Dry Eyes
What It Is and Its Causes
What Is Dry Eye?
Our eyes need tears to stay healthy, comfortable and to see well. If your eyes do not make enough tears, it is called dry eye. Dry eye is more common as we get older due to hormonal changes. It is more common in women, especially after menopause.
The tear film is made up of three layers.
The mucus layer is the layer closest to the eye. It is made by cells on the conjunctiva. It helps keep the tears spread smoothly across the eye. Without it, the tears would bead up like rain drops on the windshield.
The watery layer is the middle layer of the tear film. It makes up most of the volume of tears. It is made by tiny tear glands in the conjunctiva.
The outermost layer is the oily layer. It floats on the surface of the tear film to keep the tears from evaporating too fast. This layer is made by meibomian glands in the eyelids.
A deficiency in any one of these layers may cause symptoms of dry eye which include:
- stinging and burning
- blurry vision especially when reading, computer or watching TV
- scratchy or gritty feeling like something is in your eye
- strings of mucus in or around your eyes/mattering in the mornings
- redness and irritation
- discomfort when wearing contact lenses
- excess watering when exposed to cold dry air, or when especially irritated
What Causes Dry Eye?
- Age, especially post menopausal women
- Autoimmune diseases like rheumatoid arthritis, Sjogren’s syndrome, thyroid disease and lupus
- Blepharitis or inflammation of the oil glands in the eyelid
- Entropion (when the eyelid turns in) or ectropion (when the eyelid turns out)
- Dry climate and wind
- Reading or looking at the computer for a long time (decreases blinking)
- Using contacts for a long time
- Having refractive eye surgery, such as LASIK
- Medications such as:
- diuretics or water pills for high blood pressure
- beta-blockers for heart problems or high blood pressure
- antihistamines such as found in allergy and cold medicines
- sleeping pills
- anxiety and antidepressant medications
- heartburn medicines
How Is Dry Eye Treated?
Artificial tears are lubricating drops made to be similar to your own tears. They are available without a prescription. There are many brands of artificial tears and many different types of tears made by each brand. Try a few until you find a brand that works best for you. If you feel like you need to use them more than 4 times a day or are allergic to preservatives, you may want to try preservative-free artificial tears.
Punctal plugs are tiny little plugs that are made to be placed in the drain of your eyelid. They make the tears that you make stay in your eye longer. It is a simple procedure that may be done comfortably in the examination room. It usually takes less than 5 minutes to place them. They are made to be permanent (not dissolve), but may be removed later if desired.
Increasing your tears through the use of prescription eye drops that make you produce more of you own tears. There is also a prescription nasal spray that helps increase tear production. These are generally more expensive than over-the-counter drops.
You may try to decrease the evaporation with the use of prescription drops that act as a supplement to the oily layer. You may also enhance the production of your oil glands in the eyelids with omega-three supplements, warm compresses on the eyelids, massaging the eyelids or using certain eyelid cleaners.
If you wake up with dry and scratchy eyes in the mornings, you may try artificial tears ointment or night time gel just before you go to bed.
In the winter running a humidifier may help.
Wearing wrap around glasses or sunglasses when you are exposed to drying wind or cold, dry air helps prevent the excess tearing.
Make sure you are drinking enough water.
Keep the air vents in the car from blowing in the direction of your face/eyes.