Introduction  

Dry eyes occur when the quality or quantity of tear production in the eyes isn't enough to keep the ocular surface well lubricated.
The disease said to be chronic, can come about secondary to the Sjögren syndrome (SS) or entirely on its own.
The tear film forms a vital part of the ocular surface. It provides moisture, lubrication, nourishment and protection to the eyes from irritants. This film is comprised of three layers; the aqueous layer, the lipid layer and the mucous layer.

The aqueous layer is made up of water and proteins secreted from the lacrimal glands. The layer maintains the normal ocular surface by providing moisture and nourishment.

The lipid layer consists of oil secreted from the meibomian glands. It assists in retarding tear evaporation.

The mucous layer consists of mucus produced by the goblet cells in the conjunctiva. The mucin allows the aqueous layer to spread across the corneal surface.

When there is a problem on either of the film sources, dryness can result. The severity of the dryness varies. Some people experience mild to moderate symptoms treatable with lubricants. In extreme cases, individuals with dry eyes syndrome may have vision blurs and irritations which affect the general quality of life.

Also Known As

  • Dry eyes syndrome (DES)
  • Dry eyes disease (DED)
  • Keratoconjunctivitis sicca
  • Keratitis sicca
  • Dysfunctional tear syndrome

 

Causes and Risk Factors

The dry eyes syndrome is associated with a:

  • A decrease in tear production
  • An increase in tear evaporation
  • An imbalance in tear composition

 

Other factors that increase the risk of dry eyes syndrome include:

  • Advanced age
  • Prolonged screen use
  • Smoking
  • Use of certain medications such as antihistamines, hormone replacement therapies, antidepressants, and anti-inflammatory drugs.

In addition, women are more likely to experience the dry eyes disease due to hormonal changes in their bodies, particularly those in the post-menopausal stage.
In the case of secondary dry eyes syndrome, the condition may arise from autoimmune disorders such as the Sjögren syndrome (SS), vitamin A deficiency, among others.

Signs & Symptoms

One of the symptoms is referred to as ‘foreign body sensation.' This refers to when a patient feels as though there’s some grit inside the eyes. 
Other symptoms include:

  • Burning eye sensation
  • Heavy eyelids 
  • Itchiness
  • Fatigued eyes
  • Soreness
  • Sensitivity to light
  • Blurred vision
  • Redness of the eyes. 
  • Patients may also have a stringy discharge which does not offer any relief to the dryness.
     

Diagnosis

The symptoms of the disease may be enough to diagnose dryness. Further tests can also be performed for confirmation. These tests include:

  • Vital staining
  • Tear film osmolarity
  • Quantity or quality exams such as the Schirmer's test and the tear breakup time (TBUT).
     

Treatment 

Treatment of dry eyes is aimed at restoring proper lubrication of the ocular surface.

Medical Treatment

Dry eyes syndrome is essentially treated using supplemental lubrication. The drugs range from gels and ointments to autologous serum eye drops and artificial tear substitutes. The eye doctor may also prescribe topical anti-inflammatory drugs to relieve inflammation.

Individuals can also use of therapeutic eyewear. There are specially made glasses known as moisture chamber spectacles. They help retain moisture and provide protection against irritants.

Surgical Treatment

Punctal plugs made of silicone or collagen are inserted in the eyes. These are useful in preventing the tear drainage from the eyes. Surgery can also be done to close the tear ducts altogether. In severe cases, the doctor may perform tarsorrhaphy. Here, the eyelids are sewn together to reduce evaporation of the tears.

Alternative Treatment

Individuals with dry eyes can also use dietary supplements such as Vitamin A and omega-3 fatty acids. The latter has been found to improve tear secretion although it does not affect tear film stability.

Prognosis/Long-term outlook

With proper treatment, the condition resolves within months. If left untreated, corneal scarring and ulcers may occur.

Prevention/Follow Up

Patients should limit their use of contact lens and their time on screens. Certain environmental conditions e.g., smoking areas should be avoided. Regular eye checkups are also vital; whether you suffer from the condition or not.