For World Sight Day this year we have collated a series of eye health related articles by surveying the eye experts who work at OQ. Our hope is to share this expert advice in order to further education on eye health topics and potentially help those who suffer from eye health related issues.
We have recently started stocking dry eye products at Ollie Quinn. So that you our readers and customers have all the information, we asked the Optometrist at OQ Covent Garden, Meesha, a few questions around what dry eye is and how you can prevent and treat it.
What is dry eye?
Dry eye is a common syndrome caused when the eyes’ tears are unable to provide adequate lubrication to the front of the eye. This could be due to the eyes not producing enough tears, the eyes producing poor quality tears (which can cause the tears to evaporate too quickly), or the ineffective spread of the tears across the eye. Dry eye syndrome is considered a chronic condition, which requires long-term routine management, and in most cases can be addressed without further complications. More severe cases can carry a risk of secondary eye infections or inflammatory disorders.
Some people may experience their eyes "drying out" in certain situations due to triggers in their environment, but they may not necessarily have a dry eye syndrome where an underlying problem with the quality or quantity of the tears is seen. Examples of such triggers are wind and sun, air-conditioned/dry/smoky environments, and excessive digital screen use.
Who is more at risk?
Common risk factors for dry eye syndrome include:
- Age - as we age tear quantity and quality generally diminish and the eyelids become less efficient at holding tears in the eye.
- Cis-female gender - tear production is affected by hormonal changes caused by menopause, oral contraceptives, and pregnancy.
- Certain medical conditions such as rheumatoid arthritis, diabetes, thyroid disease, Sjögren's syndrome, lupus, and rosacea.
- Certain medication groups including contraceptives, antihistamines, decongestants, blood pressure medications, and antidepressants.
- Blepharitis and meibomian gland dysfunction - common eyelid conditions which directly affect tear quality and quantity.
- Refractive laser surgery - dry eye is one of the most common side effects.
- Overwear of contact lenses.
- Eyelid issues such as incomplete lid closure when sleeping (causes evaporation of the tears), or abnormal inward/outward turning of the lower eyelid (causing tears to spill out of eyes).
How might I know if I have dry eyes?
Common symptoms of dry eye syndrome include grittiness, a stinging/burning sensation, watery eyes (ironic but true!), intolerance or reduced comfort with contact lens wear, intermittent blurred vision, general eye redness, and a stringy mucous discharge. In more advanced cases light sensitivity and increased glare at night may be experienced. It is important to note that dry eye syndrome is not the only cause of these symptoms, so it is advisable to have your eyes examined by an optometrist to confirm the cause.
Environmental triggers usually cause grittiness, stinging/burning, reduced contact lens comfort and watery eyes. The duration of the symptoms is generally associated with the duration of the exposure, but in those with underlying dry eye syndrome these triggers will exacerbate the already existing symptoms.
How can dry eye be treated?
The first-line treatment for both dry eye syndrome and eyes "drying out" in certain environments is lubrication agents, also referred to as artificial tears. These include drops, ointments and gels. The type of agent required will depend on the cause and severity of the dryness, but artificial tears in the form of drops are the most common.
Advanced conditions may require more invasive intervention, such as punctual plugs, which are tiny devices inserted into the tear ducts to decelerate drainage, or where eyelid behaviour is directly affecting the presence of tears in the eyes, lid surgery is considered.
What are some preventative measures I can take?
While many of the underlying risk factors such as age, hormonal influences and medical conditions cannot be prevented from causing dry eye, and neither would it be possible to prevent exposure to all of the environmental triggers mentioned above, measures can be taken to control, avoid or minimise symptoms:
- If artificial tears have been recommended, it is important to comply with the instructed frequency of use - dry eye syndrome requires long-term routine management.
- If underlying eyelid conditions such as blepharitis and meibomian gland dysfunction have been diagnosed, complying with the advice to manage them is important - such conditions also require long-term routine management.
- Humidifiers help to keep the air moist.
- Direct anything that pushes air, such as fan heaters/coolers and car vents, away from the eyes, or do not position yourself near them.
- Be mindful not to overwear contact lenses.
- Be mindful of blinking enough while using digital screens and take regular breaks from prolonged use.
- Those who have incomplete lid closure while sleeping can benefit from using a sleep mask.
What do artificial tears do?
Artificial tears supplement the eyes’ natural tears by making up for lack of quantity (whether temporarily triggered or chronic), or contributing to specific compounds in the tears to improve overall quality; the tear film consists of 3 main layers - mucin, aqueous, and lipid - if for example your dry eye is caused by the tears evaporating too quickly, then some artificial tears specifically target the lipid (oily) layer to strengthen it so that it is a more effective barrier to evaporation.
Dry eye syndrome can also cause loss of cells from the outer surface of the eye (cornea), and artificial tears can help to create a smooth fortified film over it, enabling faster regeneration of the cells.
Any tips on how to put drops in? I hate putting things in my eyes.
There is no right or wrong way to put drops into the eyes, what matters is that the technique is safe and hygienic. People will generally instil eye drops by tilting their head back, holding down the lower lid, and squeezing drops straight into the middle of the eye. If you struggle with this then you could try looking straight at yourself in a mirror, holding down your bottom lid to create a small pocket between the lid and the eyeball, and instilling the drops into there. There are also devices available that can be attached to the eye drop bottles to aid instillation. In all cases always ensure that the tip of the bottle does not come into contact with anything, and clean any attachable device as per the manufacturer's instructions.
What does a heated eye mask do?
Heated eye masks are recommended where eyelid conditions such as blepharitis and meibomian gland dysfunction are diagnosed. The masks' heat helps open up blocked glands, allowing the tear components to flow more freely. The masks also help to relieve the general symptoms of irritation associated with these conditions. The use of a heated eye mask is usually advised in combination with artificial tears.
A common question we get asked in practice - "Why do my eyes water if I have dry eyes?"
Watery eyes in dry eye syndrome is the response of the feedback loop responsible for controlling tear production - when a state of dryness is sensed, the feedback signal activates an overshoot of tear production causing an abundance of tears to be released to replenish them, and the excess spills out of the eye. This tends to occur in cycles, hence the intermittent nature of the symptom. A tendency for watery eyes in windy weather is also due to a similar reason since wind can trigger evaporation and therefore dry out the eye.