Dry Eyes: What You Need To Know – Medically Speaking Africa

Dry eyes disease is a common condition that occurs when the tears aren’t able to provide adequate lubrication for the eyes, it’s usually bilateral. The tear film has three layers: fatty oils, aqueous fluid and mucus. This combination normally keeps the surface of your eyes lubricated, smooth and clear, problems with any of these layers can cause dry eyes. The tear instability leads to inflammation and damage to the eye’s surface.

TYPES OF DRY EYE

There are two types of dry eye:

Aqueous tear-deficient dry eye: Low tear quantity
Evaporative dry eye: Low tear quality

SIGNS/SYMPTOMS

Dry eyes feel uncomfortable, it may present with the following:

Sting or burning sensation in the eyes
Stringy mucus in or around your eyes
Sensitivity to light
Eye redness
Sandy Sensation
Tearing
Eye fatigue
Discomfort/blurred vision having contact lenses on

CAUSES

Dry eyes are caused by a variety of reasons that disrupt the healthy tear film, major reasons include:

Decreased Tear Production: This condition is keratoconjunctivitis sicca, common
causes of decreased tear production are;

Ageing
Certain medical conditions including Sjogren’s syndrome, allergic eye disease, rheumatoid arthritis, lupus, scleroderma, thyroid disorders or vitamin A deficiency.
Certain medications, including antihistamines, decongestants, hormone replacement therapy, antidepressants, and drugs for high blood pressure, acne, birth control.
Corneal nerve insensitivity caused by contact lens use, nerve damage or laser eye surgery, though symptoms of dry eyes related to this procedure is usually temporary.

2. Production of Poor-quality Tears: This condition causes increased evaporation of tears, common causes of increased tear evaporation include:

Clogged Meibomian glands: This is the gland that produces the oil film tears, blocked Meibomian is seen more commonly in people with rosacea or other skin disorders – Posterior Blepharitis.
Blinking less often, which tends to occur with certain conditions, such as Parkinson’s disease; or when you’re concentrating during certain activities, such as while reading, driving or working on a computer.
Eyelid problems, such as the lids turning outward (ectropion) and the lids turning inward (entropies)
Eye allergies
Preservatives in topical eye drops
Wind, smoke, dust or dry air
Vitamin A deficiency

One may experience dry eyes in certain situations, such as:

Being in an aeroplane, an air-conditioned room for a long time or always riding on a bike.
After looking at a screen (Phone, Computers and Television etc.) for long hours.
Hormone changes, autoimmune disease, inflamed eyelid glands or allergic eye diseases.

DURATION OF DRY EYE

Acute dry eye caused by environmental factors, health problems, or medication may go away or improve once you identify the cause of dryness and make the necessary adjustments — such as treating an underlying health problem, switching medicines, lifestyle changes or adjusting the environment.
Unfortunately, severe cases of the dry eye can’t be fully cured; one may need to take some measures
indefinitely to control the symptoms of dry eyes.

RISK FACTORS

Factors that make it more likely for one to experience dry eyes include:

Anyone at any age can have dry eyes but it’s majorly seen in elderly patients. Being older than 50 is a risk factor as tear production tends to diminish as one gets older, dry eyes are more common in people over 50.
Being a woman, lack of tears is more common in women due to lack of testosterone in the oil glands most especially for post-menopausal women and hormonal changes due to pregnancy or using birth control pills.
Eating diet that is low in vitamin A, which is found in liver, carrots and broccoli, or low in omega-3 fatty acids, which are found in fish, walnuts and vegetable oils.
Wearing contact lenses or having a history of refractive surgery.

COMPLICATIONS

People who have dry eyes may experience these complications:

Eye infections
Inflammation, abrasion of the corneal surface, corneal ulcers which may lead to vision loss.
Decreased quality of life: Dry eyes can make it difficult to perform everyday activities as the symptoms are quite discomforting.

TREATMENT/ MANAGEMENT

The use of Artificial tear drops, medications that can boost tear production and reduce tear evaporation (testosterone gel).
Temporary punctal occlusion, Non-dissolving punctal plugs (If temporary plugs work well moving to longer-lasting may be considered), Punctal occlusion by cautery (application of heat to tear exit duct): These measures increase tear level by blocking the “drainpipe” through which tears usually go from the eyes to the nose.

Image credit: Punctal occlusion

3. LipiFlow: This involves the use of heat and pressure to unclog blocked glands on the eyelids.

Image credit: LipiFlow

4. Applying a warm wet washcloth to the eyelids for 30 seconds up to 4 minutes. This can be done twice a day and once a day when symptoms are gone in order to keep the problem from coming back

5. Eye Massage: This can help push the inflamed melted oil out of the glands, here’s how it’s done:

With the eyes closed, gently massage the lids by rolling your index finger in a circular motion or get a cotton swab and roll it down the upper lid toward the lashes and the edge of the lid.
To massage the lower lids, move your finger or swab up toward the lash line.
Repeat the steps 5-10 times.

6. Adding moisture to indoor air especially during winter by using a humidifier, this helps the eyes not to dry out as quickly.

7. Reduce screen time (Computer, smartphone, or tablet) because one tends to blink less when the eyes are fixed onto a screen it’s advised on adhering to the 20/20/20 rule. Take a 20-second break from your digital device every 20 minutes and look at something 20 feet away.

8. Adequate follow up with contact lenses use in terms of lens type or duration of use.

9. Recommend UV Protection Shadeswhich protects less evaporation of tears due to sun and screen rays.

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Article by Dr Nneoma Console Ukoh

Cover Photo by Danish Ahmad from Pexels

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REFERENCE