Dry Eye: Symptoms, Diagnosis and Treatment

Dry eye is a chronic condition of tear and ocular surface function. It can have multiple causes and is estimated to affect approximately 15% of the world’s population. It usually manifests itself after the age of 45, mostly in women, due to decreased tear secretion or increased evaporation.

Causes of dry eye

There are some characteristic causes of dry eye:
– Age
– Being a woman
– Ocular allergies
– Environmental factors
– Hormonal changes
– Smoking
– Meibomian gland disorders (main cause)
– Fibromyalgia
– Certain systemic diseases, the main one being rheumatoid arthritis, followed by fibromyalgia and diabetes mellitus.
– Migraine headaches
– Certain medications
– History of ocular surgery (first ophthalmologic cause)
– Use of contact lenses

In addition to these, it has also been shown that prolonged reading, due to the related reduction of blinking, may be another cause of dry eye. As the time between blinks increases, tears are not well distributed and evaporation increases. This is increased in patients who wear reading glasses because blinking is reduced even more.

What are the symptoms of dry eye?

In groups of patients who are at risk of developing dry eye, it is important to have a thorough assessment by an ophthalmology specialist to give advice on how to alleviate the symptoms of dry eye and how to plan treatment.

Dry eye alters and causes instability of the tear film, which in turn leads to visual disturbances and discomfort. In general, patients with dry eye have the following symptoms:
– Foreign body sensation
– Irritation
– Blurred vision
– Photosensitivity to light
– Redness of the eyes
– Eye itching
– Tearing

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There are also certain environments in which symptoms are more noticeable, especially those with pollution, smoke or wind. Atmospheric or seasonal variations can also increase symptoms, and even air conditioning and heating produce more sensation of dry eyes. In patients with dry eyes it is recommended not to keep the room closed when the heating is turned on, due to the heat itself, which contributes to the evaporation of tears, increasing the sensation of dryness.

In any case of ocular dryness, rubbing the eyes should be avoided, as this may cause small lesions in the cornea.

How to diagnose dry eye

To diagnose dry eye, a complete ophthalmologic-optometric evaluation must be performed. In this sense, the ophthalmologist will analyze the quality and quantity of the tear film, visualize the cornea with a slit lamp and evaluate the conjunctiva, eyelids and Meibomian glands. This will assess whether the quantity or quality of the tear film has been reduced or there has been injury to the cornea and/or conjunctiva.

Avenues of treatment for dry eye

Although various treatments have been developed to reduce the symptoms of dry eye to make the patient’s daily life bearable, to date there has not been a complete cure.

The main treatment for dry eye is artificial tears or ocular lubricants. In particular, tears containing hyaluronic acid have been shown to be very effective in reducing symptoms. On the other hand, within the different possibilities of administration of tears, gels have a longer lasting and more comfortable effect. Regarding the use of artificial tears, it is important to use them in the correct position to prevent them from spilling and not having an effect. Once inside the eye, it is important to blink several times to redistribute it.

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It is important to note that not all tears are the same and that each patient needs tears that are appropriate for his or her situation.

When artificial tears fail to reduce the symptoms, other treatments will be used, such as punctal obstruction to preserve tears, PRP serum or anti-inflammatory agents, among others.

It is also very important to massage the meibomian glands and clean them carefully.

Treatments based on thermal pulsation systems have also been developed, although the results are not conclusive. When all of the above is not enough because the dry eye is more advanced, scleral contact lenses have proven to be effective due to their larger diameter. These lenses allow the tears to be maintained and delay their evaporation.

On the other hand, the ophthalmologist will recommend cessation of treatments that may increase symptoms and reduce exposure to some natural environments that may also increase them.