From environmental factors to ocular causes, an optometrist shares the most common causes and treatment tips for dry eyes.
By Stanley Keys and Medically reviewed by Dr Roger Henderson
Sore, itchy and uncomfortable eyes? You could be suffering from dry eye syndrome. While dry eyes can be incredibly frustrating, fortunately complications are uncommon.
Optometrist Stanley Keys looks at dry eye syndrome causes, symptoms and treatment options:
What is dry eye syndrome?
Dry eye syndrome, also known as keratoconjunctivitis sicca or simply ‘dry eyes’, occurs when changes occur to the film of tears that normally keep our eyes moist and lubricated. This becomes more common with age, affecting women more than men, and occurring in around one in three people over 60. The front surface of our eyes is covered by a protective layer called the tear film and this has several important roles including:
- Maintaining eye comfort by providing a lubricating film between the eye and the eyelids when we blink.
- Keeping the front surface of the eye smooth so the vision is clear.
- Washing away any dust or particles from the front surface of the eye.
- Containing cells and enzymes that kill bugs and bacteria, which can cause eye infections.
If this well-balanced tear film becomes disrupted, due to inadequate secretion of one or more of its constituents, it can become unstable and not coat the surface of the eye adequately.
Dry eye symptoms
There are various symptoms associated with a dry eye:
- Dry eye can vary from feeling mildly dry and gritty to feeling very painful in serious cases.
- There can be associated signs, such as watering, crusting and redness.
- Both eyes are usually affected and there may also be occasional very mild and short-lived blurring of vision, although dry eye syndrome does not cause permanent eyesight damage.
Dry eye causes
There are many possible causes of dry eyes ranging from environmental factors – such as working in a dry air-conditioned office, windy conditions, a hot and dry climate and wearing contact lenses – to ocular causes – such as inflammation of the eyelids known as blepharitis, or insufficient tear production.
There are many possible causes of dry eyes ranging from environmental factors to ocular causes.
Women often first develop dry eyes after the menopause, and some medicines such as diuretics (‘water tablets’), some antidepressants, beta-blockers and antihistamines may also trigger the problem.
There may be related systemic conditions such as rheumatoid arthritis, SLE and Sjogren’s syndrome. In most milder cases, the patient can usually manage the problem without needing any professional consultation, using some of the strategies below. However in severe cases, investigation and treatment with the appropriate professional is necessary.
Mild dry eye
In cases where the dryness is a cause of irritation and a nuisance rather than a significant source of pain, the patient can try several things in order to alleviate the symptoms.
- Firstly, try to consider if there’s an obvious cause for the eyes being dry.
- Environmental factors, such as air conditioning, dry heat and prolonged use of a computer, can increase the evaporation rate of the tear film from the eye, leaving it feeling dry and tired.
- Particularly when we use computers, we tend to stare and not blink as often, leaving the eye prone to losing its tear film coverage.
- Similarly outdoors in a breeze, the tear film can become compromised, causing watering and streaming of the tears, but leaving the actual surface of the eye dry.
- If possible, try to remove or control the source of the problem, for example blinking more when using a computer or taking short breaks.
- In the car ensure the air from the vents isn’t directed towards the eyes.
- Outside it can be useful to wear spectacles or sunglasses to prevent the wind from disrupting the tear film. It may not always be possible to do this, so it would be reasonable to think about taking a tear supplement to relieve symptoms.
Dry eye supplements
The best type of supplement for dry eye will depend on the severity of the dry eye symptoms. There’s an ever increasing range of products on the market for people who suffer some degree of dry eye, which can make selecting the best type of product confusing. The easiest way to think of these is that they tend to range in terms of how viscous or thick they are. Typically these products can be bought from a pharmacist or your optometrist and both can advise you on the different products:
- Artificial tear drops or sprays
For very mild dryness, there are artificial tear drops or sprays that give short-term relief of mild symptoms. Then there are drops that contain agents to make them more viscous, with the benefit of remaining on the eye surface for longer and giving prolonged benefit.
- Ocular lubricant gels
In more severe cases there are ocular lubricant gels that can range in viscosity, from those products suitable for throughout the day, to those very thick products, which are mainly designed to be used at bedtime for overnight protection.
- Preservative free eye drops
There are also variations in products as to the type of preservative they contain and some which are actually preservative free. Certain preservatives in eye drops can cause a hypersensitivity or allergic reaction which can leave the eyes red, burny and watery. In these cases products with an alternative preservative, or no preservative should be selected.
The best strategy, if you suffer from a mild to moderate dry eye, is to start with some of the less viscous artificial tear products available. If the drop gives symptomatic relief, the drop can be used as required. If a drop is not fully relieving symptoms or is needing to be used more often than is practical, consider moving to a product that is a little bit more viscous, until the eye feels comfortable. If drops alone don’t seem to be adequate, try a lubricant gel because this will give a longer action, however with the possible drawback of transiently blurred vision.
Moderate dry eye
In cases of moderate dry eye symptoms, it’s probably best that you have your eyes examined to investigate the underlying cause. The first port of call may be your own optometrist. They will be able to assess the front portion of the eye in detail and do a few tests that may reveal the underlying cause.
The optometrist will be able to advise on eyelid cleaning strategies, where the dry eye is associated with an inflammation of the eyelids, known as blepharitis. They will also have a good knowledge of the artificial tears and ocular lubricants that are available and help to instruct you on their use.
Usually in moderate cases, it can take a little bit of time for symptoms to improve once treatment has been initiated. Drops may be required several times daily, often using a combination of artificial tears and ocular lubricating gels.
Severe dry eye
In cases where the dry eye is severe and difficult to keep comfortable, referral to an ophthalmologist with expertise in this field is required. This is important, not just to provide comfort but also to prevent any potential damage that can be caused to the cornea as a result of a very poor tear film.
The corneal surface can become roughened, making the vision blurred and leaving the cornea prone to a dangerous infection. As well as assessing the eye in a detailed way, the ophthalmologist has a wider scope to investigate other potential medical causes for the dry eye.
In cases where the dry eye is severe and difficult to keep comfortable, referral to an ophthalmologist is required.
In severe cases, where the range of lubricant products has been exhausted, measures, such as occlusion of the small tear drainage ducts on the lower eyelid, can be assessed and undertaken by the ophthalmologist. Also in some cases of the dry eye being caused by marked blepharitis, a course of oral antibiotics may be required to bring this under control.
In general, most cases of dry eye are mild and can be attributed to environmental factors and be managed by the patient. If the problems persist, the advice of the optometrist should be sought. In severe cases, which go beyond the scope of the optometrist to investigate and treat, they can refer you to the local ophthalmology department where other causes can be
Dry eyes self-help treatment tips
Try the following tips at home to ease dry eye symptoms:
✔️ Wear sunglasses when in a hot or dry environment.
✔️ Use a humidifier if working in a dry atmosphere.
✔️ If you spend long periods in front of a screen, take regular breaks to rest your eyes.
✔️ If you wear make-up, use a gentle cosmetic remover and always change your mascara regularly.
✔️ Consider taking an omega-3 supplement every day. Some studies suggest fish oils may be beneficial in treating dry eyes although more work still needs to be done in this area. Check with your doctor or pharmacist as to whether these may be suitable for you, and what dose is required.