Dry eye is an eye condition that can be caused by a problem with tears. Don’t be fooled – your eyes may water a lot and you may well still suffer from Dry Eye! Symptoms of Dry Eye include; dry, scratchy, irritated and uncomfortable eyes – even pinpoint pain. Symptoms can be one or both eyes, quite often asymmetrically – with one eye is being affected more than the other. Dry Eye can often feel like you have something in your eye, like an eyelash or a piece of grit – although there is will be nothing actually in your eye. Dry eye can sometimes make your vision slightly blurry, this will usually be intermittently, rather than constantly – and usually only for short periods of time. The blurriness can sometimes get better on its own or when you blink.
If your eyes feel gritty, itchy and uncomfortable – it is important to get them checked at a qualified Opticians or GP – as once Dry Eye is diagnosed there are ways to help the condition and improve eye comfort – including using Dry Eye Drops or the revolutionary MGDRX EyeBag. There are also systemic issues that can cause Dry Eye – so it is important to discuss the symptoms with your GP once diagnosed.
In most cases, dry eye causes mild discomfort but in more severe cases it can become very painful and the dryness can cause permanent damage to the front of the eye. The extent of the Dry Eye problems depend on the cause of the dry eye. Once you have dry eye you tend to always be prone to it, but it can be treated. The MGDRX EyeBag and Dry Eye drops are one of the first steps to manage Dry Eye conditions.
Dry eye is a condition that is caused by a problem with your tears. On blinking you leave a thin layer of tears, called the tear film, over the cornea (the front of your eye). The tear film keeps the cornea healthy and it also helps the eye focus properly, giving you crisp clear vision.
The tear film is made up of three layers. If you don’t produce enough tears, if your tears aren’t of the right quality or your tears aren’t spread across the front of your eye properly then you may develop dry eye symptoms. Dry eye happens if these tears aren’t spread properly or if the tear film is of poor quality. If there are tiny patches of dryness in the tear film then your eye feels uncomfortable and each time you blink the patch will be irritated.
Dry eye is a very common condition – and usually a natural symptom of getting older. As you get older your eyelids are less effective at spreading the tears every time you blink. Tear production become less effective, so the quality of your tear film is poorer as you get older.
As well as getting older – there are other common reasons why your tear layer may become less effective:
- some common drugs, like antihistamines or oral contraceptives
- contact lenses; you should follow the advice for wearing and looking after them very carefully
- other systemic health problems, such as rheumatoid arthritis
- Sjogren’s syndrome, which may cause you to have dry eye and a dry mouth or vagina
- surgery or an accident which affects or scars your eye
- an infection or inflammation of any of the glands around your eye, or an infection of the eye lash roots (called blepharitis). Sometimes getting rid of the infection or inflammation can help to improve your dry eye.
The tear film
There are 3 layers making up the tear film. The layer of tears closest to your eye is called the mucin layer which forms a layer on the cornea. The mucin layer acts as a foundation for the other tear layers helping the watery layer of tears to remain in the right shape and in the right place.
The middle layer of tears is called the watery (aqueous) layer. This provides moisture to the eye and oxygen and other nutrients to the cornea. These watery tears also help wash away anything that gets into the eye such as dust and dirt. They also make sure that the front of the eye is very smooth – helping your eyes to focus properly. The top layer of tears furthest from the eye is an oily layer of tears called the lipid layer. The lipid layer seals in the moisture of the watery layer so that it stays on the front of the eye for as long as it needs to – stopping the watery tears from evaporating too quickly. All these layers of tears are produced by small glands around the eye and eye lids. Each time you blink the three layers of tears should be spread right across the front of your eye – performing the lubricating process. Anything that affects the make up of the tear film, eg. if you produce too little or too much of one of the layers, will stop the tear film working properly and potentially cause dry eye. Dry Eye drops are an artificial substitue for your own tear drops.
The tears in your eye are drained through the tear ducts – drainage holes that connect the eye lids to the inside of your nose.
Watery eyes
Dry eye can be diagnosed even if eyes appears to be watering all the time. This is possibly because there is a problem with a different tear layer that irritates your eye and your eye tries to deal with this by producing more watery tears. These watery tears don’t help to correct the dryness in your eye – they lack the lubricating constituents of the lipid and mucous layers. People with a watery eye may be prescribed eye drops to help with the problem in the other layers of tears, as this may prevent their eyes from watering too much.
If your eyes water a lot it can make the skin around the eye sore; this usually clears up on its own but your GP may be able to give you some cream to soothe it. The area around your eyes is very delicate so you need to take care when using cream like this as the cream itself may irritate your eye.
Diagnosis
If you have Dry Eye symptoms then you should tell your GP, optometrist or ophthalmologist (eye specialist).
Your GP may already be aware of a reason for you having dry eye, such as a medical condition or medication you are using or because you’re getting older. Environmental factors can also cause issues which may be relevant, such as working in dusty places, air conditioning, central heating – or working with a VDU screen for long hours.
There are a number of tests which your optometrist or ophthalmologist may want to do to work out if you have dry eye. These tests help them decide how to treat your eyes. The tests check how many tears you produce and detect any areas on the front of your eye that don’t have enough tears. They will examine the front of your eyes and the quality of the tears with a special microscope called a slit lamp. Other tests may also be done to aid diagnosis.
Tear film break-up time – with Fluorescein
This test is the most common test performed to asses for Dry Eye – and finds out how long after blinking your eye starts to dry out. The eye care specialist uses eye drops containing a special fluorescent yellow dye which makes your tears easy to see. They put the drops into your eye and ask you to blink a number of times to make sure that the dye is in your tears properly. They will then ask you to stop and keep your eyes open without blinking.
The optometrist or ophthalmologist uses a coloured UV light to see the dye and times the period between your last blink and the formation of dry patches. The dry patches are shown up by the dye. If your eyes start to show patches of dryness before ten seconds it usually means that there is some evidence of a dry eye. The dye does not change the colour of your eye and only stays in your eye for a short while.
2. Rose Bengal staining
This test uses a different dye, which makes damaged tissue on the front of your eye easier to see. Sometimes the front of your eye can be slightly damaged in the dry patches.
Usually only an ophthalmologist would do this test but it is not used very often as it can be uncomfortable and irritate an already dry eye.
3. Schirmer test
This is a test with filter paper which may be performed to test tears. It is not performed as often as it used to be. It involves using a special filter paper which is placed into the area between your lower eyelid and the eye. This piece of paper is then left in the eye for about five minutes. After this the ophthalmologist is able to see how many tears the eye produces in that period.
This test isn’t performed very often as it doesn’t usually change the way someone with dry eye is treated but it might be needed if your dry eye is very severe. Sometimes a similar test using a specially-prepared thread can also be used.
Treatment
Once Dry Eye has been confirmed – what can be done to help you?. You cannot “cure” dry eye but there are some treatments that can help your eyes feel more comfortable – it is a matter of long term management. If your dry eye is caused by another condition, such as an infection, then treating this infection will help with your dry eye symptoms. If your dry eye is caused by wearing contact lenses then having a break from your lenses may help the dry eye to improve. Often dry eye is caused by getting older, which can’t be helped, but there are treatments that can help with your symptoms.
There are three main ways to manage dry eye:
1. Making the most of your natural tears
Environmental factors, such as air conditioning and central heating or long periods of VDU use – You can often lower the temperature in a room because high temperatures and central heating can make tears evaporate more quickly. However, you need to make sure that you keep yourself comfortable. A humidifier is a small machine that helps put more water into the air, which may help slow down the evaporation of your tears.
Many people find that their dry eye is more uncomfortable when they’re reading or using a computer – this is because you tend to blink less when you are doing concentrated tasks, which gives the tears more chance to evaporate. You can try to blink more when you’re doing these tasks or use eye drops before you do anything, like reading, as this may help to keep your eyes comfortable.
Enhancing the tear ducts and reducing meibomian Gland Dysfunction – allows your own tears to lubricate your eyes a natural way.Use the revolutionary Eyebag – to open the meibomian glands and produce more effective tears.
Convenient, simple and ridiculously easy to use, the EyeBag is a re-usable warm compress which treats a variety of eyelid and eye problems. Eye Surgeons, doctors and opticians frequently advise regular use of a warm compress – however apart from the old fashioned flannel which is less than hygienic – the compresses do not stay at the correct temperature for long enough – are a real hassle and less effective than the MGDRX EyeBag.
2. Using eye drops
Most people with dry eye need to use some form of eye drops, also known as “artificial tears” – or Dry Eye Drops. Eye drops aim to supplement and replace your natural tears and make the eye more comfortable. They can also prevent any damage to the front of your eye, which can happen if the eye is dry for a long time.
Eye drops don’t contain any drugs, they are just replacement tears. This means that they can be used frequently, or as much as you need them. However if you are having to use your drops more than 4 or 6 times a day then you should let your ophthalmologist or optometrist know as you may need a different treatment to the drops you’re using.
There are three main types of eye drops which the GP, optometrist or ophthalmologist may prescribe or recommend:
Artificial tears
Artificial tears or Dry Eye Drops are made by many different companies. Some people find one brand works better for them than another, although no one knows why. Your doctor or eyecare practioner may suggest a selection of different brands for you to try. It is usually best to try one type for at least a month.
Some people develop sensitivity to the preservative used in the drops, especially if they’re using them a lot. This can make your eyes sore. Preservative- free drops are available.
Preservative Free Dry Eye Drops
Gels
If your standard eye drops aren’t helping, your doctor may suggest thicker gel-like drops which are made from different chemicals and may last longer in the eye. They do the same thing as the ordinary drops but you don’t have to put them in as often.
Ointments
Ointments are also available to help keep your eye moist overnight. When you sleep, sometimes your eyes aren’t fully closed, so tears can evaporate and leave your eyes very dry when you wake up. Ointments help stop the eyes drying out overnight so that they feel more comfortable in the morning. Ointments tend to be used overnight because they are sticky and cause blurry vision. Ointments are usually used as well as eye drops during the day.
3. Reducing the draining away of tears
It is possible to help dry eye by blocking up the two drainage holes in your lower eyelids to stop the tears from draining away – helping your tears to stay in your eye for longer. The medical term for blocking the tear ducts is punctal occlusion – and you should discuss this with a medical examiner to see if it would be a possibility for you.
Summary – Conclusion
Having dry eyes can be difficult – frustrating and uncomfortable. Eyes that are red, itchy and painful for long periods can be tiring and sometimes worrying. Although there is no ‘cure’ for dry eye, the drops prescribed can often make your eyes feel much more comfortable. Adjusting to dry eye and to taking the drops regularly can be a challenge, but finding out how regularly you need to take your drops and finding a drop that suits you can make a huge difference. This may take some time but usually everyone finds a system that works for them. Most people can learn to manage their dry eye so that it doesn’t have too much impact on their everyday lives.
We do all we can to ensure that the information we supply is accurate, up to date and in line with the latest research and expertise.
The information uses:
- Royal College of Ophthalmologists guidelines for treatment
- clinical research and studies obtained through literature reviews
- information published by specific support groups for individual conditions
- information from text books
Royal College of Ophthalmologists
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British Sjögren’s Syndrome Association