What is dry eye disease?

Over 75 million people in the United States suffer from dry eyes. Dry eye disease is a multifactorial condition where the natural tear film is disrupted, causing various symptoms such as blurred vision, stinging, burning, redness, tearing, and itching. The tear film is unstable, and loses water resulting in a higher salt content (hyperosmolarity). Just like when you open your eyes in the ocean, a high salt concentration in your tears due to dry eyes stings!

Dry eyes occur when the eyes are not adequately lubricated by your natural tears. Tears consist of 3 layers: a lipid layer (oils) for lubrication, a water layer for moisture, and a mucous layer for even spreading on the tears on the surface of the eye. All of these layers are secreted by specialized glands in the eye. If any one of these three components is not in proper balance, then dry eyes can result. Sometimes when the eyes are dry, the body attempts to compensate for the dryness by producing extra tears. However, these tears are only made up water and don’t have the oils and mucous necessary to prevent evaporation of the tears.

What causes dry eyes?

Several factors increase the chance of having dry eyes: Age over 50, gender (women more than men), environment (smoke, wind, dry climate), medications (antihistamines, antidepressants, blood pressure medications, decongestants, medical conditions (Sjogren’s, rheumatoid arthritis, diabetes, thyroid disease, glaucoma, blepharitis), the prolonged use of digital devices, contact lenses, and laser vision correction.

How can dry eyes be treated?

There are a variety of treatment strategies for dry eyes:

1. Artificial tears/ointments

These are the least expensive and easiest first line treatment for dry eyes. Some patients will need to constantly lubricate the eye throughout the day, even if they don’t feel as though they are dry. Preservative free artificial tears are often beneficial, as preservatives can cause irritation in some patients especially if used very frequently.

2. Dietary modification

Including supplementation with omega-3 fatty acids.

3. Warm compresses and eyelid hygiene

To help treat blepharitis (eyelid inflammation) and improve normal oil gland function.

4. Punctal occlusion

Punctal plugs are temporary plugs that are placed in the small opening, or puncta, where the tears normally drain into the nose. The plugs are usually made of silicone or dissolvable material and when placed properly in the office, most patients cannot even feel them!

5. Restasis (cyclosporine 0.05%) or Xiidra (lifitegrast 5%)

Restasis and Xiidra are the only prescription medications for dry eye disease. They both work by decreasing inflammation in the lacrimal gland (the gland that makes tears), thereby helping it to produce more tears. Some patients will sometimes complain of a stinging or burning with instillation of these eye drops.