DRY EYE SYNDROME

 Introduction

Dry eye syndrome also known as keratoconjunctivitis sicca is a multifactorial disease of the ocular surface due to loss of homeostasis of the tear film. DRY EYE disease is a common condition that occurs when your tears aren’t able to provide adequate lubrication for your eyes.

Tears can be inadequate and unstable for many reasons example, dry eye may occur if you don’t produce enough tears or if you produce poor quality tears. This year instability leads to inflammation and damage of the eye’s surface.

Ocular surface:

The ocular surface is an integrated anatomical unit consisting of seven key interactive and interdependent components; the tear film, the lacrimal and accessory lacrimal apparatus,  nasolacrimal drainage system, the eyelids, the bulbar and tarsal conjunctiva, Cranial nerve V and Cranial nerve VII.

Abnormalities or deficiencies in any of the seven ocular surface components may worsen dry eye disease,yet promise opportunities for effective therapeutic intervention.

SYMPTOMS

Signs and Symptoms which usually affect both eyes include;

1. Sensitivity to light
2. A stinging, burning or scratchy sensation in your eyes.
3. Eye redness
4. A feeling of having something in your eyes.
5. Watery eyes
6. Stringy mucus in or around the eyes.

A PICTORIAL representation of the signs and symptoms of dry eyes.

CAUSES

Dry eyes are caused by a variety of reasons that disrupt the healthy tear film. Your tear film has three layers: lipid layer aqueous layer and mucous layer.  This combination normally keeps the surface of your eyes lubricated, smooth, and clear. Problems with any of these layers can cause dry eyes.

 Reasons for tear film dysfunction are many, which include hormonal changes, autoimmune disease, inflamed eyelid glands or allergic eye disease. For some people, the cause of dry eyes is decreased tear production or increased tear evaporation.

1. DECREASED TEAR PRODUCTION

Dry eyes can occur when you are unable to produce enough water (aqueous fluid). The medical term for this condition is keratoconjunctivitis sicca (ker-uh-toe-kun-junk-tih-VY-tis SIK-uh).

Common causes of decreased tear production include:

1. Aging
2. Certain medical conditions including Sjogren’s syndrome, allergic eye disease, rheumatoid arthritis, lupus, scleroderma, graft vs. host disease, sarcoidosis, thyroid disorders or vitamin A deficiency.
3. Certain medications affect our teat production which includes ; antihistamines, decongestants, hormone replacement therapy, antidepressants, and drugs for high blood pressure, acne, birth control and Parkinson’s disease.
4. Corneal nerve desensitivity caused by contact lens use, nerve damage or that caused by laser eye surgery, though symptoms of dry eyes related to this procedure are usually temporary.

 

2. INCREASED TEAR EVAPORATION

The oil film produced by small glands on the edge of your eyelids (meibomian glands) might become clogged. Blocked meibomian glands are more common in people with rosacea or other skin disorders.

Common causes of increased tear evaporation include:

1. Posterior blepharitis (meibomian gland dysfunction).
2. Blinking less often, which tends to occur with certain conditions, such as Parkinson’s disease; or when you’re concentrating during certain activities, such as while reading, driving or working at a computer.
3. Eyelid problems, such as the lids turning outward (ectropion) and the lids turning inward (entropion).
4. Eye allergies
5. Preservatives in topical eyedrops.
6. Wind, smoke or dry air.
7. Vitamin A deficiency.

RISK FACTORS

Factors that make it more likely that you’ll experience dry eyes include:

1. Being older than 50. Tear production tends to diminish as you get older. Dry eyes are more common in people over 50.
2. Being a woman. Lack of tears is more common in women, especially if they experience hormonal changes due to pregnancy, using birth control pills or menopause.
3. Eating a diet that is low in vitamin A, which is found in liver, carrots and broccoli, or low in omega-3 fatty acids, which are found in fish, walnuts and vegetable oils.
4. Wearing contact lenses or having a history of refractive surgery.

COMPLICATIONS

People who have dry eyes may experience these complications:

1. Eye infections: Your tears protect the surface of your eyes from infection. Without adequate tears, you may have an increased risk of eye infection.
2. Damage to the surface of your eyes: If left untreated, severe dry eyes may lead to eye inflammation, abrasion of the corneal surface, corneal ulcers and vision loss.
3. Decreased quality of life: Dry eyes can make it difficult to perform everyday activities, such as reading.

PREVENTION

  If you experience dry eyes, pay attention to the situations that are most likely to cause your symptoms. Then find ways to avoid those situations in order to prevent your dry eyes symptoms. For instance:

1. Avoid air blowing in your eyes: Don’t direct hair dryers, car heaters, air conditioners or fans toward your eyes.
2. Add moisture to the air: In winter, a humidifier can add moisture to dry indoor air.
3. Consider wearing wraparound sunglasses or other protective eyewear. Safety shields can be added to the tops and sides of eyeglasses to block wind and dry air. Ask about shields where you buy your eyeglasses.
4. Take eye breaks during long tasks. If you’re reading or doing another task that requires visual concentration, take periodic eye breaks. Close your eyes for a few minutes. Or blink repeatedly for a few seconds to help spread your tears evenly over your eyes.
5. Position your computer screen below eye level. If your computer screen is above eye level, you’ll open your eyes wider to view the screen. Position your computer screen below eye level so that you won’t open your eyes as wide. This may help slow the evaporation of your tears between eye blinks.
6. Stop smoking and avoid smoke. If you smoke, ask your doctor for help devising a quit-smoking strategy that’s most likely to work for you. If you don’t smoke, stay away from people who do. Smoke can worsen dry eyes symptoms.
7. Use artificial tears regularly. If you have chronic dry eyes, use eyedrops even when your eyes feel fine to keep them well lubricated.