For many people with dry eye, the symptoms are undeniable and ever pervasive, but for others it is not so clear-cut. I see patients adapting and coping not knowing their eyes could work and feel so much better. The prevalence of dry eye varies widely between studies but could be as much as a third of our population. Recent research indicates that the percentage is likely much higher for certain groups such as office workers, with percentages approaching 50%, partially because of their extensive digital-device usage. Furthermore, these numbers are expected to rise in large part due to our aging population, increasing digital-device usage and increasing prevalence of autoimmune diseases such as Type 1 diabetes and Lupus. A number that might be even more surprising is that up to 70% of people polled don’t seek care when experiencing symptoms of dry eye.
So what sort of symptoms or signs might one experience with dry eye? Here are some of the questions I might ask a patient in the chair to confirm what I might see during the exam.
1. Do your eyes bother you while on your phone or computer?
2. Do your eyes get irritated when wearing your contact lenses?
3. Does your vision blur intermittently throughout the day?
4. Do your eyes water intermittently, especially in the wind or the cold?
5. Do your eyes get red, sore, itchy or burn?
6. Do you find you are getting sensitive to certain lighting?
7. Do you ever avoid certain activities due to your eyes?
8. Do you get frequent crusting or mucous in around your eyes?
9. Do you get the intermittent feeling that something is stuck in your eye?
10. Do you ever use or feel the need to use eye drops?
If you answered yes to more than one of these questions, it’s probable that dry eye is involved. So what exactly is dry eye anyways? In most cases, dry eye occurs when the eye does not produce enough tears or when the makeup of the tears changes so they are unstable and evaporate too quickly with the resulting irritation (inflammation) making matters worse. The tears prevent dryness, help keep the cornea smooth so we can see clearly, protect the surface from irritants and infection and so much more. So a poor tear film can result in more than just irritation. Someone with mild dry eye might be tempted to disregard the symptoms, but it’s important to realize that dry eye is usually progressive in nature and, in general, is much easier to
manage in its early stages. It is for this reason that in my practice I focus on a proactive program to maintain a healthy ocular surface, striving for prevention when possible, treatment as needed.
Common causes of decreased tear production include increasing age, certain medications such as antihistamines and antidepressants, or certain medical conditions such as arthritis or diabetes. The main cause of increased evaporation and the main cause of dry eye in general is something called Meibomian Gland Disease (MGD). These meibomian glands in your eyelids produce an oily layer for your tears which helps prevent evaporation, so when they stop functioning properly, a cascade of dry eye can begin.
So how does digital-device usage fit into the mix? Well these oil-producing glands are expressed when we blink, and it turns out if our blink frequency is reduced over extended periods of time, theses glands can get blockages or can be reduced in function. So since we blink approximately 50% less than normal when viewing digital devices, we have our answer. The problem can become chronic since if the blockages are not cleared or function restored for extended periods of time, the glands can be damaged or lost.
So what can be done to prevent and to treat? From the prevention perspective, start with a routine exam, and ask your eye care provider about the state of your tear system. If you are taking medications or have any pre-existing health issues, then ask how they might affect your eyes over time. Since most dry eye is related to MGD, maintaining the function of those oil-producing glands is a critical step in prevention in many cases. In mild cases, a simple eyelid heating and gland expression protocol can be effective prevention.
After diagnosing a patient with dry eye disease, the first step is determining the causative factors, as medications or other health issues may be contributing. Is there a decrease in tear production and/or decreased meibomian gland function? Is contact lens wear or digital-device usage compounding the situation? In some cases, the lid mechanics are part of the problem (the lids might not close properly, or the lower lid turns outwards). If diagnosed properly, the vast majority of patients with dry eye disease can find relief with proper therapy. For mild cases, a regime of eyelid heating/expression, artificial tear usage and specific oral supplements will likely be sufficient. In more recalcitrant cases, anti-inflammatory drugs together with drugs that modulate the immune system locally can help to quell severe irritation and help a person to produce more tears.
If you have dry eye disease and have been living with the symptoms, it is important to know that so much more than just using artificial tears can be done to help. On the other hand if you answered yes to any of the questions prior but have not sought out care as of yet, book an appointment; early treatment and prevention are key. As always, if you have any questions or concerns, we are here to help.
Dr. Peter Roed