Despite its prevalence, Chronic Dry Eye is among the least understood eye conditions that affect large numbers of people. Many people mistake the dry eye symptoms for allergies, climatic conditions or just "eyestrain". While all of these may aggravate Chronic Dry Eye symptoms, they are not the cause.
Your eyes need a constant layer of tears — called the "tear film"— to maintain and protect the ocular surface.
In Chronic Dry Eye, underlying changes to the health of the tear-producing glands can result in a change in the quantity and quality of the tears you make. This results in a tear film that can no longer provide enough nourishment or protection to the surface of your eye. This can lead to damage of your eye’s surface, which, in turn, can lead to the symptoms of Chronic Dry Eye.
The symptoms of dry eye vary. Different patients describe their dry eye symptoms in different ways: itching, irritation, light sensitivity, blurred vision and even too much tear production. Coping with any, or some of these symptoms is a challenge to millions of Americans. While many sufferers believe it is a condition that they must simply “learn to live with,” the truth is that untreated, Chronic Dry Eye can lead to more serious vision problems.
Causes of Dry Eye
Chronic Dry Eye is often caused by problems with the body’s system responsible for making your tears and keeping a healthy “tear film” on your eye’s surface. The system is called the lacrimal functional unit. It includes the lacrimal gland, meibomian glands and goblet cells of the conjunctiva. The lacrimal glands are responsible for producing the watery part of the tear film called the aqueous. The meibomian glands are responsible for producing lipids which keep the tear film from evaporating. Finally, goblet cells are responsible for producing mucin which allows the wetting of the ocular surface as well as stabilizes the tear film. Together, all components of the tear film maintain and protect the ocular surface.
When the glands found in the lacrimal functional unit don’t work properly, tear film composition is altered leading to a declining quality and quantity of tears production and ultimately the symptoms of Chronic Dry Eye.
Hormonal changes due to aging and menopause, thyroid problems and vitamin deficiencies can contribute to Chronic Dry Eye. Some diseases and conditions – like rheumatoid arthritis, lupus and Sjögren’s Syndrome – also cause Chronic Dry Eye in many patients. On the other hand, activities like reading or working at the computer are not a root cause of Chronic Dry Eye; they can just make the symptoms worse. Wearing contact lenses can also worsen Chronic Dry Eye symptoms.
Possible Long-Term Effects of Chronic Dry Eye
When the production of natural, healthy tears is reduced, Chronic Dry Eye can cause serious irritation of the front of the eye, particularly the cornea, which requires the presence of a healthy tear film for its own health.
Diagnosing the Condition
Only a doctor can determine if your dry eye condition is actually Chronic Dry Eye. To make this diagnosis the dry eye specialist will ask you to describe your dry eye symptoms and the impact that they have on your daily life. Does reading or working at the computer present a problem? Do you regularly experience itching, burning or the feeling there’s a foreign body in your eye?Besides creating a healthy eye surface on the cornea and lubricating the entire eye, a natural tear film works to fight infection, provides important nourishment and is vital for clear vision. When tear production is reduced over a long period of time, there is the likelihood of permanent damage and scarring to the front of the eye. Increased risk of infection and serious visual impairment may result in cases where a severe dry eye condition has gone untreated over time.
Once the two of you have reviewed your answers to the questionnaire, the dry eye specialist may perform a series of simple tests to evaluate the tears you are producing naturally. Factors such as the evaporation rate and the actual quantity of tears you make will be taken into consideration. He or she also may use diagnostic eye drops for dry eyes that can reveal damage to the ocular surface otherwise invisible to the naked eye.
Common Diagnostic Tests for Dry Eye Conditions
- Schirmer test – uses paper strips under eyelid to measure the wetness that collects over a specific period of time.
- Staining – uses special dyes to highlight areas of possible damage to the eye surface.
- Slit lamp examination – a special, focused light beam the doctor uses to see changes in the ocular surface. Many times this is used in conjunction with staining.
Dry Eye Treatment Options
There are various options available for the management of Chronic Dry Eye. Your eye doctor can provide information about which option is best for your dry eye needs.
Chronic Dry Eye treatment options include;
Over The Counter Eye Drops
Eye drops are man-made, lubricant solutions that are used to moisten the eye and thicken tears. They can help
- Lubricate the eyes
- Maintain moisture in the eyes
- Ease symptoms such as grittiness and dryness
- Soothe dry eye symptoms associated with refractive surgery (LASIK surgery)
Prescription Therapies
There are additional prescription treatment options available for dry eyes. Consult your eye doctor for more information.
Tear Duct Plugs
Tear duct plugs, also known as punctal plugs or punctal occlusion, are silicone plugs that can be inserted by your eye doctor to close the ducts that drain tears out of the eye. To check if tear duct plugs are right for you, temporary plugs can be inserted, which dissolve with time and will help your eye doctor decide if plugs will reduce your dry eye symptoms before inserting permanent plugs.
