Dry eyes

Description

Dry eye disease is a common condition that occurs when your tears are not able to provide adequate lubrication of the eyes. Tears can be inadequate and unstable, for many reasons. For example, dry eyes may occur if you do not produce enough tears or if you produce poor-quality tears. This instability of the tear leads to inflammation and damage of the surface of the eye.

Dry eyes feel uncomfortable. If you have dry eyes, your eyes may sting or burn. You may experience dry eyes in certain situations, such as in an airplane, in an air-conditioned room, while riding a bike or after looking at a computer screen for a couple of hours.

Treatments for dry eyes may make you feel more comfortable. These treatments can include lifestyle changes and drops for the eyes. It is likely that you will have to take these measures indefinitely for the control of the symptoms of dry eyes.

Symptoms

The signs and symptoms, which usually affects both eyes, may include:

  • An itching, burning, or itching sensation in the eyes
  • Abundant mucus in or around the eyes
  • Sensitivity to light
  • Redness of the eyes
  • The feeling of having something in your eyes
  • Difficulty wearing contact lenses
  • Difficulty with night driving
  • The tearing of the eyes, which is the body's response to irritation of dry eyes
  • Blurred vision or eye fatigue

When to see a doctor

Consult your health care provider if you have had prolonged signs and symptoms of dry eyes, including redness, irritation, tiredness or pain in the eyes. Your provider may take steps to determine what's bothering your eyes, or refer you to a specialist.

Causes

Dry eyes are caused by a variety of reasons that disrupt the healthy tear film. The tear film has three layers: the fatty oils, aqueous, fluid and mucus. This combination usually keeps the surface of your eyes lubricated, smooth and clear. Problems with any one of these layers can cause dryness in the eyes.

Reasons for the tear film dysfunction are many, including hormonal changes, autoimmune diseases, inflammation of the eyelid glands or allergic eye disease. For some people, the cause of the dryness of the eyes is the reduction in tear production or increased tear evaporation.

The decreased production of tears

Dry eyes can occur when you are unable to produce enough liquid tears, also called the aqueous humor. The medical term for this condition is keratoconjunctivitis sicca (ker-uh-toe-kun-junk-tih-VY-tis SIK-uh). The common causes of decreased production of tears, which include:

  • Aging
  • Certain medical conditions, including Sjogren's syndrome, allergic eye disease, rheumatoid arthritis, lupus, scleroderma, graft versus host disease, sarcoidosis, thyroid disorders or deficiency of vitamin a
  • Certain medications, such as antihistamines, decongestants, hormone replacement therapy, antidepressants, and drugs for high blood pressure, acne, birth control and Parkinson's disease
  • Corneal nerve desensitivity caused by contact lens use, damage to nerves or laser eye surgery, although the symptoms of dry eyes associated with this procedure are usually temporary

The increase in tear evaporation

The film of oil produced by small glands on the edge of the eyelids (meibomian glands) may be clogged. Blocked meibomian glands are more common in people with rosacea or other skin disorders.

The common causes of increased tear evaporation, which include:

  • Posterior blepharitis (dysfunction of the meibomian glands)
  • Blinking less often, which tends to occur with certain conditions, such as Parkinson's disease; or when we are going to concentrate on certain activities, such as reading, driving or working on a computer
  • Eyelid problems, such as the tops of the outer turning (ectropion), and the tops of turning inward (entropion)
  • Eye allergies
  • Preservatives in topical drops
  • The wind, the smoke or air dry
  • The deficiency of vitamin a

Risk factors

The factors that make it more likely that you will experience dry eyes include:

  • Be greater than 50. Tear production tends to diminish as you get older. Dry eyes are more common in people older than 50 years.
  • The fact of being a woman. A lack of tears is more common in women, especially if they are experiencing hormonal changes due to pregnancy, use of birth control pills, or menopause.
  • Eating a diet that is low in vitamin a, which is found in liver, carrots and broccoli, or low in omega-3 fatty acids, found in fish, nuts and vegetable oils.
  • Wear contact lenses or have a history of refractive surgery.

Complications

People who have dry eyes may experience these complications:

  • Infections of the eyes. Your tears protect the surface of your eyes from infection. Without the adequate amount of tears, you may have an increased risk of infection in the eyes.
  • The damage to the surface of your eyes. If left untreated, severe dry eyes may lead to eye inflammation, abrasion of the corneal surface, corneal ulcers and vision loss.
  • The decline in the quality of life. Dry eye can make it difficult to perform everyday activities, such as reading.

Prevention

If you experience dryness in the eyes, pay attention to the situations that are most likely to cause your symptoms. Then, find ways to avoid these situations in order to prevent dryness in the eyes of the symptoms. For example:

  • Avoid air blowing in your eyes. Not directly, hairdryer, car heaters, air conditioners or fans to your eyes.
  • Adding moisture to the air. In winter, a humidifier can add moisture to dry indoor air.
  • Consider the use of wraparound sunglasses or other protective eyewear. Safety shields can be added to the top and the sides of the glasses to block the wind and dry air. Ask about the shields of where you purchase your glasses.
  • Take eye breaks during long tasks. If you are reading or doing some other task that requires visual concentration, periodic eye is broken. Close your eyes for a couple of minutes. Or flash repeatedly for a couple of seconds to help spread your tears evenly over your eyes.
  • Be aware of your surroundings. The air at high altitude, in the desert and in the aircraft can be extremely dry. When the expenditure of time in an environment such as this, it can be helpful frequently close your eyes for a few minutes at a time to minimize the evaporation of the tears.
  • Position your computer screen below eye level. If the computer screen is above the level of the eyes, it'll open your eyes wider to the view of the screen. Position your computer screen below eye level so it doesn't open his eyes as wide. This can help to reduce evaporation of the tears between the blink of the eye.
  • Stop smoking and avoid smoke. If you smoke, talk with your health care provider to assist the development of a smoking cessation strategy, which is more likely to work for you. If you don't smoke, stay away from people who make it. The smoke can worsen the symptoms of dry eyes.
  • The use of artificial tears on a regular basis. If you have chronic dry eyes, use eye drops, even when your eyes feel fine to keep them well lubricated.

Dry eyes

Diagnosis

The tests and procedures that can be used to determine the cause of your dry eyes include:

  • A comprehensive eye exam. An eye exam that includes a complete history of your overall health and your eye health can help your eye care specialist to diagnose the cause of the dryness of the eyes.
  • A test to measure the volume of your lágrimas.Su eye doctor may measure your tear production using the Schirmer tear test. In this test, blotting strips of paper are placed under the lower eyelids. After about five minutes of your eye care specialist measures the amount of strip soaked by the tears. Another option for the measurement of tear volume is the phenol red thread test. In this test, a thread full of pH-sensitive dye (tears change the color of the dye) is placed on the lower eyelid, in contact with the tears of 15 seconds, and then measured by volume tear.
  • A test to determine the quality of the tears. Other tests use special dyes in eye drops to determine the condition of the surface of your eye. Your eye care specialist searches for patterns of staining in the cornea and measures the time it takes before the tears to evaporate.
  • A tear osmolarity test. This type of test measures the composition of the particles and the water in your tears. With dry eye disease, there will be less water in their eyes.
  • Tear samples to look for markers of dry eye disease, including elevated matrix metalloproteinase-9 or the decrease of the lactoferrin.

A test to measure the volume of your tears. Your eye doctor may measure your tear production using the Schirmer tear test. In this test, blotting strips of paper are placed under the lower eyelids. After about five minutes of your eye care specialist measures the amount of strip soaked by the tears.

Another option for the measurement of tear volume is the phenol red thread test. In this test, a thread full of pH-sensitive dye (tears change the color of the dye) is placed on the lower eyelid, in contact with the tears of 15 seconds, and then measured by volume tear.

Treatment

For most people with occasional or mild dry eye symptoms, it is enough to use regularly without a prescription eye drops, also called artificial tears. If your symptoms are persistent and more severe, you have other options. That depends on what is the cause of dryness in the eyes.

Some treatments focus on the investment or management of a condition or factor that is causing your dry eyes. Other treatments may improve the quality of your tears or stop your tears of quickly draining away from your eyes.

The treatment of the underlying cause of the dryness of the eyes

In some cases, treatment of an underlying health problem can help to clarify the signs and symptoms of dry eyes. For example, if a medication is causing your dry eyes, your eye doctor may recommend a different medication that does not cause that side effect.

If you have a condition of the eyelid, as your eyelids outwards (ectropion), your eye doctor may refer you to a surgeon who specializes in plastic surgery of the eyelids (oculoplastic surgeon).

Drugs

The prescription of medications used to treat dry eyes include:

  • Medications to reduce inflammation of the eyelids. The inflammation along the edge of the eyelids can keep the oil glands secreting oil into your tears. Your ophthalmologist may recommend antibiotics to reduce the inflammation. Antibiotics for dry eyes are usually taken orally, although some are used as eye drops or ointments.
  • Eyedrops to control the inflammation of the cornea. The inflammation on the eye surface (cornea) can be controlled with eye drops containing immuno-suppression of medicine, cyclosporine (Restasis) or corticosteroids. Corticosteroids are not ideal for long-term use due to possible side effects.
  • Eye inserts that function as artificial tears. If you have moderate to severe symptoms of dry eye, and artificial tears don't help, another option may be a small eye of insertion that looks like a grain of rice. Once a day, you place the hydroxypropyl cellulose (Lacrisert) to insert between the eyelid and the eyeball. The insertion dissolves slowly, releasing a substance that is used in the form of eye drops to lubricate the eye.
  • Tear-stimulating drugs. The drugs called cholinergic (pilocarpine, cevimeline) help to increase the production of tears. These medicines are available in the form of pills, gels or drops for eyes. Possible side effects include sweating.
  • Eye drops made from your own blood. These are the so-called autologous blood drops of the serum. That may be an option if you have severe dry eye symptoms that do not respond to any other treatment. To make these eye drops, a sample of your blood is processed to remove the red blood cells and then mixed with a salt solution.
  • A nasal spray to increase the production of tears. The Food and Drug Administration (FDA) recently approved varenicline (Tyrvaya) for the treatment of dry eyes. This medication is delivered through a nasal spray. Varenicline is to spray once in each nostril, twice a day.

Other procedures

Other procedures that may be used to treat dry eyes include:

  • Close the tear duct to reduce the tearing of the pérdida.Su eye doctor may suggest this treatment to keep the tears out of his eyes too fast. This can be done by partially or completely closing your tear ducts, which normally serve to drain the tears. The tear ducts can be connected with small plugs of silicone punctal plugs). These are removable. Or the tear ducts can be connected with a procedure that uses heat. This is a more permanent solution called thermal cautery.
  • The use of special contact lenses.Ask your ophthalmologist about the new contact lenses designed to help people with dry eyes. Some people with severe dry eyes can opt for special contact lenses that protect the surface of the eyes and trap moisture. These are the so-called scleral lenses or bandage lenses.
  • The unlocking of the oil glands. The application of a warm compress, or in the eyes of the masks that are used daily can help clear up blocked oil glands. A thermal pulsation device is another way to uncover the sebaceous glands, but it is not clear whether this method provides no advantage over the application of warm compresses.
  • The use of light therapy and eyelid massage. A technique called pulsed light therapy followed by massage of the eyelids can help people with severe dry eyes.

Close the tear duct to reduce the tearing of the loss. Your eye doctor may suggest this treatment to keep the tears out of his eyes too fast. This can be done by partially or completely closing your tear ducts, which normally serve to drain the tears.

The tear ducts can be connected with small plugs of silicone punctal plugs). These are removable. Or the tear ducts can be connected with a procedure that uses heat. This is a more permanent solution called thermal cautery.

The use of special contact lenses. Ask your ophthalmologist about the new contact lenses designed to help people with dry eyes.

Some people with severe dry eyes can opt for special contact lenses that protect the surface of the eyes and trap moisture. These are the so-called scleral lenses or bandage lenses.

Self-care

You may be able to manage your dry eyes, with frequent eyelid washing and the use of medications without a prescription eye drops or other products that help lubricate your eyes. If your condition is long-term (chronic), the use of eye drops, even when your eyes feel fine to keep them well lubricated.

The selection and use of otc products for dry eyes

A variety of otc products for dry eyes are available, including eye drops, also called artificial tears, gels and ointments. Talk to your eye doctor about what might be best for you.

Artificial tears can be everything that you need to control mild dry eye symptoms. Some people need to put drops several times a day, and some of them only once a day.

Consider these factors when choosing a nonprescription product:

  • Preservative vs nonpreservative drops.The preservatives that are added to a few drops for the eyes to prolong the shelf life. You can use eye drops with preservatives up to four times a day. But the use of a condom reduces more often can cause irritation of the eyes. Nonpreservative eye drops come in packets that contain multiple single-use vials. After you use a vial of strips. If you trust in drops more than four times a day, nonpreservative drops are safe to use.
  • Drops vs ointment. Lubricating eye ointments layer of the eye, providing longer lasting relief of dry eyes. However, these products are thicker than the eye drops and it can cloud your vision. For this reason, the ointments are the most used, just before bedtime. Eye drops can be used at any time and does not interfere with the vision.
  • The drops that reduce redness. It is best to avoid these as your solution for dry eyes, such as prolonged use may cause irritation.

Preservative vs nonpreservative drops. The preservatives that are added to a few drops for the eyes to prolong the shelf life. You can use eye drops with preservatives up to four times a day. But the use of a condom reduces more often can cause irritation of the eyes.

Nonpreservative eye drops come in packets that contain multiple single-use vials. After you use a vial of strips. If you trust in drops more than four times a day, nonpreservative drops are safe to use.

The washing of the eyelids to control the inflammation

For people with blepharitis and other conditions that cause inflammation of the eyelids, which blocks the flow of oil to the eyes, frequent, and soft eyelids hand-washing can help. To wash your eyelids:

  • Apply a warm washcloth to your eyes. Dampen a clean cloth with warm water. The cloth over your eyes for five minutes. Rewet the cloth with warm water when it cools down. Rub gently with the towel on her eyelids — including the base of the lashes to loosen any dirt.
  • Use a mild soap on your eyelids. The use of baby shampoo or other mild soap. Put the cleaner on your clean fingertips and gently massage your eyes closed, close to the base of your lashes. Rinse thoroughly.

Alternative medicine

More studies are needed, but some alternative medicine approaches can help to relieve your symptoms of dry eye. Discuss the benefits and risks with your eye doctor.

  • Fatty acids. The addition of omega-3 fatty acids in your diet can help relieve the dry eye signs and symptoms. These are available as supplements and foods, such as flaxseed, salmon, and sardines.
  • Castor oil eye drops. These eye drops can improve symptoms by reducing tear evaporation.
  • Acupuncture. Some people have seen their dry eye symptoms improved after acupuncture therapy.

Preparing for your appointment

It is likely to start by seeing your family doctor. Your provider can then refer you to an eye specialist (ophthalmologist). Because appointments can be brief, it is a good idea to be well-prepared for your appointment.

What you can do

  • List of the symptoms that you are experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • The list of personal information, including any recent changes in life.
  • Make a list of all the medicines, vitamins, and supplements you are taking.
  • List of questions to ask during your appointment.

For dry eyes, some basic questions to ask include:

  • What is the most likely cause of my dry eyes?
  • Do I need any tests?
  • It can dry out the eyes get better on their own?
  • What are my treatment options?
  • What are the possible side effects of each treatment?
  • I have other health conditions. How can I best manage these conditions?
  • It is a generic drug available to the medicine you're prescribing me?
  • Do you have any brochures or other printed material that I can take with me?
  • What sites do you recommend?
  • I need a plan for a follow-up visit?

Don't hesitate to ask additional questions that may occur during your appointment.

What to expect from your doctor

You may ask:

  • Can you describe your symptoms?
  • Do you remember when you first started to experience symptoms?
  • The symptoms been continuous or occasional?
  • Do other members of your family have dry eyes?
  • Have you tried without prescription drops? Made to provide relief?
  • Are your symptoms worse in the morning or late in the day?
  • What medications do you take?
  • Have you had any radiation to the head or in the neck?

What you can do in the meantime

To relieve the signs and symptoms, while waiting for your appointment, try over-the-counter eye drops. Search drops to lubricate the eyes, also called artificial tears. Avoid those that call for reducing the redness in the eyes. Eye drops that reduce redness of the eyes can cause more irritation in the eyes.

Symptoms and treatment of dry eyes