What are dry eyes causes and how to treat them?

Symptoms of dry eye: causes, treatment and prevention

What are dry eyes causes

DRY EYE

The dry eye or dry eye syndrome (SOS) is a process that affects many people still undiagnosed. It is estimated that more than 60% of the population over 45 years of age suffer from this disorder. An ocular pathology that mainly affects women increasing with age, up to 80% in those over 60 years.

What is dry eye?

The dry eye is an eye irregularity in which the eye produces an insufficient amount of tears, very related to hormonal changes in the case of women, as well as its poor quality or rapid evaporation, usually caused by alterations in the glands of Meibomio (DGM).

These glands, which are found in the eyelids and secrete lipids (fats), are responsible for lubricating the ocular surface and preventing the tear film from evaporating, which is known as Meibomian Gland Dysfunction (DGM).

Circumstances that affect the ocular surface composed of the eyelids, the tear film, the conjunctiva and the cornea .

This lack or nonexistence of the tear in the eye is going to be a problem since the tear is responsible for nourishing, humidifying and lubricating the surface of the eye.

It is placed under the eyelids and works like the oil of a machine so that the flicker passes smoothly over the eye without scratching or damaging it.

Causes of dry eye syndrome

Causes of dry eye syndrome

At present, dry eye is one of the most frequent causes or reason for urgency more common in an ophthalmological service because of the discomfort generated since it affects, according to the severity, the quality of life of the patients who suffer it.

In this line, there are multiple factors that cause the Meibomian Gland Dysfunction (DGM) of people suffering from dry eye, causing the tear film to break and be exposed to air.

Therefore, it can influence its appearance in the following scenarios: 

• Alterations in the skin: acne rosacea.
• Allergic disorders
• Rheumatic diseases: antidepressants, antihistamines or contraceptives, among others.
• Hormonal changes: menopause.
• Addiction to tobacco.
• Having undergone previous eye surgery, such as Lasik surgery, for the treatment of myopia , hyperopia and / or astigmatism , since a decrease in the sensitivity of the cornea can occur.
• The abuse of contact lenses that can even lead to a corneal ulcer .
• Read for long periods of time as the frequency of blinking is reduced and the tear evaporates faster.
• Using an electronic device very often can produce a greater lacrimal evaporation.
• Aging, especially after 50 years.
• Indoor environments (air conditioning, heating systems) and outdoor environments (mainly arid climates with low levels of humidity and wind)
• Take the plane a lot: the air in the cabins of the plane is very dry.
• Some diseases such as diabetes, lupus, rheumatoid arthritis or Sjorgren's syndrome can contribute to the appearance of dry eye.
• Eyelid problems: such as blepharitis , the inability to close the eyelid, a disease caused by aging or after a blepharoplasty surgery , called lagophthalmos, can cause severe dry eye.
• A laser eye operation or corneal refractive surgery in general can also cause dry eyes. 

Pollution also affects the dry eye

The high levels of air pollution are related to health problems, mainly of the respiratory type. This high concentration of pollution in the air, according to the  World Health Organization  (WHO), contains particulate matter, ozone, nitrogen dioxide and sulfur dioxide.

As a consequence, the lack of humidity and the increase of air pollution, by the smoke of the cars and the chemical compounds of the factories, contribute to a growth of ocular inflammations and the appearance of the dry eye.

Symptoms of dry eye

Some of the symptoms that can indicate us to be before a case of dry eye, in addition to ocular dryness, are:

• Burning: burning sensation
• Itching: itchy sensation in the eyes.
• Redness
• Grit sensation.
• Upset when performing everyday tasks such as reading, driving or fixing the look on a television screen, as well as intolerance to contact lenses.
• You may also notice blurred vision or excessive sensitivity to light.
• Heaviness in the eyelids.
• Photophobia (hypersensitivity to light)
• Visual fatigue
• Tearful eyes, since the dryness of the surface of the eye overstimulates the production of the aqueous component of tears as a protection mechanism.
• Dry eye also causes inflammation and pain.

It will be necessary to visit your ophthalmologist immediately in the presence of these symptoms since their multifactorial origin makes diagnosis and treatment difficult. Your ophthalmologist should therefore perform a proper examination to determine the causes of your symptoms and the evolutive state of your dry eye.

Diagnosis of dry eye

Until now, the diagnosis of dry eye was relatively complex since there was no diagnostic test to help the detection, identification and measurement of the severity of this annoying pathology.

Until then, some tests that were performed in the ophthalmology consultations were the  ocular surface staining with fluorescein , for a more detailed visualization of the cornea, as well as to see the presence or not of possible corneal ulcers. A Schirmer Test has also been used ,  consisting of placing small strips of filter paper in the lower eyelids of both eyes in order to quantify the patient's production of tears.

At Oftalvist we have acquired an advanced technology called DX Analyzer to make a qualitative leap in diagnostic matters and obtain better control, monitoring and prevention of dry eye. 

DX Analyzer

DX Analyzer is a useful, effective and highly accurate tool for the analysis of the quality of the tear film that offers us important data to know the objective changes of the tear film and the visual quality of the patient at every moment.

Thanks to this information, the specialist ophthalmologist will be able to evaluate the best therapeutic treatment to apply to the patient.

OSDI test

The OSDI test is used to establish the type of severity and classification of the dry eye according to its symptomatology. It gives us a clue as to the type of dry eye the patient has, as well as the treatment.

Download the following PDF to perform the test and check the box that best suits your situation. You will get a score that classifies your dry eye into normal, mild / moderate or moderate / severe.

Dry eye treatment

As it is generally a chronic and progressive ocular pathology, the treatment until now used to be long term .

Artificial tears

The most widespread classical treatment was the application of artificial tears without preservatives to help maintain moisture. Composed of water, they are an isotonic or hypotonic saline solution that helps to prolong the permanence of artificial tears on the ocular surface, in addition to preventing any contamination, as well as preventing any type of ocular irritation.

Topical cyclosporine

In more complex cases, eye drops have been used  with growth factors obtained from the patient's own serum and immunosuppressive drugs to fight inflammation, such as cyclosporin A.

Probing of the Meibomian glands

It is a non-invasive surgical procedure that aims to open the outlet of the Meibomian glands, extract the fat content from inside and apply an antibiotic to normalize the microbial flora. It is done with superficial sedation and is painless.

Exfoliation of the free edge of the eyelids and glandular drainage

It is one of the least invasive techniques. It is about removing the membrane that clogs the Meibomian glands through an exfoliation. Next, a massage is performed to empty the contents of the glands applying cold and antioxidants to reduce the inflammation of the eyelids and improve lymphatic drainage.

Other treatments

Dry Eye treatment 

Other treatments that have been used, guided only by an ophthalmologist are: topical corticosteroids, sodium hyaluronate, autologous serum tears, pilocarpine (in patients with Sjögren's syndrome) or hyaluronic acid in combination with other products such as xanthan gum or the HP-guar, among others.

Pulsed light treatment for dry eyes

In addition to the procedures mentioned, in the  Ophthalmist Dry Eye Unit  we have taken the step towards new  pulsed light technologies  that offer much more truthful and useful data to establish a more effective and safe lasting treatment.

For this reason we have two advanced non-invasive and painless high-frequency pulsed light laser technologies ( ThermaEye and Ellipse ) that serve to stimulate Meibomian glands without the need to enter the operating room. The pulsed light helps to stimulate circulation and acts on the nerve endings in order to control the production and secretion of fats improving the visual quality of the patient with excellent results.

For more information about our procedure for the treatment of pulsed light click  here. 

Prevention of dry eye 

People most susceptible to dry eye can find relief by incorporating omega-3 fatty acids into their diets that can be found in foods such as blue fish , salmon, sardines, tuna, mackerel or trout, as well as  seafood , like the crab, the prawns or the mussels.

Vegetable foods such  as flax seeds or chia seeds are also recommended , as well as nuts such as nuts and drinking lots of liquid.

Recent studies affirm that diets low in omega-3 and antioxidants, but rich in omega-6 produce an oxidative stress that generates inflammatory effects on the meibomian glands, the cornea and the conjunctiva.

In addition, it is also recommended to be away from  dry environments , air currents , smoke snuff and air conditioners that can irritate our eyes because they promote the evaporation of the tear. It is also advisable to use a humidifier and even protective sunglasses every winter during the year.

On the other hand, it is convenient to blink frequently, clean the eyelashes (where the lacrimal glands are) with warm compresses or put on artificial tears from time to time to compensate for the lack of natural tears.