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Dry Eye Disease
Dry Eye Disease (DED), also known as keratoconjunctivitis sicca, is a common condition that occurs when the eyes don’t produce enough tears or when the tears evaporate too quickly, leading to dryness and irritation of the eyes. It can cause discomfort, and if left untreated, it may lead to vision problems. DED can affect people of all ages but is more common in older adults and women.
Background
Tears play a critical role in maintaining the health of the eyes. They help to keep the surface of the eye moist, wash away debris, and protect against infections. The tear film is made up of three layers:
- Lipid layer: The outer layer, which helps prevent evaporation.
- Aqueous layer: The middle layer, which provides moisture and nourishment.
- Mucin layer: The innermost layer, which helps the tear film adhere to the eye’s surface.
In Dry Eye Disease, the balance of these layers is disrupted, leading to insufficient tear production or poor-quality tears. This can result in symptoms such as irritation, redness, and a gritty feeling in the eyes.
Signs and Symptoms
Common signs and symptoms of Dry Eye Disease include:
- Dryness: A feeling of dryness or the sensation of something in the eye (foreign body sensation).
- Irritation: Burning or stinging sensations in the eyes.
- Redness: Increased redness in the white part of the eye (conjunctiva).
- Blurred vision: Vision may fluctuate, especially after reading or using a computer for a long time.
- Excessive tearing: Paradoxically, the eye may produce excessive tears in an attempt to relieve dryness, which can lead to watery eyes.
- Light sensitivity: Discomfort when exposed to bright lights.
- Fatigue: Difficulty keeping the eyes open or feeling tired from prolonged visual tasks.
Risk Factors
Several factors can increase the likelihood of developing Dry Eye Disease, including:
- Age: The risk increases with age, especially after 50.
- Gender: Women are more likely to develop DED, often due to hormonal changes during pregnancy, menopause, or the use of birth control.
- Environmental factors: Exposure to dry climates, wind, smoke, or air conditioning can exacerbate symptoms.
- Medical conditions: Conditions like rheumatoid arthritis, diabetes, thyroid disorders, sjögren’s syndrome, and blepharitis (inflammation of the eyelids) increase the risk of DED.
- Medications: Certain medications, such as antihistamines, antidepressants, beta-blockers, and oral contraceptives, can reduce tear production.
- Extended screen time: Spending long hours on computers, tablets, or smartphones can reduce the frequency of blinking, leading to increased evaporation of the tear film.
- Contact lens use: Long-term use of contact lenses can lead to dry eye symptoms, especially in people who wear them frequently or for long hours.
Treatment
Treatment for Dry Eye Disease varies depending on the severity and underlying cause of the condition. Common treatment strategies include:
- Artificial tears: Over-the-counter lubricating eye drops help replace the missing tears and provide relief. There are different types available, including preservative-free options.
- Punctal plugs: Small devices inserted into the tear ducts to block tear drainage and help retain moisture on the eye’s surface.
- Prescription medications:
- Anti-inflammatory drugs (e.g., cyclosporine A or lifitegrast) help reduce inflammation in the eye and increase tear production.
- Steroid drops may be prescribed for short-term use in cases of inflammation.
- Warm compresses: Applying a warm compress to the eyelids can help unclog blocked glands and improve the quality of tears.
- Eyelid hygiene: Cleaning the eyelids to remove debris, oil, and bacteria can help reduce inflammation, especially in cases of blepharitis.
- Lifestyle changes:
- Reducing screen time or taking frequent breaks when using devices (the 20-20-20 rule: every 20 minutes, look at something 20 feet away for at least 20 seconds).
- Increasing humidity in your environment using a humidifier.
- Surgical treatments: In severe cases, a surgical procedure to close the tear ducts may be considered, preventing tears from draining too quickly.
- Nutritional supplements: Omega-3 fatty acids (from fish oil or flaxseed oil) are sometimes recommended to reduce inflammation and improve tear production.
