Dry Eye Therapy
Dry Eye (Disease and) therapy
Dry eye is a multi-factorial condition that may have no early symptoms, but typically consists of any or all of the following symptoms: gritty or foreign body sensation, red eyes that are often worse by the end of day, fluctuating vision, tired and/or watery eyes. It is the most common presenting complaint and is considered a chronic, inflammatory condition that requires both monitoring and maintenance therapy. With increased screen time there is an uptick in the prevalence of dry eye disease and is increasingly affecting younger patients. There are a number of treatment options:
- new pharmaceuticals (Restasis and Xiidra)
- artificial tears (preserved and undpreserved)
- autologous serum drops
- scleral lens fittings
- medical procedures such as punctal plugs
- the fitting of amniotic contact lenses in moderate to severe cases
- eyelid cleansing or debridement
- warm compresses
- nutritional supplements such as Omega-3s or other anti-inflammatories
- and light/heat treatment of the meibomian glands) to relieve symptoms and minimize ocular tissue damage.
Blepharitis is another eye condition that can exacerbate dry eye sensation. Wikipedia offers the following definition: “Blepharitis is one of the most common ocular conditions characterized by inflammation, scaling, reddening, and crusting of the eyelid. This condition may also cause burning, itching, or a grainy sensation when introducing foreign objects or substances to the eye. Although blepharitis is not sight-threatening, it can lead to permanent alterations of the eyelid margin. The overall etiology is a result of bacteria and inflammation from congested meibomian oil glands at the base of each eyelash. Other conditions may give rise to blepharitis, whether they be infectious or noninfectious, including, but not limited to, bacterial infections or allergies.”
The tear film is comprised of 3 layers: mucin, aqueous and oil (meibum) that protects the surface of the eye. When the tear film is disturbed from its optimal composition, it results in the symptoms already mentioned. The most common cause of dry eye is secondary to meibomian gland dysfunction (MGD).
Understanding the tear film can help us determine the underlying cause and what needs to be supplemented or addressed.
These are some of the common contributing factors that can lead to chronic dry eye disease:
- Auto-immune disorders such as rheumatoid arthritis, Sjogren’s syndrome, thyroid disease and lupus
- Medicines such as beta-blockers, antihistamines, diuretics, Accutane, glaucoma and anxiety medications
- Refractive eye surgery such as LASIK or cataract surgery
- Contact lens use
- Large eye openings known as the interpalpebral fissure
- bacterial infestation of the eyelids known as blepharitis (see below and one of its treatments)
Other contributing factors that cause dry eye symptoms to worsen can include: dry climates, smoke, wind, low indoor humidity, allergies, decreased blink rates (often seen with computer viewing), menopause, advancing age, entropian and ectoprian (inward and outward misdirection of the eyelids, respectively).
Dry Eyes & Computer Vision Syndrome
Long periods staring at a computer or smartphone screen contributes to dry eyes from a lack of blinking, as previously mentioned. Computer vision syndrome, or CVS, can consist of any of the following symptoms while working on a digital device or computer screen: tired, sore eyes, burning or gritty sensation, blurred or strained vision and watery eyes. Proper screen ergonomics, prescription lenses, and ocular lubricants are some of the tools we have available to alleviate symptoms. A good rule to follow is known as the 20-20-20 rule. For every 20 minutes in front of a digital screen, take a 20 second breaking while looking at something 20 feet (i.e. far) away.