tips on how to maintain healthy, comfortable eyes.

What is Dry Eye?

Dry eye, or dry eye disease (DED), is a condition that occurs when your eyes don't produce enough tears, or the tears you do produce are of poor quality. This can leave your eyes feeling dry, irritated, and uncomfortable. Understanding the components of a healthy tear film can help explain why dry eye happens.

Your tears aren’t just water; they’re made up of three essential layers:

1. Mucin Layer: Imagine this layer as a sticky base that helps the tear film adhere to the surface of your eye. It’s produced by cells in the conjunctiva, which is the white part of your eye.
2. Aqueous Layer: This is the watery part that makes up the bulk of your tears—about 90% of the volume. It keeps your eyes hydrated and maintains a balanced salt level.
3. Lipid Layer: The outermost layer, which is oily, prevents the watery part of your tears from evaporating too quickly. This oil is released by tiny glands along the edge of your eyelids, called meibomian glands.

When any of these layers is out of balance, your tear film can’t do its job properly, leading to the symptoms of dry eye. For instance, if your mucin layer isn't sticky enough, your tears won’t adhere well to your eye’s surface. If your aqueous layer is lacking, your eyes won’t stay properly hydrated. And if your lipid layer is deficient, your tears will evaporate too quickly, leaving your eyes dry and irritated.

 

Causes of Dry Eye

Dry eye can be triggered by a variety of factors, and understanding these can help you identify what might be causing your discomfort.

Environmental conditions play a significant role. Hot, windy weather or spending too much time in air-conditioned spaces can speed up the evaporation of your tears, leaving your eyes dry and irritated. Imagine spending a day in a windy park or sitting in an air-conditioned office all day—it’s no wonder your eyes might feel dry by the end of it.

Wearing contact lenses is another common culprit. While they’re convenient and often necessary, contact lenses can disrupt the normal production and distribution of your tears. Over time, this can lead to discomfort and dryness.

Certain medical conditions can also contribute to dry eye. Conditions like blepharitis (inflammation of the eyelids) and meibomian gland dysfunction (where the oil glands in your eyelids don’t work properly) can lead to poor-quality tears. Additionally, diseases like diabetes can affect tear production.

Medications are another factor to consider. Some common medications, including antihistamines, decongestants, antidepressants, and ocular glaucoma medications, can reduce tear production. If you’ve recently started a new medication and your eyes feel drier than usual, this could be why.

Hormonal changes are particularly significant, especially for women over 45. During menopause, hormonal fluctuations can reduce tear production, making dry eye a common issue in this demographic. Many of our patients at Zenith Pharmacy fall into this category and experience dry eye as a result.

Prolonged screen time can also lead to dry eye. When you’re staring at a screen—whether it’s a computer, tablet, or phone—you tend to blink less frequently. Blinking is crucial for spreading tears evenly across your eyes, so less blinking means more dryness. This is why people who work in air-conditioned offices and spend long hours on screens often experience dry eye symptoms.

In essence, many aspects of our daily lives, from the environments we spend time in, to the medications we take can affect the health of our eyes.

Symptoms of Dry Eye

Dry eye can present itself in various ways, and being aware of these symptoms can help you identify the condition early.

Some of the most common symptoms are burning, stinging, or itching eyes. You might feel like there’s something gritty in your eye, or your eyes may burn or sting, especially in dry environments or after long periods of focus.

One surprising symptom is watering eyes. It might seem strange, but when your eyes are dry, they can actually produce more tears in response to the irritation. However, these tears are often of poor quality and evaporate quickly, failing to keep your eyes properly lubricated.

Blurred vision is another frequent complaint. You might notice that your vision blurs intermittently, especially after reading or using a computer for a while. This happens because the tear film on your eye isn’t stable, causing the surface of your eye to dry out and blur your vision.

Glare sensitivity is also common. Bright lights, whether from the sun or artificial sources, can become particularly uncomfortable when you have dry eye. This sensitivity can fluctuate throughout the day, worsening as your eyes become drier.

Lastly, eye fatigue is a significant issue. Your eyes may feel tired or heavy, especially towards the end of the day. This fatigue can be exacerbated by activities that require prolonged visual attention, like reading or working on a computer.

Types of Dry Eye

Understanding the type of dry eye you have is crucial for finding the right treatment. There are two main types of dry eye, each requiring different approaches:

Aqueous Deficient Dry Eye (ADDE)

This type occurs when your eyes don’t produce enough of the aqueous (watery) component of tears. Without sufficient aqueous layer, your eyes can't stay properly hydrated. Imagine a pond that starts to dry up because there’s not enough rain to fill it—that is essence of what happens with ADDE.

Treatment Options for ADDE:

• Ocular Lubricants: These help supplement the natural tear film and provide temporary relief from dryness.
• Punctual Plugs: Tiny devices inserted into the tear ducts to reduce tear drainage, helping to keep the eye surface moist.
• Bandage Contact Lenses: Special lenses that protect the surface of the eye and help retain moisture.
• Moisture Chamber Goggles: Goggles that create a humid environment around the eyes, reducing evaporation.
• Overnight Gels/Ointments: Thicker preparations applied before sleep to keep the eyes lubricated throughout the night.
• Hormonal/Serum Eye Drops: For late-stage problems, these specialised drops can help improve tear production.

Evaporative Dry Eye (EDE)

EDE occurs when the lipid (oily) layer of the tear film is inadequate, leading to rapid evaporation of tears. Think of it like a puddle that evaporates quickly on a hot day because there’s no protective cover to keep the water from disappearing.

Treatment Options for EDE:

• Omega-3 Supplements: These can help improve the quality of the lipid layer of your tears.
• Oil-Based Ocular Drops/Sprays: These products help replenish the oily layer and reduce evaporation.
• Lid Wipes: Regular cleaning of the eyelids to manage blepharitis and improve the function of the meibomian glands.
• Manuka Honey Drops: Particularly beneficial if rosacea is present on the lower lids.
• Intense Pulsed Light (IPL) Therapy: A treatment that uses light pulses to treat meibomian gland dysfunction.
• Lid Hygiene Therapy: Regular cleaning and maintenance of the eyelids to ensure healthy gland function.
• Oral Antibiotics: In some cases, antibiotics can help treat underlying inflammation and improve gland function.

Diagnosing Dry Eye

One challenging aspect of diagnosing dry eye is that its symptoms often overlap with those of other conditions. At Zenith Pharmacy, we try to accurately determine whether you have dry eye by not only asking about your symptoms but also delving into the frequency and severity of these symptoms. These nuances help us differentiate between dry eye and other potential issues. Here are some examples of questions we might ask to better understand your symptoms.

• Does the itchiness worsen with rubbing? If rubbing makes the itchiness worse, it could be a sign of an allergic reaction rather than dry eye. Allergies typically cause itchiness that intensifies with contact. On the other hand, if rubbing doesn’t change the itchiness, it’s more likely to be related to dry eye or another non-allergic irritation. For some, rubbing may even provide some temporary relief when they have dry eye.
• Did something go in your eye or do you wear contact lenses? Feeling like there’s a foreign body in your eye or experiencing discomfort from contact lenses can mimic dry eye symptoms but usually indicates a different issue that needs to be addressed, such as a foreign body sensation or a lens-related problem. If there’s no foreign body and you don’t wear contact lenses, then dry eye becomes a more likely culprit.
• Is the watering constant or variable? Constant watering might suggest a blocked tear duct, where tears are produced but cannot drain properly, leading to overflow. This is distinct from dry eye, where tear production or quality is compromised, causing intermittent, rather than constant, tearing. Variable watering is more typical of dry eye.
• Does your vision fluctuate? Vision that blurs intermittently is often associated with dry eye because the instability of the tear film can cause blurring that clears with blinking. However, if your vision is consistently blurry, it might be a sign of a prescription issue or a more serious ocular condition like cataracts, which requires entirely different management.
• Is the glare sensitivity getting worse? Increasing glare sensitivity might suggest inflammatory conditions like iritis, uveitis, or keratitis, which typically cause progressively worsening sensitivity. In contrast, dry eye usually causes glare sensitivity that fluctuates, due to the inconsistent nature of the tear film in dry eye patients.

At Zenith Pharmacy, if your answers to these questions indicate that your symptoms are constant and/or getting worse, we will most likely refer you to an eye care professional. Persistent and worsening symptoms are less consistent with a typical dry eye diagnosis and may require more specialised evaluation and treatment.

General Diagnostic Methods

While our team at Zenith Pharmacy can help guide you in understanding your symptoms, a proper diagnosis of dry eye often requires a visit to an eye care professional. Here are some of the methods they might use:

• Slit Lamp Examination: A microscope is used to examine the eye’s surface with special dyes like fluorescein or lissamine green, which highlight abnormalities in the tear film and corneal surface.
• Tear Break-Up Time (TBUT): This test measures how long it takes for the tear film to break up after a blink. A faster break-up time can indicate evaporative dry eye.
• Osmolarity Testing: This measures the concentration of salts in your tears. Higher osmolarity levels can indicate dry eye.
• Meibography: Advanced imaging technology used to examine the meibomian glands in your eyelids. Issues with these glands are a common cause of evaporative dry eye.
• Tear Prism Height: Measuring the volume of the tear meniscus at the lower eyelid margin can help assess tear production.
• OSDI Questionnaire: This is a standardised questionnaire that helps quantify the severity of your symptoms and their impact on daily life.

These methods provide a comprehensive evaluation of your eye health and help tailor a treatment plan to your specific needs. If your symptoms persist or worsen, it’s important to seek a detailed evaluation from an eye care professional.

Managing Dry Eye

We’ve already discussed the various treatment options for each type of dry eye. However, incorporating lifestyle changes can also provide significant relief and improve your overall eye health. Here are some essential tips and strategies that we like to give to our patients:

• Protect Your Eyes: Wear wrap-around sunglasses to shield your eyes from wind and dust.
• Limit Screen Time: Follow the 20-20-20 rule (every 20 minutes, look at something 20 feet away for at least 20 seconds).
• Avoid Irritants: Steer clear of cigarette smoke and other irritants that can worsen dry eye symptoms.
• Use a Humidifier: Keep the air in your home or office moist, especially in dry environments.
• Stay Hydrated: Drink plenty of water throughout the day.
• Warm Compresses: Apply warm compresses to your eyes to help unblock oil glands and improve tear quality.

The Issue with Dry Eye Treatments

Distinguishing between Aqueous Deficient Dry Eye (ADDE) and Evaporative Dry Eye (EDE) can be challenging because many symptoms overlap. For instance, when we ask our patients if their symptoms are worse upon waking, it can often yield the same response for both ADDE and EDE patients, albeit for different reasons. ADDE often results in dry mouth and eyes upon waking, while EDE causes irritation due to blocked oil glands.

Given this issue, we try to recommend a versatile product that can address both types of dry eye. Here’s why a comprehensive treatment approach is beneficial:

• ADDE: Requires enhancement of the aqueous layer with moisture-retaining agents. This includes viscosity enhancers, osmoprotectants, and wound-healing components to address not just dryness but also inflammation and cell damage.
• EDE: Needs improvement of the lipid layer to reduce tear evaporation. This involves oil-based formulations that create a stable tear film and prevent rapid drying.

One such product that effectively targets both layers is Cationorm. We often recommend this product as it is versatile and addresses both ADDE and EDE. Cationorm works by:

• Boosting the Aqueous Layer: Enhances moisture retention and addresses inflammation with viscosity-enhancing agents and osmoprotectants.
• Boosting the Lipid Layer: Provides an oily component that stabilises the tear film and reduces evaporation.

This dual-action approach ensures comprehensive management of dry eye, making it easier for pharmacists like us to recommend a single, effective treatment without needing to precisely diagnose the type of dry eye.

Conclusion

Dry eye is a common condition that can impact your daily life, but understanding its causes and symptoms is key to effective management. At Zenith Pharmacy, we know that diagnosing dry eye can be complex due to overlapping symptoms of Aqueous Deficient Dry Eye (ADDE) and Evaporative Dry Eye (EDE).

Implementing lifestyle changes, such as protecting your eyes, limiting screen time, staying hydrated, and using warm compresses, can significantly alleviate symptoms. However, if symptoms persist or worsen, seek professional advice. As a pharmacy, we’re always happy to help you find the best solutions to keep your eyes comfortable and healthy. We also recommend seeing an eye specialist for a more comprehensive diagnosis and targeted treatment when it is necessary.