Dry Eye Syndrome is a common condition. Its medical name is Keratoconjunctivitis Sicca (KCS). It is caused by sub-optimal production of tears or tears of sub-optimal quality which reduce the normal healthy lubrication of the eye. A constant flow of tears is essential for good eye health, comfort, and vision. Tears not only wash away dust and foreign matter but also ensure the eye is moist and lubricated and are essential to clear vision.
Two major glands and groups of glands produce the tears
- The lacrimal glands – which produce the major watery component located under the upper eyelid
- The meibomian glands – which are numerous and located in the upper and lower eyelids. They keep the eye moist by preventing tears on the surface of your eye from evaporating. They do this by producing an oily film over your tears.
Dry Eye: Overview
Dry Eye Syndrome can develop due to either a problem with the quality or the quantity of tears. There are a few reasons for the cause such as the eye may not produce enough tears, or the quality is poor and the tears either do not spread well or they may evaporate too quickly. Unusual as it may seem, one of the most common signs of Dry Eye Syndrome is the production of too many tears or watery eyes, which is termed ‘reflex tearing.’
Dry Eye Syndrome can occur in one or both eyes and symptoms can include:
- A feeling of sand or grit in the eye
- Scratchiness or irritation
- Red eyes
- Blurred vision, and/or
- An inability to wear contact lenses
In addition, factors which exacerbate Dry Eye Syndrome include:
- Lengthy periods spent in air conditioning such as an office or supermarket
- Prolonged periods of time at a computer or watching television (as you do not blink as often when looking at a monitor for extended periods).
- After vision correcting laser surgery (disruption to the surface of the eye) you will experience this however you will be given lubricating drops after the procedure to alleviate this.
- Prolonged wearing of contact lenses which prevents the required amount of oxygen to enter through the cornea.
- Travelling on an aeroplane.
- Windy, dry weather conditions.
- As we age due to a reduction in tears being produced.
- Some medications may decrease tear production and/or
- Irritants such as dust, smoke or chemical exposure.
Before an Ophthalmologist is able to diagnose whether a patient is suffering from dry eye syndrome they will carefully examine the eye as well as collecting a full medical history. They will check the cornea to determine if there is any damage as well as diagnosing the extent of the dryness. Tests may be performed to determine the underlying cause.
Dr Eye Syndrome is usually a long-lasting condition that commonly comes and goes with varying severity. In general, the tear producing glands of the eye become less functional with time so it is more common as we age. There is currently no cure for dry eye and therefore the treatment has been directed at the management of symptoms in order to support the existing tears and increase patient comfort rather than cure the disease.
Management of all stages of dry eye includes moisture replacement using artificial tears as well as lubricating ointment at night; as often blurred vision is observed for a short period of time. In general, these treatments are not supported by the PBS but may be readily found at the pharmacy. Your specialist may be able to offer advice on which product type may be best suited for your eye.
If lubricating drops are themselves insufficient, further treatment may include
- Cyclosporine A drops – these are prescription only anti-inflammatory and immunomodulator drops aimed to increase the function of the lacrimal gland. Thus it is aimed to produce more of your own tears.
- Punctal Occlusion – sometimes keeping the tears on the surface of the eye is needed, which is when the punctum or tear drainage duct may be intentionally obstructed to keep the eye moist. This may include a temporary ‘plug’ or used long term depending on the need.
- Lateral Tarsorrhaphy – in severe cases, the outside third of the eyelids may be brought closer together to limit the amount of the surface of the eye exposure. This is a surgical procedure which may be reversible or permanent, depending on the cause and its prognosis to improve the condition.
- Dry eye is common, and becomes more common with age
- It can be exacerbated in dehydrating or windy environments, when concentrating (ie screen work) or with certain eyelid problems
- Treatment usually involves supplementing the tear film with lubricating eye drops, but may include other drops, treatments or eyelid hygiene / cleaning and avoiding or minimising exacerbating factors
- It may be a long term condition, but whose symptoms can usually be adequately managed.