Dry Eye Disease
Dry eye disease is a very common cause of ocular discomfort often leading to feelings of ocular fatigue, grittiness, stinging or variable vision. Take the 12-Second Test below to see if you might have it.
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What is Dry Eye Disease?
Dry eye disease is a very common cause of ocular discomfort often leading to feelings of ocular fatigue, grittiness, stinging or variable vision. Symptoms can range from mild irritation toward the end of the day, difficulty in opening the eyes on waking to severe problems requiring intensive medical treatment. This complexity is reflected in the current TFO DEWS II global definition of DED as:
“Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”
Take the 12 second test!
Can you stare at the following video clip for 12s or more without blinking. If not or if your eyes feel uncomfortable or sting during the test, you may have dry eye disease (DED).
Dry Eye Disease Causes & Symptons
The symptoms of DED are wide-ranging and are influenced to a great degree by environment. A feeling of ‘tired eyes’, burning, stinging or occasional reflex watering are frequently described. Many people who have previously worn contact lenses successfully will start to notice reduced contact lens tolerance and reduced comfortable wear time as they get older. Unfortunately, when our eyes feel tired, so do we, so many DED sufferers will struggle to feel alert and active later in the day.
We have been helping DED patients for over 20 years and over that time one factor has increased in impact more than any other in our experience: screen use. We can’t avoid using screens in modern life but taking regular breaks and remaining hydrated can help significantly. Here are some of our other more frequently asked questions:
Dry Eye FAQs
Dry eye disease results from reduced production of the liquid or aqueous part of the tear film and or reduced stability or increased evaporation of the tear film. Other factors such as inflammation caused by eyelid conditions e.g. blepharitis can also contribute to this. Age, use of computer screens, certain medications and environmental factors such as wind, air pollution, air conditioning can also contribute.
Many patients with DED will notice that their symptoms worsen as the day progresses. This is because the longer we have our eyes open, the greater the evaporative stress on our tear film. In the evening, people will often relax by engaging in activities which require visual concentration e.g. reading or watching the television, these activities reduce the frequency of blinking in turn reducing the refresh rate for our tear film, so symptoms are worsened.
Similar to the above, environmental factors can play a significant role in causing the symptoms of DED. Use of screens at work during the day may make symptoms significantly worse which taking a walk at lunchtime may relieve. Windy conditions however, may increase evaporation so multiple factors can influence symptoms. Overnight our production of tears naturally falls so sometimes on waking, people with DED can experience a feeling of their eyelids being heavy or slow to open, or of feeling stuck together.
A healthy balanced diet is best for overall health as well as DED. Humans are unable to produce essential fatty acids (EFA’s) and therefore must obtain them from their diet. Recently two such types of EFA; omega-3 and omega-6 have been shown to be of benefit in DED. Omega-3 EFA’s are present in high concentrations in oily fish e.g. tuna, salmon and trout, omega-6 EFA’s are found in vegetable oils, both can be obtained individually or combined in dietary supplements. Staying hydrated is equally important and avoiding dehydration before going to sleep will improve symptoms significantly overnight.
Lubricating drops or tear supplements will not reduce the ability of your lacrimal gland to produce tears but do need to be instilled regularly to be of benefit.
Multiple factors relating to contact lenses can reduce tolerance and cause discomfort in DED including poor fit, issues related to the material the lens is made from, lens care materials and contact lens practice. Contact lenses can be worn in DED but special care should be taken to address the above factors and other treatments e.g. laser eye surgery may be safer and more convenient in the longer term.
Yes, DED can have a significant impact on visual quality because the tear film coats the front of the cornea and is the first structure associated with the eye that light passes through as it enters our visual system. When considering eye surgery it is important that the surface health of the eye and quality of the tear film are optimized so that the full benefit of surgery can be enjoyed.
Many people find that their eyes are less comfortable when driving or being driven. When we drive we concentrate visually and this reduces the frequency of blinking and therefore the refresh rate of our tear film. Many cars have air conditioning which reduces cabin humidity or blows air across the face increasing evaporation of the tear film further worsening symptoms.
Managing Dry Eye Disease
We are able to offer a wide range of diagnostic as well as therapeutic approaches for patients with DED. Diagnosis must always precede treatment and will take into account general health and medications, lifestyle and more specific aspects of the examination relating to the surface of the eye and tear film.
We are pleased to offer TearLab diagnostic testing to enable advanced laboratory measurement of the tear film and this can be performed as a painless and quick outpatient procedure with results available at the time of consultation. TearLab testing measures the natural ‘salt’ concentration of the tear film, as the aqueous component of the tear film is reduced in DED, so the ‘salt’ concentration increases and this can be measured and compared with a standardized scale to provide an objective measure for DED.
Treatment plans will vary according to individual circumstances and a complete ophthalmological examination will be performed at your consultation including advice on optimizing your response to environmental factors. Treatment is ultimately designed to break the vicious cycle of DED and restore the natural balance of the ocular surface. Different treatments may be required at different times and as with many chronic or long-term conditions, more than one treatment may be recommended. Treatment will focus on some or all of a number of areas:
- Reducing inflammation at the surface of the eye
- Treating any associated blepharitis
- Adding artificial tears or lubricant eyedrops
- Retaining the tear film for longer e.g. the use of punctal occlusion
- The use of nutritional supplements
- Managing environmental conditions
- Advanced therapeutic treatments e.g. the use of immunomodulating drops such as Ikervis® Santen Pharmaceuticals
Preservatives are used in a variety of eyedrops to maintain the activity of the therapeutic agent over time and allow a drug to be maintained in a stable condition in a bottle, typically for a 28 day period. Preservatives such as BAK however, can irritate the eyes and worsen the symptoms of DED by contributing to stinging, burning and irritation. In treating DED, we recommend the use of preservative free (PF) medications as far as possible.
The recommended frequency of use of lubricant eyedrops can vary from three to four times daily to every hour depending on individual circumstances. Instilling eyedrops efficiently is important, a minimum frequency would be three to four times daily although this may apply to use at work with screens only, or afternoon to evening time when symptoms are present.
There are many different ways to apply eye drops and also a variety of devices or compliance aids to help you do so. Many people find using certain containers difficult so we can advise you on alternatives depending on your circumstances. In general, having taken the steps above, we recommend that you close your eye once, gently, when the drop is instilled and keep the eye closed for a minute without blinking before gently wiping any excess fluid away. If you are able to confidently, applying gentle pressure to your tear duct where the eyelid meets the nose can provide additional time for the drop to be absorbed before draining away into the nose.
Tears produced naturally in the lacrimal gland drain away from the surface of the eye through small channels which open on the lower and upper eyelids a few millimeters from the nose. These openings are called the puncta, so that blocking the puncta, temporarily or permanently will allow less fluid to drain away from the surface. This can be highly effective because tears are being continuously produced and draining, whereas instilling eye drops takes place at fixed intervals. Tears produced naturally by the lacrimal glands are also preferable in quality to lubricant drops. The puncta can be occluded temporarily by the use of a variety of different types of punctal plugs and more permanently by surgical, typically thermal occlusion.