Understanding dry eye
Sometimes your eyes sting so much that you never want to stop rubbing your eyeballs.
“The burning can feel like sandy grit is in your eyes, and this can cause eye fatigue, red eyes, sensitivity to light, and blurry vision,” says Angela Bevels, an optometrist who runs Elite Dry Eye Spa in Tucson, Arizona. That’s what life is like for the millions of people who live with dry eye.
Dry eye is much more than just a nuisance, she says. “When you are dealing with it every day, you use eye drops all day, your eyes are always red, and it really affects your quality of life.” When it’s really bad, it can also impair your productivity at work and at home, according to a 2020 study published in the journal Ophthalmology.
What is dry eye?
Dry eye occurs when your eyes don’t produce enough tears or they make the wrong kind of tears. Nearly five million Americans aged 50 and older may have dry eye and tens of millions more have less severe or even silent symptoms, according to the National Eye Institute.
Anyone can develop dry eye, but it seems to be more common among older people.
There are many potential sources of the condition. Some, like medication side effects, pregnancy, exposure to smoke, or other eye irritants, are temporary.
Others are more chronic such as immune system diseases including lupus, rheumatoid arthritis, and Sjögren’s syndrome, which occurs when your body misfires against the glands that make tears and saliva.
Skin issues on or around your eyelids and diseases of the glands in the eyelids can also increase your risk of developing dry eye. In addition, if you wear contact lenses or have had eye surgeries such as LASIK or cataract surgery, you are also more likely to develop dry eye.
Understanding your tears
Your tears have several jobs. They bathe the surface of your eye to keep it moist, flush out debris, and protect your eye from outside invaders. When your tears aren’t up to task, your eyes can dry out and your defenses will weaken.
Your eye doctor can run some tests to help diagnose dry eye. The two major types of dry eye:
Aqueous tear deficiency—This type of dry eye occurs when your tear glands don’t make enough tears.
Evaporative dry eye—This is the most common type of dry eye and occurs if you have deficient tear film, which increases tear evaporation. Tear film comprises the layers of your tears: an oily layer on the outside, a watery layer in the middle, and an inner mucus layer.
Your eye doctor will also try to determine what the underlying cause of your dry eye is, and this can guide treatment. If it is a medication side effect, switching to a different drug may solve the problem.
First, try lifestyle changes
Certain habits can aggravate dry eyes, explains Aditya Kanesa-thasan, MD, an ophthalmologist at the Wills Eye Hospital in Philadelphia.
When you start at your computer screen, you forget to blink, and blinking is what cleans the surface of your eye with fresh tears.
“Taking a break if using a screen, phone, or during other focused tasks can help to decrease stress on the tear film,” he says. “We have more incomplete blinks during screen time, which adds up to more time that our eyes are exposed and our tears are working overtime.” Remind yourself to blink regularly, he says.
Turn off the fans or other direct air as this can increase the evaporative loss of tears as well, he says. The American Optometric Association suggests turning the humidifier on to keep the air moist, wearing wraparound sunglasses when you’re outdoors, and making sure to get a good night’s sleep.
Diet and nutrition can also play a role in keeping your eyes lubricated, Bevels says.
“Hydration is key and so are supplements of omega-3 fatty acids,” she says. The American Optometric Association suggests aiming for 8 to 10 glasses of water every day.
Over-the-counter dry eye treatments
Your drugstore carries solutions that can make dry eye more bearable, Bevels says. Some OTC dry eye remedies include:
Artificial tears: Oasis TEARS Lubricant Eye Drops
One of the easiest ways to treat dry eye on the fly is with over-the-counter artificial tears, says Dr. Kanesa-thasan. “Having good artificial tears on hand can help to decrease immediate symptoms.”
These can be used as needed, adds Bevels.
All artificial tears are not created equally, she says. Choose tears that are free of preservatives (they’ll say so on the label); the additives can further irritate your already dry eyes.
“Also look for glycerin-based eye drops as these replace the oil that is missing,” she says. “Oasis is my go-to brand because it is non-preserved, glycerin-based and also has hyaluronic acid so it helps deliver a better tear,” she says. (These are some of the best eye drops for dry eye.)
Heat mask: Oasis REST & RELIEF Eye Mask
Heat masks like this one from Oasis that can help moisten dry eyes are readily available, says Bevels. There are even some that use USB ports to activate the heating mechanism so you can use them on the go.
“Heat tends to stimulate secretion of oil in the meibomian glands that line the margin of your eyelids, and this can prevent tears from evaporating,” she says. “Heat is your best friend when you have dry eye.”
Use the mask twice a day for dry eye relief, she says. Bevels is also a fan of Tranquil eyes XL.
Don’t have a special eye mask on hand? “You can also splash warm water on your eyes.”
Eyelid cleaner: OCuSoft Lid Scrub Plus Platinum
Eyelid cleaners like this top Amazon pick from OCuSoft can help decrease inflammation around the surface of your eyes, which can cause or worsen dry eyes. Follow the instructions on the label carefully.
Prescription dry eye treatments
There are some dry eye treatments that are only available with a prescription or at your doctor’s office.
“This includes in-office heat and compression treatments of the eyelids to improve the tear film, prescription anti-inflammatory eye drops, and temporary plugs that can be placed in the eyelids to keep the tears around longer,” says Dr. Kanesa-thasan. These are usually indicated when you are not getting relief from over-the-counter remedies, he says.
Thermal pulsation systems use heat plus pressure to unblock your meibomian glands. (Remember that heat is your BFF if you have dry eyes.) There are several devices available including some that you can bring home.
“Opening these blocked glands can allow them to resume natural production of oils needed for a healthy tear film,” Bevels explains. Results appear gradually and can last as long as nine months.
Another option your doctor may suggest is intense-pulsed light therapy, which is followed by a massage of the eyelids. Although it’s not technically approved for dry eyes, doctors have had success using the treatment to unblock meibomian glands, reports the American Academy of Ophthalmology.
The light cools inflammation and loosens blockages. The treatments take 10 minutes and need to be repeated four times per year. Intense pulsed light therapy runs about $400 per session.
Dry eye inserts
With this option, doctors place punctal plugs in your tear ducts (known as puncta) to prevent fluid from draining from your eye. The plugs can last for a few days up to a few months. The idea is that tears will stay in your eyes longer if there is nowhere for them to drain. The main side effect is a scratchy feeling where the plug is inserted. After a while, your doctor may remove the plug; there are also types of plugs that dissolve on their own.
There are also several surgical procedures that block the ducts and preserve tears, such as a procedure called thermal cautery: This out-patient procedure uses heat to seal the tear ducts where tears would normally drain.
A less-invasive insert option—hydroxypropyl cellulose (Lacrisert)—involves a tiny tube-shaped lubricant that you can place yourself: Once a day, you use a simple device to put it between your lower eyelid and your eyeball. The tube slowly dissolves, releasing a substance that keeps your eye lubricated.
Prescription eye drops
You’ve likely seen commercials for prescription dry eye treatments such as cyclosporine (Restasis) or lifitegrast (Xiidra). These can help your eyes make more tears, Bevels says. “They reduce inflammation, so if that is what is causing your dry eye, they can be very effective,” she says. Certain antibiotics may also stimulate oil production in the glands around your eyes.
When to get help
If you are using over-the-counter tears more than six times a day, it’s too much. See an eye doctor to find out what is causing your dry eye so you can treat it more directly.
“Unpacking a particular patient’s dry eye symptoms and figuring out the underlying cause is a critical step to fixing the problem,” says Dr. Kanesa-thasan. “Dry eye patients are some of my most grateful patients and it’s rewarding to bring them together with a strategy that works for them.”
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