Dry eye is one of the most frustrating disorders to diagnose and treat. It has a complex etiology and symptoms and can have serious consequences for quality of life.

Keeping your eyes healthy and comfortable requires lifestyle changes, home treatments, and doctor care. Your doctor may recommend lubricating eye drops, prescribe a medication to increase tear production or fit you with a special type of contact lens that preserves tears. Contact Dry Eye Baltimore, MD now!

If home remedies and over-the-counter treatment don’t improve your symptoms, visit an eye doctor. Your eye doctor will evaluate your symptoms and determine if an underlying condition may be to blame for your dry eyes.

Any number of factors can cause dry eye. Tear production decreases naturally with age, as a result of certain medical conditions, or as a side effect of medications. Environmental factors like hot, windy weather and dry climates can also reduce tear volume by evaporating tears too quickly from the surface of the eye.

In addition, certain contact lens solutions and medications can cause or worsen dry eye. A common culprit is the anticholinergic drug cimetidine (Tagamet). Other drugs that can contribute to dry eye include those used for depression, high blood pressure and other health issues, such as rheumatoid arthritis and lupus.

The most typical symptom of dry eye is a feeling that there’s something in your eye, but many people also notice itchy, gritty or scratchy eyes, blurry vision, excessive tears, burning and watery eyes. Some experience a dry mouth or nose, red lips or skin around the eyes, and even trouble sleeping at night due to irritated or dry eyes.

There are several conservative treatments for dry eye. These include over-the-counter and prescription eye drops, gels and ointments. These help to increase the quality and quantity of your tears, improve Meibomain gland oil production and treat any inflammation on the surface of the eyelid or in the tear ducts. In addition, your eye doctor might recommend nutritional supplements and warm compresses to decrease inflammation on the surface of the eye.

Avoid any environment or lifestyle factors that aggravate your symptoms. For example, try to minimize exposure to air conditioning, cigarette smoke, and windy or dry environments. Wear wraparound sunglasses when outdoors, and consider a humidifier for your home. Avoid opening your eyes wide for extended periods of time, especially when viewing computer screens. If possible, position your screen below eye level so that you won’t have to open your eyes as wide. If you smoke, talk to your eye care team about strategies to quit smoking.

Diagnosis

If over-the-counter eye drops and a change in your lifestyle don’t ease your symptoms, you should visit an eye doctor or GP. They will ask you about your symptoms and examine your eyes. They will also look at your medical history and discuss any medications you are taking. They will need to know if you have any conditions that can cause dry eyes, such as a systemic condition like Sjogren’s syndrome or a chronic inflammatory disease such as rosacea, Demodex mites, ocular herpes or graft versus host disease.

Your eye care professional will likely use a fluorescein orange dye and a blue light to see how long your natural tears cover the surface of your corneas. The dye will highlight any areas where the tear film isn’t holding up well or is damaged by your symptoms. They may also use lissamine green staining to help identify degenerated cells in the conjunctiva.

A meibomian gland dysfunction (MGD) evaluation is another important test to diagnose DED. Your eye care professional will use a LipiScan machine to capture high-resolution digital images of your meibomian glands. The images will allow your doctor to assess the oil content of your tears and determine if the glands are functioning properly.

An ophthalmologist or ocular surgeon can also perform a tear film analysis by placing a small amount of a fluorescent dye over your closed eye. They will then ask you to blink slowly and look straight ahead without moving your head or eyes. This will give them an idea of how long the dye remains on the eye, which can help them determine how quickly your tears evaporate.

The doctor will then need to examine your eyelids, the surface of your corneas and how you blink. They will also ask you about any other symptoms you are having, such as a feeling of a foreign object in the eye, that you might have.

If they suspect that you have dry eye syndrome, your doctor will probably prescribe ocular lubricants and possibly a dietary supplement to help increase your tear production. If the problem is severe, they may prescribe ocular steroids for short periods of time or oral cyclosporine or lifitegrast to increase tear production. They will also tell you about any lifestyle changes they recommend, such as using a humidifier or limiting your contact lens wear to keep your eyes healthy and comfortable.

Treatment

There’s no cure for dry eye, but effective treatment can significantly reduce symptoms. Your eye care professional may recommend a combination of conservative treatments, including eye drops, gels or ointments. They may also prescribe other medications, such as cyclosporine (Restasis or Cequa) and lifitegrast (Xiidra), which can help increase tear production, reduce inflammation and decrease the signs and symptoms of chronic dry eyes.

Your doctor may advise you to modify your environment to improve dry eye symptoms. They might recommend a humidifier, avoiding direct airflow from heaters and fans and reducing screen time on your computer or TV. They might also suggest lid hygiene, such as using warm compresses or cleaning the eyelids daily. Your eye care provider might also refer you to a specialist who treats conditions that affect the eyelids (oculoplastic surgeon). They might recommend an analgesic or anti-inflammatory for eye pain and a treatment regime to manage blepharitis, a condition where oil glands along the eyelid become clogged.

The next step might be to try prescription eye drops that promote the production of tears or block the openings of the tear ducts to keep the tears on the surface longer. These might include a class of drugs called prostaglandin analogues. They can help improve symptoms in about 80% of people.

Other prescription options include topical steroids, oral secretagogues and therapeutic contact lenses. In some cases, a person might need to have their tear ducts blocked permanently with tiny plugs or surgically closed. Some severe patients might need to have autologous serum eye drops, scleral lenses or other procedures such as Lipiflow thermal pulsation therapy and intense pulsed light therapy.

For many patients, treating the underlying health condition is essential for managing their symptoms. They might have to make changes to their diet, stop smoking, or change the way they use their medication, depending on the cause of their autoimmune disease. Some patients might need to see a primary care provider or rheumatologist for further management of their symptoms in addition to an eye care provider. It is important for a patient to communicate with all their providers to ensure they are getting the best care for their symptoms and the underlying health problems that might be causing them.

Prevention

In addition to treating symptoms, eye doctors work with patients on preventive measures to reduce the risk of dry eye. This includes educating them on environmental or behavioral modifications that may reduce their symptoms. These include avoiding fans or air conditioners that blow air directly into the eyes, blinking awareness training (or taking frequent breaks when using digital devices), and avoiding excessive use of artificial tears or contact lenses. Patients are also advised to eat a healthy diet that includes sources of omega-3 fatty acids, which have been shown to decrease dry eye symptoms in some people.

Dry eye symptoms often occur because the tear film — a mixture of oil, water and mucus — has been compromised by an imbalance in the ingredients or because the tears evaporate too quickly. The symptoms can be temporary — caused by an overly windy environment, an airplane ride or too much screen time — or chronic, and they can lead to a variety of complications including vision loss, inflammation, corneal ulcers and even conjunctivitis.

Tears are produced by a group of glands in the corner of each eyelid called the lacrimal glands. The main role of the tears is to lubricate the front surface of the eye and keep it moist. The tears flow into the tiny channels that drain into the nose and into the mouth, and from there they are absorbed into the blood stream.

The most common cause of dry eye is aging, but certain medications can also increase the risk, including antihistamines, antidepressants, blood pressure pills and anticholinergics. Some medical conditions, such as blepharitis and meibomian gland dysfunction, can also cause dry eye.

Over-the-counter artificial tear drops can provide immediate relief for mild symptoms. If you use artificial tears, look for preservative-free ones to avoid irritation. You can also use ointments or thick gels that don’t need to be refrigerated. For more severe dry eye, your ophthalmologist may prescribe a prescription medication to encourage the production of more tears or reduce inflammation. In very severe cases, doctors may recommend surgery to plug the small holes in the corners of each eyelid — known as punctal plugs — to help retain moisture on the eye.