Dry eye syndrome is one of the most common eye diseases. As many as 25% of patients who visit an ophthalmologist report symptoms of dry eyes. The disease is caused by the eyes not producing enough tears or the tears disappearing too quickly. This condition often leads to discomfort, visual disturbances and tear film instability. Possible risk factors for dry eyes include advanced age, female gender, smoking, extreme hot or cold weather conditions, low humidity, frequent use of screens, refractive surgery, wearing contact lenses and certain medications. Fortunately, there are a number of therapies that can reduce the symptoms of dry eyes. This increases the quality of life of patients with dry eyes.
- Dry eyes
- Epidemiology
- Causes of eye problem
- Risk factors for eye disease
- Symptoms
- Diagnosis and examinations
- Traditional treatments for dry eye syndrome
- Alternative treatment
- Prognosis
Dry eyes
Every time a patient blinks, he gets a layer of tear fluid over his eyes. This consists of fats (lipids), proteins and a water layer. Dry eyes are possible if the composition is changed. Several factors are thus involved in dry eyes. The condition is associated with increased osmolarity of the tear film and inflammation of the ocular surface. Dry eyes are temporary (episodic) or permanent (chronic). Episodic dry eyes occur, for example, when the patient blinks less due to visual or environmental conditions. This reduces tear production and the composition of the tear fluid, resulting in dry eyes. Chronic dry eyes no longer disappear, causing possible damage to the ocular surface because the tear film no longer provides the protection required for proper structure and function, often resulting in visual impairment.
Epidemiology
The condition has a higher prevalence in patients with autoimmune diseases such as Sjögren’s syndrome. Dry eyes affect more women and the elderly. Postmenopausal women and women who use the contraceptive pill (hormone replacement therapy) in particular have a significantly higher risk of dry eyes. Various figures about the exact prevalence circulate in the medical literature. The number of adults suffering from dry eyes in Western culture is estimated to be between 5 and 20%.
Causes of eye problem
Understanding the etiology and pathogenesis of dry eye has increased significantly since the early 2000s. An important step forward is the recognition of the two separate elements of the disease, namely tear evaporation and insufficient tear production. Medical science now better understands the separate and simultaneous roles these two elements play in dry eye.
Risk factors for eye disease
Dry eyes appear more quickly due to various environmental factors.
Contact lenses
In addition, dry eyes worsen with incorrect contact lens hygiene, such as wearing contact lenses for a long time.
climate
Climatic and environmental factors such as humidity, indoor climate, pollution, aviation and extreme temperatures also play a role in the prevalence of dry eyes. With low humidity such as in the office environment, with air conditioning in extremely cold or hot weather, etc., the prevalence of dry eyes increases and vice versa. The indoor air is therefore quite “dry and cool” with a humidity of about 40%. This percentage is better for the eyes than a humidity percentage below 30%. Furthermore, exposure to sunlight (summer period), dust and wind worsens or accelerates dry eyes. In the autumn the symptoms are often more prominent than usual.
Various medications increase the risk of dry eye syndrome / Source: Stevepb, Pixabay
Medication
Many risk factors play a role in dry eyes. Certain medications used, such as some antihistamines and antidepressants, aggravate or lead to dry eyes.
Medical treatments
Several months after refractive surgery such as laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK), patients exhibit significantly more dry eyes.
Smoking
Smoking also increases the risk of dry eyes
Vitamin deficiencies
A vitamin A deficiency is more likely to lead to dry eyes.
Heavy strain on the eyes
Furthermore, visual tasks such as computer use, watching television and reading for long periods of time also increase the risk of dry eyes.
Blurred vision occurs with dry eyes / Source: Nufkin, Flickr (CC BY-2.0)
Symptoms
A patient usually experiences burning eyes, stinging eyes and/or gritty eyes with something foreign in them. Sometimes, however, a patient is unaware of dry eyes and the ophthalmologist makes the diagnosis anyway. However, a patient usually shows one or more of the following symptoms:
- burning eyes
- dry eyes
- irritated eyes
- feeling that there is something constantly in the eyes
- sensitive to bright light (photophobia)
- itchy eyes
- inflamed eyes (eye inflammation)
- eye pain when blinking
- Red eyes
- visual impairment
- tired eyes
- see spots
- blurred vision
Diagnosis and examinations
An ophthalmologist, optician or contact lens specialist carries out a comprehensive eye examination to provide a definitive answer to the diagnosis of dry eyes. He thoroughly examines the eye fluid and the cornea. The Research Fund Cornea Center Netherlands, in collaboration with the VU Medical Center, has created special measuring glasses that measure the evaporation rate of tear fluid. The temples of the glasses contain fine, sensitive sensors for measuring evaporation. This makes it possible to draw up a better treatment plan for the individual patient.
Traditional treatments for dry eye syndrome
Address risk factors
To choose the appropriate topical treatment, the ophthalmologist looks at the underlying cause of the disease, the age and gender of the patient. He also takes into account concomitant medications such as antihistamines or hormone replacement therapy and the presence or absence of an inflammatory eye disease.
The comprehensive treatment approach for dry eye focuses on the various potential risk factors. First of all, a patient should wear glasses that reduce the evaporation of tears, such as good cycling glasses that are closed at the sides. Another type of lenses can also be tried. It is also best to change the air vents/humidity at home, in the office and in the car. In addition, it is best for a patient to stop smoking and exposure to tobacco smoke is also prohibited, as this destabilizes the tear film and reduces tear production. There are also some tips regarding foods. Patients should consume less alcohol as this causes dehydration and worsens the symptoms of dry eyes. Omega-3 fatty acids, fish oil, linseed oil and caffeine improve the tear film so this is definitely recommended. If possible, a patient avoids diuretics and systemic antihistamines. In addition, it is best for the patient to use as little medication as possible as many contain preservatives that damage the epithelial cells and the tear film. Sometimes patients benefit from artificial tears (ointment, gel or eye drops).
Approach to (eye) disease
If possible, an ophthalmologist will also treat the (eye) disease that causes dry eyes, such as blepharitis (inflammation of the eyelid margins). Occasionally he performs a surgical procedure to temporarily or permanently close the tear drainage duct (tear fluid occlusion). In this way, the existing tear fluid remains present for as long as possible. In severe cases he removes the tear glands.
Alternative treatment
Some alternative and newer treatments are available for dry eye syndrome. The patient would be well advised to discuss this first with an ophthalmologist.
Acupuncture
For some patients with dry eyes, no tips or treatments help. Therefore, in their desperation, they sometimes switch to an alternative treatment. Traditional treatments and tips ease the symptoms of the disease, but do not solve them. A possible alternative is therefore acupuncture. This is an ancient Chinese method of using fine needles to prick specific points on the body to alleviate or even temporarily or permanently eliminate the symptoms of dry eyes. Acupuncture also brings the body back into balance. This treatment method is said to improve energy supply to the eyes and tear glands.
More and especially larger-scale research is needed into acupuncture for dry eyes. Many scientific studies provide conflicting results. Some studies conclude that acupuncture helps, but the figures are often based on small clinical studies. In a clinical study in which one group of patients received acupuncture treatment and the other group received a placebo acupuncture treatment, there appeared to be no significant differences between the two groups. Researchers do not yet agree on the influence of acupuncture on dry eyes.
Acupuncture in itself is certainly not unsafe. However, there is always a chance of some minor complications. Occasionally, infection occurs at the site of the needle injection, but this is very rare for trained physicians. Also, acupuncture does not work well for some patients while it works for others, but it is not clear why this is the case.
Eye implant
An eye implant for dry eyes may provide a solution to dry eye syndrome.
Castor oil
Castor oil eye drops reduce tear evaporation in dry eye syndrome
Omega 3 fatty acids
Omega 3 fatty acids further reduce the incidence of dry eyes.
Prognosis
Dry eyes are often of a chronic nature. The burden for the patient cannot be underestimated. The condition significantly affects work productivity, quality of life, visual function, daily activities, and social and physical functioning. Unless dry eyes occur only episodically, the burden of dry eyes reduces the quality of life for many patients.
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