Dry eye is a common condition that many patients deal with, ranging from being mildly irritated to having extreme pain. It is a multifactorial malady with many possible treatments.
We offer several ways to assess and treat dry eye disease in our clinic. This article will explain where dry eye comes from and how it is commonly managed.
What Causes Dry Eyes?
Dry eye disease can be categorized into aqueous deficient or evaporative in its underlying cause, but almost all patients with dry eyes have some combination of these factors. Using these terms to describe the condition helps to decide which set of treatments will be most effective for an individual.
These two categories have to do with what part of the tear film is affected, as the tear layer is made up of water and mucous components with an overlying oil layer and many nutrients and minerals dissolved within. All of these have to present for the tear film to function properly and nourish the adjacent eye tissues.
Aqueous deficient dry eye disease arises from a lack of water in the tears due to an issue with the various glands that produce this layer in the eyes. This can result from inflammation, mechanical insult or trauma to the glands that produce the fluid, medications, issues with the nerve pathway that causes the tears to be produced, etc.
Evaporative dry eye results from an issue with the glands in the eyelids that produce the oil component of the tears, leading to greater instability and evaporation of the tear film. This can happen due to dietary changes, medications, hormonal changes, aging, etc.
What Dry Eyes Treatments Are Available?
There are a variety of treatment options available for dry eye disease, some specifically tailored for each type of dry eye described above.
In aqueous deficient dry eye disease, artificial tears are often recommended initially, with preservative-free artificial tears as the best option. These will help replenish the tears that are not being produced at an adequate level.
Punctal plugs are small silicone or collagen plugs that can be inserted either temporarily or permanently into the tear drainage holes at the upper and lower inner corners of the eyelids. This will help to decrease the rate of outflow of the tears and help them stay on the eyes to provide relief.
An ointment can be used overnight to prevent drying of the ocular surface during sleeping hours, especially in people that do not completely close their eyes when sleeping.
In evaporative dry eye disease, preservative-free artificial tears can also be offered. In this case, an artificial tear with more lipid content will be recommended in order to compensate for oil that would have been produced by healthy oil glands.
A daily hot compress is also recommended, as this will help to promote expression of the oil glands. It is important that the hot compress is an eye mask that is able to retain heat for at least ten minutes, rather than a warm cloth that will dissipate the heat within minutes.
Advanced technologies exist for dealing with clogged oil glands, including IPL (intense pulsed light), radiofrequency, etc. These work exceptionally well in moderate to severe disease to quickly and decisively improve symptoms.