Dry eye, also known as keratoconjunctivitis sicca, is a common condition where the eyes feel dry, scratchy, or irritated. It affects a lot of people, especially those who spend long hours on screens, wear contact lenses, or are older. Despite its common occurrence, many people don’t recognize it as a real problem. It can be frustrating for both patients and doctors because the symptoms vary widely, and it’s tough to treat.

What is Dry Eye?

Dry eye happens when the tears that keep our eyes moist don’t work properly. This can lead to discomfort, blurred vision, and irritation. The International Dry Eye Workshop (DEWS) defines it as a disease that affects both the tears and the surface of the eye, causing symptoms like discomfort and visual disturbance.

Recent studies have shown that inflammation is a key cause of dry eye. This inflammation is often triggered by the immune system, especially by T-cells (a type of white blood cell). This finding has helped shape new treatments that focus on reducing this inflammation, rather than just addressing the dryness with eye drops.

What Causes Dry Eye?

Several factors can lead to dry eye, and many of them are linked to inflammation. The immune system can attack the eyes, disrupting tear production and causing damage to the eye’s surface. Age, especially for women after menopause, and hormone changes play a big role. Other factors that worsen dry eye include:

• Wearing contact lenses for long periods.
• Spending long hours in front of a computer or screen.
• Living or working in dry, air-conditioned environments.
• Using medications like antihistamines or certain eye drops.

The eyes may also become drier in certain weather conditions, such as windy or very hot or cold environments.

The Inflammation Cycle

In dry eye, the problem often starts with a disruption in the tear film that covers the eye. This causes irritation, which leads to inflammation. When the immune system senses the irritation, it sends inflammatory cells to the eye, which makes the problem worse. This creates a vicious cycle where inflammation causes dryness, and dryness causes more inflammation. It’s a loop that can result in serious damage if not treated.

Diagnosing Dry Eye

To diagnose dry eye, doctors look for both symptoms and signs of damage to the eye surface. Common symptoms include a gritty or sandy feeling in the eyes, burning, itching, and blurry vision. Doctors also use tests like the Schirmer test (which measures tear production) and special dyes to see how the eye surface is affected.
Dry eye can be classified into three levels:

• Mild: Dryness without noticeable damage to the eye.
• Moderate: Some visible damage to the eye surface, like small erosions.
• Severe: Significant damage, like ulcers or infections.

Treatment Options

Tear Substitutes (Eye Drops):

The most common treatment for dry eye is lubricating eye drops, which help temporarily relieve dryness. These are often made from substances like cellulose or hyaluronic acid, which help the tears stick to the eye. However, some eye drops contain preservatives, which can irritate the eye with long-term use, especially for people with moderate to severe dry eye.

Anti-inflammatory Medications:

Recent research has shown that inflammation plays a major role in dry eye, so treatments that reduce inflammation are now a key focus. Medications like cyclosporine A work by stopping immune cells from damaging the eye surface. This approach addresses the root cause, not just the symptoms.

Punctal Occlusion:

This is a procedure where small plugs are inserted into the tear ducts to keep tears from draining away too quickly. It can be a helpful option for people who don’t respond to other treatments.

Lifestyle Changes:

Simple changes can make a big difference in managing dry eye. These include:

• Taking regular breaks when using screens.
• Using a humidifier in dry environments.
• Wearing sunglasses or glasses with side shields to protect the eyes from wind and dust.

Surgical Options:

In rare cases, surgery may be necessary. One option is tarsorrhaphy, where the eyelids are partially sewn together to reduce tear evaporation.

New Treatments and Future Directions

Researchers are continually exploring new ways to treat dry eye. Some of the latest treatments include:

• Omega-3 Fatty Acids: Found in fish oil, these help reduce inflammation and may improve dry eye symptoms.
• Autologous Serum Drops: These are made from the patient’s own blood and can help reduce inflammation and promote healing.
• New Drug Therapies: Other medications, like hydroxychloroquine and tetracycline, are being tested for their ability to reduce inflammation in the eye.

Dry eye is more than just a minor inconvenience. It can seriously affect your quality of life if left untreated. While lubricating eye drops are still widely used, newer treatments are focusing on tackling the inflammation that causes dry eye. If you suffer from dry eye, talk to your ophthalmologist about newer options that target the underlying causes of the disease, not just the symptoms. With the right treatment, it’s possible to break the cycle of dryness and inflammation and get relief.

Our Focus Is On You!

When you come to us as a patient at Barth Vision & Optical, we will begin your treatment with a comprehensive eye exam that will employ the most advanced, state-of-the-art diagnostic equipment available. This new year, make healthy eyes a priority and set your sights on a lifetime of good vision. Make an appointment today to find the best treatment for your needs!