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Keratoconus - Frequently asked Questions: Dry Eyes
 
 
Dry Eyes FAQs
Produced Exclusively for KC Global
 

What are the symptoms of dry eye?

Dry Eye symptoms are often mistaken for allergies or seasonal discomfort. They can include:

  • Stinging
  • Burning
  • Scratchy Sensation
  • Foreign body Sensation
  • Sensitivity to Light
  • Tearing
  • Tired Eyes
  • Contact Lens Discomfort/Irritation
  • Blurred Vision
  • Eye and Eyelid redness
  • Pain

While these symptoms may aggravate Dry Eye Disease, they are not the cause.

 

What causes dry eye?

Environmental:

Hot, dry and/or windy climates, high altitudes, excessive sun exposure, central heating, air conditioning, cigarette smoke, air pollution, air travel.

Contact Lens Wear:

In the United States, two million people a year give up on wearing contact lenses. 50% of these contact lens “dropouts” say its due to dryness or discomfort. If you have Dry Eye Disease, your doctor can prescribe a specific lens for your condition or prescribe treatment to allow you to wear your lenses more comfortably.

Diseases:

Some diseases associated with dry eye disease are; Keratoconus, Diabetes, Parkinson’s disease, Sjögren’s syndrome, Rheumatoid arthritis, Lupus, Lacrimal Gland Deficiency, Blepharitis, Stevens-Johnson syndrome, and Rosacea.

For patients suffering from Keratoconus, dry eye is often a result of the corneal irregularity and is aggravated by the continual and prolonged use of contact lenses.

Medication:

It is important that your eye doctor knows your medical history and all of the medications that you take. Some medications known to aggravate dry eye disease are:

  • Allergy medications (antihistamines and decongestants)
  • Decongestants
  • Antidepressants (SSRIs or Selective Serotonin Reuptake Inhibitors)
  • Blood pressure medication (antihypertensives and diuretics)
  • Birth control pills (sex hormones such as estrogen)
  • Pain medication (ibuprofen, naproxen)

Gender and Hormonal Changes:

Women older than 50 are more prone to dry eye than their male counterparts. Post-menopausal women experience hormonal changes that affect ocular health. Thyroid conditions are also known to cause dry eyes while pregnant women may experience pregnancy-induced dry eye due to hormone level changes.

Eye Surgeries:

Dry Eye is the most common complaint following LASIK surgery. Symptoms occur in nearly all LASIK patients; however, they tend to be temporary for the majority. Tear quality will return to normal within 6 to 9 months of appropriate dry eye treatment. For the rest, chronic dry eye symptoms become debilitating and affect daily life activities.

Some patients have reported a negative reaction to eye drops used after cataract surgery. In addition, cataract patients tend to be older and have a higher incidence of preoperative dry eye than their younger counterparts.

 

What can I do to prevent or control symptoms?

Dry eye is the result of a low amount of natural lubrication and moisture in your eyes; as a consequence, you can follow these tips to minimize your chances of developing Dry Eye Disease.

  • Remove contact lenses before irritation becomes constant. Even when contacts are kept well lubricated, they are still the cause for an increase dryness of the eye. Give your eyes a rest in between wears as well.

  • Use a humidifier to maintain a proper level of humidity in your home or office.

  • Dry Eye sufferers experience an increase in symptoms when in dry and arid climates. If you know you’ll be traveling to a dry location, bring eye drops with you.

  • Blink! Every time you blink, a new layer of moisture coats and refreshes your eyes.

  • Another way to refresh your eyes is to apply cold compresses to your eyes for a few minutes. Also, there is a reason why home-made beauty masks contained cucumbers, if you apply a couple of slices to your eyes they will gain moisture and feel refreshed.

 

Who’s at risk?

Although Dry Eye Disease can occur at any age, there is a certain demographic that is at a higher risk of developing dry eye. Women outnumber men 3 to 1, and because of menopause-related hormonal changes they are at the highest risk for dry eye. Women who experience an early onset of menopause are more likely to damage the eye surface because of chronic dry eye symptoms.

People suffering from certain diseases such as Keratoconus, Diabetes, Sjögren’s syndrome are also at risk (see Dry Eye causes).

 

How do you find out if you have dry eye?

If you are experiencing some of the symptoms associated with dry eye (see symptoms) you should have an eye exam and ask the doctor to test for Dry Eye. There are various tests that can determine if you have dry eye.

The following is a list of the most commonly used dry eye tests:

  • TearLab Osmolarity Testing: The test is simple and completely pain free. A small quantity of tear film is collected using a testing card placed on a small hand held device that that briefly rests on the corner of the lower eyelid. Fast and accurate results are provided in seconds using only 50 nanoliters (nL) of tear film to diagnose Dry Eye. The osmolarity is calculated and displayed as a quantitative numerical value. A patient with an Osmolarity level of over 308 is considered to have dry eyes.

  • The Schirmer Test: A piece of filter paper is placed over the conjunctival sac of your eye for five minutes. It will absorb an amount of tears and the resulting amount will be compared to a “normal” result. Schirmer Tests are not conclusive and often two or three attempts are needed to verify initial findings and conclude on a positive diagnosis.

  • Phenol Red Threat Test: It gets its name because of the colour of the dye used in the test. A cotton thread containing phenol red dye is placed in the lower eyelid fornix. The thread will change colours from yellow to red as it absorbs tears and the length of this section will be measured in millimeters in order to diagnose dry eye. Anything less than 9 millimeters will be considered dry eye.

  • The Fluorescein Breakup Time Test: This test can easily detect how long eyes stop producing tears. Just like in the Phenol Red Threat Test, a strip – this time containing fluorescein – is placed in the lower eyelid fornix and it is left there for 15 seconds. The patient then blinks three times and looks forward. A cobalt-blue light is used to detect the first appearance of tears after the last blink. Fluorescent tear breakup time of less than 10 seconds is consistent with dry eyes.

 

What is the difference between dry and watery dry eye?

There is no difference between watery dry eye and dry eyes; one is a consequence of the other. Watery eyes on dry eye patients is a natural reaction from your body. When eyes become dry and irritated the brain receives a distress signal and it prompts the lacrimal glands to rush to the rescue and produce tears to moisture the irritated ocular surface, so many tears in fact that it may look like you are crying. These tears; however, do not have the same consistency as the real tears that coat your eye on a daily basis and will only provide temporary comfort.

Other reasons for watery dry eyes include the blockage of the ducts that would normally drain away your tears. Smoke or dust in the air can also trigger an overproduction of tears as they are the body’s defense mechanism against infection and expelling debris.

 

What is the difference between mild and chronic dry eye?

Mild:

Mild dry eye symptoms are often confused with allergy symptoms because they can come and go, flaring up only after long hours on a computer or while in arid environments. Bloodshot eyes, inflammation, stinging, teary eyes…these are all common symptoms. A proper eye exam will be able to tell you if you suffer from mild dry eye. Your doctor will most likely prescribe you tear drops to help with symptoms – use them sparingly. Your eyes can easily get accustomed to the drops and it will affect your moisture balance, eventually increasing your symptoms.

As a cautionary note, avoid using Visine-type products to treat the redness in your eyes. These products contain tetrahydrozoline or naphazoline, which act as vasoconstrictors shrinking the outer blood vessels in the white parts of your eye and depriving it of oxygen (this is how they reduce the redness), once you stop using the drops; however, they will ask your brain for more oxygen to repair the damage, enlarging the blood vessels again and in turn making your eyes redder than before. This is known as the “rebound effect” and your eyes will eventually need more and more product to achieve the same effect.

Chronic:

The symptoms that accompany chronic dry eye are debilitating. Your eyes are burning, itching, irritated, light-sensitive, crusty, and in some cases you can’t keep your eyes open long enough to work or drive. It affects your quality of life drastically. Patients develop a dry eye routine that is in place 24/7, it becomes an ongoing battle with symptoms flaring up when you think relief has been found.

Because tears’ main functions besides lubrication is to protect your eyes from bacteria and dust, having chronic dry eye means your eyes are exposed to infection and you need to clean them daily in order to relieve symptoms.

 

What are the treatments?

Over-the-counter Tear Drops & Ointments: Artificial teardrops are available over the counter and there are various brands to choose from. No one drop works for everyone and many patients will go over 6 or 7 of them until they find the right formula that treats their specific symptoms. Drops need to be used sparingly to prevent a moisture imbalance. Chronic dry eye sufferers; however, will need to keep moisturizing their eyes even when symptoms are not present. For some patients, dryness occurs mostly at night, thicket lubricants or gels can be applied overnight to ease symptoms. 

Prescription Eye-Drops:

Restasis (Cyclosporine Ophthalmic) - Ophthalmic cyclosporine is used to increase tear production in people with dry eye disease. Cyclosporine is in a class of medications called immunomodulators. It works by decreasing swelling in the eye to allow for tear production. Your doctor can determine if Restasis is the right treatment for you and monitor your treatment using a test like the TearLab test.

Temporary and permanent punctal occlusions:

When tears evaporate or drain too fast, it is necessary to block the tear ducts to prevent tear drainage. Your doctor will be able to identify if plugs are needed. They will first insert temporary plugs that will dissolve over a few days into the tear drain of the lower eyelid. This painless procedure will be able to tell the doctor if permanent plugs will increase eye lubrication. Permanent plugs are made out of silicone and contrary to their name they can be removed. If everything goes well, the patient will experience an improvement in symptoms and their need for artificial tears will be reduced.

Medicine:

Dry Eyes could also be caused by an infection and inflammation of the oil glands in the eyelids, this is called meibomitis. Antibiotics can treat this condition and thus treat dry eyes. It is also important to note that certain medications can also cause dry eye, in that case, discontinuing the drug will generally stop symptoms. Make sure you consult with your doctor before stopping any medication.

Scleral Lenses:

While scleral lenses are mainly used to treat eye diseases such as Keratoconus or Stevens-Johnson syndrome, they can also help patients with chronic dry eye to retain moisture. Scleral lenses improve the overall quality of life of chronic dry eye patients as it reduces pain and photophobia.

Moisture Chamber Goggles:

They look like regular glasses with a thick frame, but they help trap moisture around the eyes and some of them contain moisture chambers that slowly release moisture for up to 6 hours. In addition to the added moisture, these glasses help protect your dry eyes from air currents, dust, and light sensitivity if you opt for the dark lenses with UV protection.

Surgery:

In some rare cases, the tear ducts need to be permanently close to allow more tears to remain in the eye. If permanent plugs alleviate symptoms, then surgery to permanently close the ducts by cauterization can be done using local anesthetic with no limitations after surgery.
Treatment of an underlying condition: Dry Eye can also come as a consequence of an underlying systemic or ocular condition. For example, pregnant women have experienced dry eye because of hormonal changes, women going experiencing menopause have also experienced dry eye symptoms also because of hormonal changes.

Multivitamins and Supplements:

While they are not considered a “treatment”, certain vitamins and supplements are known for having a positive effect when treating dry eye disease. Vitamins A and E, for example, act as antioxidants that boost up the body’s immune system and help prevent damage to skin, liver, heart, eyes, bone development. Omega-3’s are also recommended as an anti-inflammatory agent that can help restore function to the glands that help provide lubrication to the eye.

 

Can dry eye be cured?

While mild dry eye symptoms may come and go sporadically, Dry Eye Disease has no cure. Its symptoms can be managed through various treatment options to the point where sufferers are able to maintain an acceptable quality of life. It is important that patients are educated on the disease and understand that it requires long-term therapy.

 

Complied for KC Global with thanks to Adriana.

 

Dry Eyes

For Patient and Professional support for Dry Eyes

 

Dr Arthur Cummings
M.B. Ch.B, MMed(Ophth), (Pret), F.C.S.(S.A), F.R.C.S.Ed
Consultant Ophthalmologist

Dr Richard Corkin
M.B Ch.B. (Cape Town), F.C.S. (Ophth) SA, M.R.C. (Ophth)
Consultant Ophthalmologist 

Wellington Eye Clinic
Level 2, Suite 36,
Beacon Hall, Beacon Court,
Sandyford, Dublin 18,
Ireland.

Tel: + 353 1 293 0470
Fax: + 353 1 293 5978

Web: www.wellingtoneyeclinic.com
E-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

 

FAQ reviewed by Dr Authur Cummings and Dr Dr Richard Corkin on the 9th of February 2012.

With acknowledgments going to the contribution provided courtesy of TearLab. The TearLab Osmolarity System, the first objective and quantitative test for diagnosing and managing dry eye disease.

 

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