Dr Hilary Jones
GP and medical broadcaster
Dry eye syndrome or dry eye disease is a common, inconvenient and sometimes distressing condition to millions of people who simply put up with it in its milder forms believing it to be a form of dry skin. It isn’t.
Dry eye disease is a common yet very under reported disease driven by aging, use of smartphones and computers, as well as some medications that cause dry eye disease as a side effect. It is an inconvenient and sometimes distressing condition that Opticians and eye surgeons frequently see in their practices with patients coming in blinking and rubbing their eyes, but millions of people simply put up with it in its milder forms believing it to be a form of dry skin. It isn’t.
Causes are varied. Staring at a pc, smartphone or tablet for hours on end certainly doesn’t help, nor does living in a hot or windy climate, nor wearing contact lenses. The side effects of certain medications such as diuretics beta-blockers antidepressants and antihistamines may also contribute, and hormonal changes such as during the menopause, taking the oral contraceptive pill or in pregnancy can play a role.
What causes dry eye disease?
Three main conditions account for the majority of cases of dry eye disease.
1. Meibomian gland dysfunction
Tears need an oil layer to seal them and prevent against excess evaporation. This oil comes from glands in the upper and lower eyelids. This oil should be thin and flow easily. However, the oil can thicken due to ageing, lifestyle factors such as use prolonged use of computer screens and smart phones and a poor diet that is high in processed foods and low in omega 3 essential fatty acids.
For some, an underlying medical condition such as psoriasis, acne rosacea, Parkinson’s disease, polycystic ovary syndrome and androgen deficiency may cause their dry eye disease.
Medications such as anti-depressants and antihistamines can cause dry eye disease as a side effect, as can medication for benign prostate hyperplasia and oestrogen formulated contraceptive implants and hormone replacement therapies.
2. Anterior Blepharitis
Caused by a buildup of oil at the base of the eyelashes, Anterior Blepharitis allows an increase in the number of normal skin bacteria which start to release toxins that damage the protective oil layer on the surface of the tears. People with medical conditions such as seborrheic dermatitis, acne rosacea, psoriasis and demodex parasitic infestation are at risk of developing this condition.
3. Sjögren’s syndrome
This is an autoimmune disorder that affects the moisture secreting glands in the eyes and the mouth, and also other parts of the body such as the joints, liver, lungs and skin. Sjogren’s syndrome is more common in people over the age of 40. It affects more women than men and is more prevalent in people with an underlying disease such as rheumatoid arthritis or lupus.
3 Steps to Managing Dry Eye Disease
Step 1 – Identify and modify lifestyle factors
Addressing diet, stopping smoking, and modifying environmental conditions such as taking regular breaks when using the computer, using the correct position of the computer screen, and avoiding sitting in a draughty area can have considerable impact on symptoms. Identify your risk areas take steps to make changes.
Step 2 – Practice good eye hygiene
Eyelid hygiene essential, historically advice was given to use baby shampoo to clean the eyelashes and a hot flannel to heat the eyelids. There are very good regulated and scientifically proven commercially available products to perform these functions. Daily hot compress therapy and cleaning of the eyelids is advised. These products are far superior to the previous advice and in my opinion hot flannels and baby shampoo should no longer be used.
Step 3 – Lubrication
The volume of tears is reduced in dry eye disease. Residual tears become concentrated and they become more acidic and salty. Using a good lubricating eye drop will help dilute the tears and improve comfort. Preservative-free eye drops should be used in severe cases. For patients with Meibomian Gland Dysfunction, an oil containing eye drop will help replace lost oils in tear layer. Ask your pharmacist or Optometrist for further advice.
