Dry Eye Syndrome

Dry Eyes Syndrome

In recent times, the use of screens has become a necessity on a daily basis whether it is related to work or entertainment.

The extended periods of screen usage may lead you to dry eye syndrome. Although the dry eye syndrome can be prevented at an early stage when detected well on time.

There are some inborn causes of the dry eye syndrome for example association with Sjogren syndrome, which is an autoimmune disease, or it can occur as a separate entity such as dry eyes in people exposed to certain environmental factors such as low humidity, increased screen time, poor blinking habits, etc

What are the other terms used for dry eyes

The other terms used for dry eyes are dry eye disease and dry eye syndrome or DES/DED

What are the Causes of Dry Eyes

The normal blinking rate of your eye is reduced during extensive concentration or constantly staring at the screen. The contact between the eye surface and the air is also increased. This causes disruption in the normal tear production and its stay in the eye.

The meibomian glands in the eyelids produce mucin, a part of the tear film, due to infrequent blinking the squeezing time is reduced and can lead to tear film disruption.

This implies that the normal blink rate should be maintained all the time.

What are the Symptoms of Dry Eyes

Dry eye may present as a stinging or burning sensation, excessive watering, sandy or gritty sensation, blurred vision redness, and sensation of dryness in the eyes. 

Layers of Tear Film

The normal tear film is composed of three layers. The outer lipid layer is secreted by meibomian glands. It plays a main role in preventing the evaporation of the aqueous layer.

The middle aqueous layer is secreted by the lacrimal gland.

Its function is to provide oxygen to the cornea, wash out debris, and have antibacterial activity. The inner mucous layer, secreted by goblet cells maintains the overall lubrication in order to maintain lipid and aqueous layers.

What are the Factor Involved in Effective Tear film

Three factors are involved in the effective spread of tear film.

• Normal blink reflex
• Contact between eye surface and eyelids
• Normal corneal epithelium

The normal blink rate ensures regular and even spread of the tear film on the surface of the eye. The normal contact between the eye surface and eyelids is disrupted in conditions like facial palsy, bell’s palsy, ectropion, entropion, thyroid eye disease, etc.

These diseases should be treated well on time in order to avoid further damage. Any abrasion or corneal ulcer may lead to an uneven surface of the cornea, this will reduce the even spread of the tear film.

Normal Blinking

The spontaneous or involuntary blink rate is 12 times per minute with an amplitude of 9.5 mm and a duration of 0.3s.

What are the Steps to Avoid Dry Eye

• Keep the screen at the appropriate distance of about12 inches in length.
• Make the fonts of the writing bigger and bold.
• Reduce the brightness of the screen and avoid places that can induce glare.
• Windows and curtains should be closed during screen time.
• Follow the rule of 20/20/20. After every 20 minutes take a break of 20 seconds and stare at an object about 20 feet away.
• Maintain a good humidified environment by using a humidifier.
• Artificial tears can be used to avoid dry eye over-the-counter contact with your care health worker if things did not improve.

Home Remedies for Dry Eyes

The home remedies may encompass lifestyle modification including the maintenance of compliance on the following. It is one of the best management plans in the early stages of dry eyes.

Dietary Supplements

According to the American Optometric Association, taking omega-3 fatty acid supplements can help relieve dry eyes. Omega-3 fatty acids can also be found in fish, some types of seeds, and nuts.

A 2021 review of credible sources suggests that, in some cases, vitamin A and D supplements may help improve the symptoms of dry eyes.

It is a good idea to talk to your doctor about possible vitamin deficiencies and whether you should take dietary supplements.

Lifestyle review:

It includes knowing the importance of blinking during reading, watching television, or using a computer screen and the management of contact lenses. Prolonged use of contact lenses or improper fit of CL may lead to dry eyes.

Environmental review:

It includes increasing the humidity of some environments, especially in hot areas.

Systemic medication review:

It includes discontinuation of offending drugs such as topical eye drops with preservatives, if possible.

A warm compress over the eyelid is highly recommended and lid hygiene may be considered as an early measure.

Dry Eye after Lasik Surgery

During the ablation phase of Lasik, some of the corneal nerves are damaged which causes the condition of dry eyes. It is one of the most common complications of Lasik.

It should be kept in mind while undergoing Lasik that the procedure may exacerbate the condition postoperatively. The treatment involves an extended period of artificial tear
substitute usage.

Can Dry Eyes go Away

Yes, with effective management and maintaining compliance dry eyes can subside completely.

Treatment for Dry eye Syndrome

These includes

Botulinum toxin injections:

Injecting botulinum toxin into the orbicularis muscle helps to control blepharospasm that occurs in most dry eyes. It is usually injected into the medial canthus.

Oral cholinergic agonists:

These include pilocarpine and cevimeline and may reduce symptoms of dry eyes and dry mouth in patients with Sjogren syndrome.

Submandibular gland transplantation:

Serum eye drops:

Autologous or umbilical cord serum has produced subjective and objective improvement in dry eyes.

Eye Drops Used for Dry Eye

The topical medications used for dry eye include the following

Drops and gels:

For mild cases, cellulose derivatives can be used for example Hypromellose and methylcellulose. For long-standing conditions, carbomer gels can be used. Some other preparations include polyvinyl alcohol, sodium hyaluronate, glycerin, propylene glycol, etc.
Diquafosol is a new drug that is used for topical purposes.

Ointments:

Ointments containing paraffin mineral oil can be used at bedtime to supplement daytime eye drops during night time. Daytime use is avoided due to blurring of vision.

Eyelid sprays:

These contain liposome-based agents that are applied over the closed eyelids.

What is the surgical treatment for chronic dry eye syndrome

It includes temporary, reversible, or permanent punctal occlusion. Silicone or collagen plugs are used for temporary blockage of the puncta. For permanent plugging coagulation or laser, cautery is used.

Take-Home Message

Prevention is better than cure. The lifestyle modification is the keep to keep your eyes healthy and reduce the recurrence of dry eyes.