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Chronic Dry Eye Causes and Treatments

Dry eye syndrome, also simply known as dry eyes, is a chronic condition affecting 4.91 million Americans 50 years and older. Reports estimate that millions of younger people are also affected but have less severe symptoms that are mostly episodic.

While exact numbers for the prevalence of chronic dry eye among the younger population are difficult to pinpoint, dry eye can be promptly diagnosed and appropriately treated if you consult with an experienced dry eye specialist. Identifying the correct underlying cause is critical to finding the best way to alleviate the discomfort attributed to dry eye.

It is important to learn about possible causes of dry eyes, how a diagnosis is made, and the different treatments available for chronic dry eye today. This information will be outlined below.

Dry Eye Causes

Symptoms of dry eye can differ from one person to another because underlying causes tend vary. These include but are not limited to the following:

  • Natural process of aging
  • Hormonal imbalance (which explains why dry eye is common in women, particularly those who are menopausal, pregnant, or taking oral contraceptives)
  • A side effect of certain medications such as antidepressants, decongestants, antihistamines, and anti-hypertensive drugs
  • Medical conditions such as autoimmune disorders (Sjögren’s syndrome, rheumatoid arthritis, diabetes, and thyroid problems)
  • Inflammation of the eyelids
  • Chronic exposure to dry climates, smoke, and dry wind
  • Long-term use of contact lenses
  • Staring at digital screens for long periods of time
  • Post-refractive eye surgeries such as LASIK


Dry Eye Diagnosis

Dry eye syndrome is usually diagnosed with a thorough evaluation of the patient history, careful physical assessment, comprehensive eye examination, and ocular surface tests. Testing may include the following:

  • Schirmer test
  • Tear osmolarity
  • Corneal sensation test
  • Corneal staining

Other testing methods may be used to rule out medical conditions that can cause dry eye symptoms.

Your Options for Dry Eyes Treatment

If your dry eye symptoms are caused by an underlying condition, recommended treatments will be focused on the condition itself. You can also discuss medications, surgical procedures, and non-surgical methods with your eye doctor.

Dry Eye: Non-surgical Approach

  • Warm Moist Compresses: When applied to your eyelids, this approach helps stimulate the meibomian glands of the eyelids to produce more lipids, a component of our tears.
  • Punctal Plugs: Punctal plugs are often made of silicone, acrylic, or hydrogel. They are inserted into the tiny ducts where tears drain. These plugs help keep the tears on your eye’s surface and prevents them from evaporating quickly.
  • Blinking: Frequent blinking while reading or working with computers helps sufferers of mild dry eye cases. This can be hard to remember to do while performing focused tasks.
  • Intense Pulsed Light Therapy (IPL): IPL is recommended for dry eye caused by ocular rosacea, a condition where tiny blood vessels along the eyelid margin are unusually dilated. IPL helps return the blood vessels to their regular size decreasing the appearance of redness. It also heats the eyelids, allowing the meibomian glands to open and release lipids.
  • Meibomian Gland Expression: This is recommended for dry eyes caused by meibomian gland disease. A forceps-type device is used to gently squeeze out the clogged contents from the meibomian glands. Once the clogged contents are out, natural oil production will return to normal and will keep tears from evaporating as quickly.
  • LipiFlow Thermal Pulsation System (TearScience): This patented device combines the results of warm compress and meibomian gland expression.


Dry Eye Medications

There are a few basic medications that can be used in mild cases of dry eye. They can also be used after procedures to keep the eyes moistened. These include:

  • Eye lubricating drops: These are popularly known as artificial tears. Ask your doctor for recommendations or prescriptions. Brands have different sets of ingredients, depending on the what is missing in the layers of your tear film. Eye drops range from oil-based drops to hypotonic drops. Consider using preservative-free brands if you’re going to use these drops more than four times a day.
  • Nonsteroidal prescription drops: Eye drops like Restasis or Xiidra are the treatment of choice for dry eyes caused by inflammation of the surface of the eye.
  • Serum tears: This formulated teardrop is typically used in moderate to severe cases and contains the clear portion, or serum, of the patient’s blood. The formula contains saline, as well as other nutrients and growth factors.


Dry Eye: Surgical Approach

Often, surgery is the last resort to treat dry eye syndrome. Punctal cautery is a quick procedure that permanently closes the tear drainage holes to keep tears within the eye’s surface for a longer period of time.

Preventing Dry Eye Syndrome

While there are cases when dry eye syndrome is a secondary condition from an underlying cause, there are also things most people can do to prevent it from happening:

  • Take frequent breaks when working for long periods in front of the screen.
  • Wear sunglasses with wraparound frames when going outdoors, particularly in dry climates
  • Use a humidifier during winter to help moisten the air
  • Avoid smoking or going near people who smoke
  • Strive for a diet rich in omega-3’s (e.g. flax seed oil, chia seeds, fish, cod liver oil)

Ignoring dry eye symptoms can potentially lead to inflammation of the cornea, conjunctivitis, and permanent vision loss in extreme cases. Surgery is not the automatic first choice, but it is nevertheless critical to get in touch with an eye specialist immediately once you notice early signs of dry eye symptoms.

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