Dry eye, when there is a deficit of tears

Dry eye syndrome is a very common ocular pathology, in which there is mainly a deficit of tears on the ocular surface. Tear has many important functions for corneal and conjunctival health, and its decrease can lead to significant problems that can range from mild subjective discomfort when using data display screens (computers, tablets…), to corneal ulcers, with permanent vision alterations. It is something that should not be taken lightly and requires a personalized diagnosis and treatment by an ophthalmology specialist.

What may be the causes of dry eye?

There are two types of dry eyes: one is due to a lack of tear production, the other is due to increased tear evaporation.

The latter is the most frequent type. This is because the tear film is made up of different layers (components), two of them being the aqueous component and the more superficial lipid (fat) layer. The lipid layer is formed by glands that reside in the interior of the eyelids, and that pour their liquid fatty content on the edge of the eyelid through small orifices. The function of this layer is to prevent the tear from evaporating earlier than normal. Thus, it is easy to understand that, if this fatty layer does not work properly, we will have dry eye symptoms, not because we do not produce tears, but because they evaporate prematurely.

This happens in blepharitis, a very frequent eyelid pathology in which this fat is very dense, remains for a long time inside the eyelid, oxidizing, and its content, not being liquid, is not able to carry out its function. There is a third type of dry eye, which is mixed, that combines both pathologies.

It should also be remembered that there are systemic diseases, especially autoimmune diseases, which can manifest themselves in the eye as dryness, and there are medications prescribed with high frequency (antihypertensives, anxiolytics, antidepressants) that cause dry eye.

Can dry eye be prevented?

They are alterations with an important genetic component but in which the environment in which we move (environmental humidity, dust, exposure to irritants…), and ergonomics at work (height of the screen, being aware of the need to blink frequently, screen resolution, environmental luminosity, reflections) influence the perceived symptomatology.

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How should dry eye be treated?

Before prescribing treatment, a precise study of the cause, the conformation of the tear (its osmolarity), the type of dry eye and its severity must be carried out. This is done in the clinic, in the dry eye section, which consists of a sophisticated apparatus called Keratograph, which performs the Tenvis test that, in an automated way, allows to see live the internal glands of the eyelids, measure the tear and its quality. In addition, an osmolarimeter is needed, which measures the dissolved salts in the patient’s tears. All this allows for a personalized treatment.

Based on this, the treatment is prescribed. It consists of tear substitutes, remembering here that not all artificial tears are the same, and that each dry eye needs its own individualized one. In addition to artificial tears, at certain times of the pathology, special drops are needed for ocular inflammation, which do not contain preservatives and, if they are necessary in the long term, drops made in specialized laboratories for Ophthalmology, which are not prescribed in the pharmacy, should be included.

In more severe cases it is necessary to use autologous serum, which are drops obtained from the patient’s own blood, or hematic derivatives with growth factors, whose equipment is available in our department.

On the other hand, to dilute the intrapalpebral fat it is necessary to apply pulsed light and modulated light, using the Eye-Light device, a painless treatment that is performed in the same office and is able to reduce eyelid inflammation and promote the formation of a correct palpebral fat.

In addition, Blephex can be used to perform a thorough cleaning of the eyelid margin and remove detritus that may harbor bacteria and toxic substances.

All these devices are only available in ophthalmology clinics highly specialized in ocular surface, such as our Clínica Oftalmológica Pérez Silguero.