Dry Eye Syndrome: Causes, Symptoms & Treatment

Dry eye syndrome is one of the most common eye conditions, affecting millions of people worldwide. This comprehensive guide explores the causes, symptoms, and evidence-based treatments to help you find relief from dry eye discomfort.

What is Dry Eye Syndrome?

Dry eye syndrome (DES), also known as keratoconjunctivitis sicca, is a multifactorial disease of the tears and ocular surface. It occurs when your eyes don't produce enough tears, or when the quality of your tears is compromised, leading to inadequate lubrication of the eye surface.

This condition can result in discomfort, visual disturbances, and potential damage to the ocular surface. Dry eye is particularly common in older adults, but it can affect people of all ages.

Common Symptoms of Dry Eye Syndrome

Dry eye symptoms can range from mild irritation to significant discomfort that interferes with daily activities. Common symptoms include:

• A stinging, burning, or scratchy sensation in your eyes
• Stringy mucus in or around your eyes
• Increased sensitivity to light (photophobia)
• Redness in the eyes
• A feeling like something is in your eyes
• Difficulty wearing contact lenses
• Difficulty with nighttime driving
• Watery eyes, which is the body's response to the irritation of dry eyes
• Blurred vision or eye fatigue

What Causes Dry Eye Syndrome?

1. Age and Hormonal Changes

Dry eye syndrome becomes more common with advancing age, particularly after age 50. Hormonal changes, especially in women during menopause, can contribute to dry eyes due to decreased tear production.

2. Environmental Factors

Environmental conditions that can increase tear evaporation include:

• Wind, smoke, or dry air
• High altitude
• Air-conditioned or heated environments
• Prolonged screen time (digital eye strain)

3. Medical Conditions

Several medical conditions are associated with dry eye, including:

• Autoimmune disorders like Sjögren's syndrome, rheumatoid arthritis, and lupus
• Diabetes
• Thyroid disorders
• Vitamin A deficiency
• Blepharitis (inflammation of the eyelids)

4. Medications

Certain medications can decrease tear production, including:

• Antihistamines and decongestants
• Antidepressants
• Blood pressure medications
• Hormone replacement therapy
• Acne medications (isotretinoin)

Evidence-Based Treatments for Dry Eye Syndrome

1. Artificial Tears and Lubricating Eye Drops

Over-the-counter artificial tears are the first-line treatment for mild dry eye. These lubricating eye drops can temporarily relieve symptoms by supplementing your natural tear production.

For moderate to severe cases, prescription eye drops like Restasis (cyclosporine) or Xiidra (lifitegrast) may be recommended to reduce inflammation and increase tear production.

2. Nutritional Supplements

Research has shown that certain nutritional supplements can help improve dry eye symptoms:

• Omega-3 fatty acids: Found in fish oil and flaxseed oil, omega-3s can help improve the oil layer of the tear film. The DREAM study found that while omega-3 supplements didn't outperform placebo for all patients, they may be beneficial for specific subgroups.
• Vitamin A: Essential for eye health and tear production. Vitamin A deficiency can lead to dry eyes and other ocular issues.
• Vitamin D: Some studies have found associations between vitamin D deficiency and dry eye syndrome.

3. Lifestyle and Environmental Modifications

Simple changes to your environment and habits can help reduce dry eye symptoms:

• Use a humidifier to add moisture to the air
• Take regular breaks during computer use (follow the 20-20-20 rule: every 20 minutes, look at something 20 feet away for 20 seconds)
• Position your computer screen below eye level to reduce eye opening
• Avoid direct air from fans, heaters, or air conditioners blowing toward your eyes
• Wear wraparound sunglasses when outdoors to protect from wind and sun
• Stay hydrated by drinking plenty of water

4. Medical Procedures

For more severe cases, your eye doctor might recommend:

• Punctal plugs: Tiny devices inserted into the tear ducts to block drainage and keep tears on the eye surface longer
• LipiFlow: A treatment that uses heat and pressure to unclog blocked meibomian glands
• Intense Pulsed Light (IPL) therapy: Used to treat inflammation of the eyelids and improve meibomian gland function
• Autologous serum eye drops: Made from your own blood and containing growth factors and other components that can promote healing

Prevention Strategies

While some causes of dry eye can't be prevented, these strategies may help reduce your risk:

• Maintain proper eyelid hygiene with regular cleaning
• Include omega-3 fatty acids in your diet through fish or supplements
• Stay hydrated throughout the day
• Use a humidifier in dry environments
• Take screen breaks and practice the 20-20-20 rule
• Protect your eyes from wind and sun with appropriate eyewear
• Avoid smoking and minimize exposure to secondhand smoke

When to See a Doctor

Consult an eye care professional if you experience:

• Severe or persistent dry eye symptoms
• Eye redness that doesn't improve with over-the-counter treatments
• Pain or vision changes
• Symptoms that interfere with daily activities

An ophthalmologist or optometrist can perform specific tests to evaluate your tear production and quality, allowing for a tailored treatment approach.

Conclusion

Dry eye syndrome is a common but manageable condition. With the right combination of treatments, supplements, and lifestyle changes, most people can find significant relief from dry eye symptoms. Remember that treatment is often ongoing, and it may take some time to find the approach that works best for your specific situation.