Dry Eye Syndrome

What is a Dry Eye Syndrome?

Dry Eye Syndrome or DES is a common disorder of the thin tear film that coats the eyes affecting a significant percentage of the population most commonly individuals who are forty years old and above. This thin tear film has three main layers, namely:

Innermost Layer

This is the thinnest layer composed of mucus, which is produced by the tiny cells in the conjunctiva. Conjunctiva is the clear skin that lines the eye.

Middle Layer

  • Also known as the aqueous layer, this is the thickest and the largest
  • This is composed of very dilute saltwater solution produced by the lacrimal (glands under the upper eyelids) and the accessory tear glands
  • This layer functions to keep the eye moist and help eliminate dust, debris, or foreign objects that may enter the eye
  • Problems of the aqueous layer gives rise to the common dry eye syndrome or keratoconjunctivitis sicca or KCS.

Superficial layer

  • This is composed of thin layers of fats or oils produced by the meibomian glands and the glands of Zeis.
  • This layer functions to decrease the evaporation that occurs in the watery layer beneath.

Symptoms

Dry Eye Syndrome often exhibit the following symptoms:

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  • Dry, scratchy, or filmy feeling in the eyes
  • Itching sensations in the eyes
  • Eye redness
  • Blurry vision
  • A feeling of having a foreign object in the eyes
  • Sensitivity to light

These symptoms are said to get worse on the following unfavorable conditions:

  • Dry climate
  • Windy weather
  • Higher temperatures
  • Lower humidity
  • Prolonged use of the eyes (e.g., reading, long-term use of the computer, watching TV)
  • Later part of the day

In some cases, a symptom of DES is an intermittent, excessive tearing. And when the eyes is a bit dry and irritated, this may cause reflex tearing, producing large amounts of tears all at the same time in an effort to try to get moist and feel comfortable. However, the situation is not really favorable to you because once the eye produces large amount of liquid, some of it will just overflow down the cheek and are, indeed, wasted. After a few minutes, the eyes will get dry and irritated again.

Causes

Although the main predisposing factor for a person to develop dry eye syndrome is the imbalance in the tear-flow system of the eye, it can also be caused by drying the tear film in the eye, which can be brought about by some conditions such as the following:

  1. Aging process
    • The aging process can cause the cells in the body not to regenerate anymore.
  2. Side effects of medications such as birth control pills and antihistamine drugs, beta blockers, etc.
  3. Diseases that may affect the ability of the eyes to produce tears such as Sjogren’s syndrome, rheumatoid arthritis, and collagen vascular diseases.
  4. Eye problems or conditions that do not allow the eyelids to close properly can cause excessive or rapid evaporation of the liquid (e.g., Bell’s palsy, stroke).
  5. Decreased tear production.
  6. Excessive tear production.
  7. Underproduction of lipids in the superficial layer covering the eye which can lead to excessive evaporation of the liquid in the layer beneath it.
    • This happens when there is a dysfunction of the meibomian glands.
    • An infection in the eyelids called blepharitis may break down the oils in the eye, making it insufficient.
  8. Abnormal mucin production by the conjunctiva
    • This is the result from chemical burns to the eye brought about by different autoimmune disorders such as Stevens-Johnson syndrome.
    • If there is less production of mucin, there is less spreading of tears in the surface of the eye because this is supposed to be the main function of mucin.
    • Eventually, this can damage the eye.

Treatment

Homecare Treatments

Here are tips on how to alleviate the symptoms of dry eye syndrome:

  • Use of humidifier
    • This puts moisture in the air
    • When the air is filled with moisture, tears evaporate more slowly, keeping the eyes feel comfortable
  • Decrease the speed of fans because excessive air movement tends to dry out the eyes.
  • The use of an air filter may be helpful to ward off large amount of dust and other matters that may enter the eye
  • Hot compresses or baby shampoo may help in maintaining a thicker and stable lipid layer. This is often beneficial if you have blepharitis or Meibomian glands dysfunction.
  • Artificial tears and lubricating drops helps provide more moisture and lubrication to the eyes. For effective results, these are often applied four times a day but can be used as often as needed.
  • For more longer-lasting effect, lubricating eye ointments are used; however, because of its thickness, this can often blur one’s vision if used during the day. Therefore, this is often used during the night.
  • If you notice that your eyes get dry when facing the computer or watching TV, take frequent breaks to allow tour eyes to rest. Closing the eyes for ten seconds every ten minutes can help moisturize your eyes and make it comfortable again.

Medical Treatment

Although there is no fix cure for DES, however, the availability of many treatments make it a more manageable condition. Treatment is dependent on the severity of the disease. Some may only need a humidifier or drops and gels while some needs surgery. During surgery, the ducts that drain tears into the nose can be permanently closed to allow more tears to stay in the eyes. This can be done with the patient in local anesthesia and is on an outpatient basis, so this is a rather quick procedure.

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