Dry Eye Syndrome

Dry eye syndrome is a condition where your tears, also called your aqueous fluid, aren’t able to provide adequate lubrication for your eyes. This can result from not producing enough tears, or from producing tears that don’t work properly. This tear ‘instability’ can lead to inflammation and damage of the eye’s surface. The medical term for dry eye syndrome is keratoconjunctivitis sicca. Studies have revealed that dry eye syndrome is very common, especially in Asian populations. [6]

Having watery eyes in a condition called dry eye syndrome seems confusing, but this is a common symptom of the disorder. When your tears are evaporating too quickly, more and more tears are produced, but they aren’t able to stay on the eyeball so they drip out in the form of weeping tears.

Causes of Dry Eye Syndrome

Common causes and risk factors of dry eye syndrome include:

• older age
• perimenopause and menopause
• certain medical conditions including Sjogren’s syndrome, rosacea, rheumatoid arthritis, lupus, thyroid disorders, or vitamin A deficiency
• over the counter medications including antihistamines, decongestants and heartburn medicines
• prescription medications including hormone replacement therapy, antidepressants, sleeping pills, medications for high blood pressure, acne, birth control, Parkinson’s disease, or beta-blockers for heart problems
• using contact lenses for too long
• nerve damage
• laser eye surgery or cataract surgery
• increased tear evaporation
• decreased tear production
• meibomian gland dysfunction
• blinking less often when you’re concentrating during certain activities, such as while reading, driving or working at a computer
• eyelid problems, such as the lids turning outward (ectropion) and the lids turning inward (entropion)
• allergies
• preservatives in topical eye drops
• windy or smoky conditions or dry air
• vitamin A deficiency

[1][5][9][11]

Self-care & Natural Remedies

There are a number of at-home remedies that may be helpful in treating dry eye syndrome. These include:

Lifestyle adjustments can also make a difference, including the following actions:

• rest your eyes by reducing screen time where possible
• taking frequent breaks while reading
• remember to blink frequently
• practice the 20/20/20 rule when doing activities that could strain your eyes. Stop every 20 minutes and focus your eyes on an object 20 feet away for 20 seconds
• protect your eyes, including wearing wrap-around sunglasses, as these can block dry air and wind along with the bright light
• avoid irritants like pollen and smoke where and when possible
• invest in a humidifier to moisten any dry air near you
• eat a diet rich in vitamin A and omega-3 fatty acids to help produce healthy tears.
  • Omega-3 fatty acids are found in fatty fish, particularly salmon, mackerel, sardines, and anchovies, and some seeds and nuts including ground flaxseed.
  • Vitamin A is found in carrots, sweet potato and beef liver among many other sources. [5] [9]
    

Therapy & Treatment

There is no single diagnostic test for dry eye syndrome. Your eye care provider can use one or several of the following tests to diagnose dry eye syndrome:

Therapies, treatments and interventions for dry eye syndrome include:

• corticosteroid eye drops
• medications that reduce eyelid inflammation
• prescribed ointments for use at night
• cyclosporine A eye drops that treat inflammation in your tear glands
• lifitegrast eye drops are also used to treat inflammation in your tear glands
• varenicline nasal spray stimulates the trigeminal nerve which triggers the production of natural tears
• autologous serum drops, which are custom artificial tears made from your own blood serum (part of your blood)
• punctal plugs (temporary or permanent) where a plug is inserted into the tear drain (punctum) in your lower eyelid, allowing more tears to stay in the eye instead of draining away. Temporary punctal occlusion uses a dissolving plug. If it is effective, a permanent silicone plug can be inserted. [5] [9]
• thermal pulsation therapy massages and warms your eyelids and helps your meibomian glands produce oil
• intense pulsed light (IPL) therapy uses pulses of light to unblock your meibomian glands, opening them up to let the meibum flow. [9]
• therapeutic contact lenses reduce the pain and damage caused by dry eye syndrome by protecting and lubricating the surface of your eye. Soft bandage lenses protect your eyes and help heal any damage to your cornea. Rigid scleral lenses contact the white part of your eye instead of the cornea, so they protect your eyes while also correcting your vision.[9]
  

The Science

Tears act to keep the eye’s surface lubricated and protected. They are made up of three layers:

• A inner mucous layer
• A middle watery layer
• An outer oily layer

The mucous layer helps spread the middle watery layer over the eye’s surface, and keep tears sticking to the eyeball. The watery layer makes up most of our tears. It acts to keep the eye clean by washing away any material that doesn’t belong in the eye. The oily layer, called meibum, is the outer layer of tears. It acts to make the surface of the tears smooth and protects the watery layer from drying up too quickly.

The mucus layer is made in the conjuctiva, or the clear tissue covering the whites of the eyes. The watery layer is made in the lacrimal glands located above each eyeball, and is wiped across the surface of the eye each time you blink your eyelids. Excess fluid drains through the canaliculi into the lacrimal sacs, or tear ducts, that then drain into the nose. This is why your nose will run if you are crying and producing lots of tears that need to drain.

The oily out layer, called meibum, is made in the meibomian glands, small glands that line the top and bottom edges of the eyelids. [2] [11]
Reasons for tear film dysfunction are many, including hormone changes, autoimmune disease, inflamed eyelid glands or allergic eye disease. For some people, the cause of dry eyes is decreased tear production or increased tear evaporation. [1]