Dry eye syndrome affects many Albertans. The Alberta Association of Optometrists conducted a study in February 2019 with 1000 random participants. They found that 90% of respondents experienced some symptoms of dry eye, and 74% experienced tearing or a sensation of foreign objects in their eyes.
Dry eye can have many causes, and it’s natural to want the cure as soon as you’re affected by it. Unfortunately it’s not so simple for eye doctors to find and present the cure. What’s needed is a better understanding of what dry eye is, and how patients can restore moisture to their eyes, especially in Calgary or rural Alberta’s climate.
The basal (normal) level of tears in your eyes plays an important role, and it’s called the tear film. Your tear film is made of 3 layers:
Mucin Layer: mucous comes from specialized cells under your eyelid and in your cornea, and it supports the aqueous layer.
Aqueous Layer: water forms a large part of your tears. Coming from the lacrimal gland, it provides the moisture and oxygen your eyes need, especially the cornea.
Lipid Layer: fats and oils cover the aqueous layer, preventing evaporation. Oil comes from the meibomian glands, small productive shafts in your eyelids.
Dry eye isn’t just one chronic condition. Since your tear film is a delicate balance with a careful ratio, preserving it can be a juggling act for your body. One of the reasons there’s no real cure for dry eye is that your tear film relies on steady, balanced, and orderly production and combination of your tear film.
Any deviation from normal tear production can result in dry eye symptoms, and finding relief means supporting your tear film where it’s struggling. But that delicately balanced system can be upset in several totally different ways.
Aqueous Tear-Deficient Dry Eye
One type of dry eye involves underproduction of tears. With this tear-deficient kind of dry eye, the lacrimal glands can’t provide the required water level to your tear film. Your eyes need to breathe, and the tear film provides a medium for oxygen to preserve your cornea. The causes can vary, including but not limited to:
- Thyroid disorders
- Rheumatoid arthritis
- Sjogren’s syndrome
- Vitamin A deficiency
- As a side effect of certain medications
Evaporative Dry Eyes
Evaporative dry eye (EDE) is a condition where your tears evaporate too quickly, leading to a dry cornea. More often than not, there’s a blockage in the oil glands, which upsets the lipid layer. Some causes of EDE include:
- Skin conditions on or near the eye
- Vitamin A deficiency
- Excessive contact lens use
- Scarring from physical trauma to the eye
- It can also set in as a side effect of certain medications.
MGD & EDE
Meibomian gland dysfunction (MGD) significantly contributes to EDE. These two conditions appear intertwined so much that it’s unclear whether one can be a cause for the other.
At times, a blockage in your meibomian gland due to MGD can result in blepharitis, a condition defined by inflammation of the underside of your eyelids. In fact, posterior blepharitis and MGD are sometimes synonymous.
To understand just how intertwined these factors are, posterior blepharitis also goes by the name meibomian gland dysfunction (MGD). It’s also more common than the other types of blepharitis. When meibomian glands struggle, dry eye disease becomes more and more likely.
Whether due to infection or foreign substances, the impact on your lipid layer can make problems for you. One complication from inflammation, infection, foreign irritants is atrophied meibomian glands. All of these factors compound and diminish the lipid layer, making your eyes dry out too quickly.
Rosacea & MGD
One skin condition called rosacea can cause blepharitis as well as evaporative dry eye (EDE). Rosacea comes in four subtypes in numerical order: type 1, erythematotelangiectatic rosacea (ETR); type two, papulopustular (or acne) rosacea; type 3, rhinophyma; and type 4, ocular rosacea.
If a patient suffers from MGD due to rosacea, EDE becomes very likely. It’s best to call your eye doctor right away if you think you might have symptoms of ocular rosacea.
Since MGD has become so common, optometrists have been on the lookout for innovative solutions in the treatment of dry eye. Our office uses LipiFlow, an effective technology that can restore meibomian gland function to those managing MGD.
Diagnosing Dry Eye
If you’re suffering from any kind of dry eye syndrome, optometrists have to take a few important steps to finding the source of the discomfort. That way they can provide some relief to your eyes and your tear film.
Comprehensive Eye Exam
A dry eye diagnosis usually begins at a comprehensive eye exam for adults or seniors, since these age ranges, especially seniors, are more at risk for dry eye. At our office, we have a specialized comprehensive eye exam for patients describing dry eye symptoms. We test for tear volume and tear composition.
Tear Volume Tests
A Schirmer test places blotting strips under your lower eyelids and left in for 5 minutes. Your optometrist can then measure the amount of your basal (normally present) tears to find the gap in your tear film.
A phenol red thread test is quicker. A thread filled with pH-sensitive dye changes colour when in contact with tears. These threads can work in just 15 seconds and they measure you basal tear level.
Tear Composition Tests
Sometimes you’ll have enough tears, but they might lack the right composition of mucous, water, oil, and other substances making up a healthy tear film.
A tear osmolarity test measures ratios of water to other particles, revealing tear-deficiency. Some specialized tests use special eye drops with reactive dyes that can reveal the quality of your tears. Others reveal chemical markers of dry eye disease, like elevated matrix metalloproteinase-9 or decreased lactoferrin.
Dry Eye Management
Dry eye is something you have to live with, but if you have a mild case and dry eye therapy works well for you, you might not even notice it sometimes! Dry eye includes medication, but it can go so far as to include prosthetics. It really depends on your type of dry eye, and the severity.
Medication remains a linchpin for dry eye therapy. Multiple categories for dry eye medications exist, helping to target several vulnerabilities in your tear film.
In case of blepharitis, there are a few prescriptions to reduce eyelid inflammation. They may take the form of antibiotics in case of infection. You might also need ointments or eyedrops for inflammation stemming from other sources.
As dry eye advances to a severe case, your cornea might become inflamed. In that case you might need immune-suppressing medication like Restasis or corticosteroids.
Some eye insert medications like Lacrisert are dissolving solids that can release a substance slowly. This substance allows even lubrication evenly over a long period, after placing it between your eye and eyelid.
Some medications like cholinergics (pilocarpine, cevimeline) help your lacrimal glands increase tear production. They come in pills, gel, or eyedrops.
For some patients, it’s necessary to get eye drops made from their own blood. Called autologous blood serum drops, these eye drops are resorted to when other medications fail to provide sufficient relief. To make it, doctors remove red blood cells from your blood, so you can apply it to your eyes in small droplets.
Other Forms of Dry Eye Therapy
If your eyes suffer from the natural drainage of your tears, you might benefit from closing your tear ducts to dam your natural level of tears. There are prosthetic solutions like punctual plugs, which are removable, and surgical solutions like cautery for this purpose.
Sometimes contact lenses with special function help. Scleral lenses cover most of the eye, and trap moisture on the cornea, so you don’t need eye drops for extended periods.
Ask Your Optometrist for Help
Living with dry eye doesn’t have to be uncomfortable. Just because there’s no cure doesn’t mean there’s nothing you can do yourself, even as you get professional dry eye therapy. Medication can go a long way, and provide you some relief as you adjust. Book an appointment in Calgary or Didsbury, and we can work on it together!