Reasons for Dry Eyes and Common Types

Written by Rachel Reiff Ellis

Medically Reviewed by Neha Pathak, MD on December 03, 2021

• When Your Eyes Don’t Make Enough Tears
• When Your Tears Don’t Stick Around Long Enough
• Other Causes

There are two main reasons for dry eye. Either your eyes don’t make enough tears, or your tears aren’t sticking around long enough to keep your eyes moist.

You can have one type of dry eye. You can also have both at the same time.

You may hear this called aqueous tear-deficient dry eye. A gland in the corner of your eye called your lacrimal gland makes your tears. Normally, this gland makes enough moisture to keep your eye healthy. Tears wash away dust and anything else that may fall in. They also protect your peepers from germs and infection.

When your lacrimal gland doesn’t make enough tears, it causes dry eye. Another name for this type is keratoconjunctivitis sicca. You might have it because your eyes have aged and aren’t able to make tears the way they used to.

You might also have it because of a medical condition, like:

• Diabetes
• Rheumatoid arthritis
• Lupus
• Scleroderma
• Sjogren’s syndrome
• Thyroid disorders
• Vitamin A deficiency

You may also get this as a side effect of a medicine, like:

• Antihistamines
• Decongestants
• Hormone replacement therapy
• Antidepressants
• Blood pressure medication
• Acne medicine
• Birth control
• Parkinson’s disease meds

Sometimes, lacrimal glands can have trouble making enough tears after laser vision correction surgery. This usually goes away after a few months. You can also get this type of dry eye if inflammation or radiation damages your lacrimal glands.

When your tears dry up too quickly to help protect your eyes, you have something your doctor may call evaporative dry eye. Sometimes it happens because of a problem with the makeup of your tears. Other times, it comes from changes to your eye, or the environment.

Tears have three layers: an oily outer, a watery middle, and an inner mucus layer. The oily outer layer helps keep the watery middle from evaporating too quickly. The mucus one spreads tears evenly over the surface of your eye. A problem with any of these can cause dry eye.

Glands inside your eyelids called meibomian glands make the oil in your tears. Sometimes they get clogged. When that happens, your tears don’t get enough oil. The watery layer of your tears loses its protection, and your tears evaporate.

This is common in people who have a condition called blepharitis (inflammation of the eyelid) or folks with skin conditions like rosacea.

Sometimes, dry eye happens because you can’t keep moisture in your eye long enough. Tears don’t dry up. They just leave.

Reasons for this include:

• Things in the environment like wind, smoke, or dry air
• Not blinking enough, as may happen when you’re staring at a screen or reading
• Eyelid problems like ectropion (your eyelids turn outward) or entropion (your eyelids turn inward). Sometimes, the eyes can’t close completely after cosmetic eyelid surgery.
• If the exposed surface of your eye gets bigger, your tears may have a hard time covering it. This can happen if you have thyroid issues that make your eyes bulge, or if you have eye surgery that opens your eye too far.

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Types of Dry Eye Disease

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Types of Dry Eye Disease

Why are Tears important?

Tears are necessary for overall eye health and clear vision. Tears are produced by the lacrimal glands and consist of proteins, electrolytes and vitamins that are critical to maintain the health of the eye surface and to prevent infection. They are constantly produced to clean, nourish, and protect the eye surface. Tears bathe the eye’s surface keeping it moist and wash away dust and debris. Any condition that alters the proper production of tears can make the eyes unhealthy and result in dry eye.

Tears are comprised of 3 layers: lipid (oil), water, and mucus. The composition of these components is what helps to protect and nourish the surface of our eyes. The lipid or oil layer prevents the evaporation of the water layer. The mucus layer helps spread the tears evenly over the eye surface. When these layers are not functioning properly, the tears can either evaporate too rapidly or they do not reach the entire eye surface, which will then cause the symptoms of dry eyes.

There are 2 predominant forms of dry eye:

aqueous and evaporative.

Aqueous Dry Eye

Aqueous dry eye is characterized by tear deficiency. It occurs when the lacrimal glands don’t produce enough of the watery component of tears. In recent years, we have learned that true reduced tear production is rare. What we know now is that the problem almost always originates with blockage of the tiny Meibomian Glands in our eyelids. These glands produce essential oils that form the top layer of the tear film and are the core protective element that is essential to long-term visual comfort.

Evaporative Dry Eye 0r Meibomian Gland Dysfunction (MGD)

Evaporative dry eye affects 65% of dry eye patients. It is caused by Meibomian gland dysfunction (MGD), which creates a deficiency in the oil layer of the tear film. These glands make the lipid or oily part of tears that slows evaporation and keeps the tears stable. This can be the beginning of other dry eye disease problems including damage to the cornea and sight-related issues.

When the Meibomian glands are blocked or the glands have been compromised, the eye becomes exposed. Gland blockages can occur over time from debris that is caught in the eyelids, digital device and computer usage and, for women, just putting on make-up over the course of many years.This leads to dry eye signs and symptoms. This is known as MGD or Meibomian Gland Dysfunction. MGD is easy to diagnose. The treatment of MGD is essential for the long term management of dry eye.

Meibomian gland dysfunction (MGD) is perhaps the most common cause of dry eye and has without a doubt been the most challenging to treat. Traditional therapies have failed to consistently provide effective results leading to ongoing suffering and frustration for patients and physicians alike.

Normal Gland Structure

Gland Shortening and Loss

Significant Gland Loss

Severe Gland Loss

Learn more about Dr. Cremers’s cutting edge Meibomian Gland Treatment Dysfunction for those who have severe dry eye syndrome.

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Dry Eye Syndrome: Symptoms and Treatment

Ophthalmologists from the Lucky Look chain of optics talk in detail about dry eye syndrome – symptoms, causes of the disorder, its diagnosis and treatment.

What is dry eye syndrome

Another name for the disorder is xerophthalmia. This is a pathological condition in which the natural hydration of the cornea is disturbed. This happens when the eye partially or completely loses the ability to produce tear fluid.

Also, tear fluid can be produced in normal volume, but evaporate quickly.

Causes

Dry eye syndrome can develop for a wide range of reasons – from internal failures of the body to the external environment. But more often, a combination of factors leads to the development of chronic dryness.

Let’s consider the main reasons:

• Long work at the computer – while using a computer or other gadgets, the blinking frequency is significantly reduced. This leads to drying of the mucous membrane of the eye. If at the same time a person is in a room with dry air (for example, in an office where there are several computers), the situation is aggravated;
• Age and hormonal changes – one of the reasons for the development of dry eye syndrome can be menopause in women;
• The quality of the tear fluid – the tear consists of water, mucin and lipids. If the percentage of any of the components of the tear is reduced, the normal nutrition of the eye is disturbed. For example, if there are not enough lipids in the tear, the liquid will quickly evaporate, resulting in chronic dryness;
• The quality and volume of tear fluid produced can be affected by a variety of conditions, including diabetes or rheumatoid arthritis. Also, pathology can develop against the background of taking medications. As a rule, these are antihistamines or anti-inflammatory drugs, as well as COCs;
• Lack of sleep, together with other factors, can lead to the development of the disorder.

Symptoms

Patients with dry eye syndrome have characteristic symptoms:

• Burning, feeling of “sand in the eyes”;
• Itching and pain;
• Redness of the eyes;
• Photophobia and eyelid edema may occur.

In the early stages, the discomfort experienced by the patient may be subtle, but when the pathology reaches a higher severity, it will be impossible to ignore xerophthalmia.

Diagnosis

The patient may suspect chronic dry eye, but a visit to an ophthalmologist is required to confirm the diagnosis and receive a treatment plan. The specialist will start the appointment by taking an anamnesis, after which the patient will have to undergo a set of diagnostic procedures:

• External examination, during which the doctor assesses the condition of the eyelids, the degree of their closing, as well as the frequency of blinking;
• Slit lamp biomicroscopy of the eye to evaluate the condition of the tear film;
• Additional tests and samples, such as the Schirmer test, which allows you to determine the rate of formation of tear fluid.

If necessary, the doctor can also take a smear for a cytological examination. If during the reception the ophthalmologist suspects the presence of systemic diseases that provoked xerophthalmia, the patient may be assigned an additional examination by specialized specialists.

Only after a diagnosis has been made can the doctor decide on the appropriate treatment.

Treatment of dry eye syndrome

Patients with mild xerophthalmia are given artificial tear drops. They supplement the natural lacrimal fluid, provide long-term and uniform hydration of the eye surface. Drops must be used regularly throughout the day.

If the patient’s condition is more severe, the doctor may prescribe prescription drops to stimulate natural tears.

Self-treatment or the use of alternative methods is unacceptable – this is fraught for the patient with an aggravation of the condition.

Prevention of xerophthalmia

Prevention should begin with lifestyle changes. If possible, reduce computer time and install a humidifier, especially if the patient spends a lot of time in the office.

When outdoors, wear wide goggles (sunglasses can be used) to protect your eyes from the wind, which also causes the cornea to dry out. Patients who smoke are advised to give up bad habits.

Dry eye syndrome and contact lenses

In rare cases, contact correction products may contribute to the development of dry eye syndrome. For example, if the patient uses an inappropriate solution or purchases poor-quality lenses. In this case, it is necessary to consult with a specialist and choose a more suitable remedy, as well as buy lenses only in specialized opticians.

It should also be noted that when xerophthalmia occurs, the use of contact lenses is difficult. In the early stages, the patient may experience minor discomfort, which can be minimized with moisturizing drops. However, if the violation has reached a high degree, the patient cannot even put on the means of contact correction.

Conclusions

Dry eye syndrome can develop under the influence of a number of factors – both external and related to the characteristics of the organism. It is not recommended to treat the violation on your own; in order to prescribe adequate therapy for , the ophthalmologist must determine the cause of dryness and the severity.

Dry eyes – a global problem of modern man

Dry eyes, tired eyes, reddened eyes – these are just a small part of the complaints that ophthalmologists are increasingly listening to. Patients feel a burning sensation in the eyes, dryness, redness of the protein, blurred, blurred vision.

Author
Elena Levina

Today it is difficult for us to imagine our life without computers, mobile phones, flickering TV screens. But along with the convenience that technology has brought to our lives, it has also brought new challenges. Among which one of the first places is occupied by the problem of eye health.

Dry eyes, tired eyes, reddened eyes – these are just a few of the complaints that are increasingly heard by ophthalmologists. Patients feel a burning sensation in the eyes, dryness, redness of the protein, blurry, blurry vision.

Dry eye syndrome – what is it?

Dry eye syndrome, or it is also called corneal xerosis, indicates a chronic lack of moisture on the surface of the eye. The eye lacks natural lubrication and this causes inflammation of the outer layer of the eye.

What ensures the normal functioning of the eye?

Ordinary tears serve as the first defense of our eyes from the penetration of external irritants (impurities, pollution). The main function of tears is to provide constant moist lubrication of the eyes. Tears are scattered in a thin layer on the cornea of ​​the eye. They give the cornea a smooth surface, keep the eyes moist, and preserve the epithelium (the outer layer of the cornea). They contain enzymes that weaken the effect of external stimuli. Dry eye syndrome is characterized by the fact that the lacrimal gland ceases to secrete a sufficient amount of moisture, in addition, its chemical composition changes.

Dry eye symptoms

Dryness, burning, itching, fatigue, a feeling of sand in the eyes are the main symptoms that accompany the syndrome. As a rule, most patients complain of a deterioration in the condition of the eyes by the end of the working day. Dryness can increase sensitivity to bright light and is often accompanied by double vision. In other cases, patients may complain of watery eyes, which is also caused by excessive dryness. But in this case, tears do not alleviate the feeling of discomfort, since they do not have the lubricating properties of ordinary tears.

Discomfort is increased when the eye is exposed to external irritants such as dust, smoke, computer/TV screen. Also in conditions of dry air – during the summer heat or in rooms where the air conditioning system causes dry air.

According to statistics, women are more prone to this problem, since dry eyes are caused by estrogen deficiency in a woman’s body during pregnancy, breastfeeding, and menopause. Among men, the syndrome is less common, more often it appears with age. Age is one of the factors in the development of the syndrome: over the years, our body produces less and less fatty secretion, which affects the evaporation of the tear film.

How to get rid of dry eyes?

• Avoid environmental irritants such as dust, smoke, powerful air conditioning that causes dryness.
• If you have to sit at the computer for a long time, try to blink more often.
• Symptom can be relieved by periodically rinsing eyes with cold water.

In mild cases (up to moderate severity of symptoms), drops can be used without a doctor’s prescription, which serve as a substitute for tear fluid (“artificial tears”). Just remember that old generation drops, which are really effective, should not be used for a long time: their constant use can damage the cornea, because they contain preservatives.

New generation drops, packed in small disposable capsules, do not contain preservatives. Each ampoule is used for one day and then should be discarded. In more complex cases, the latest gel preparations are used to eliminate irritation, dryness, pain, and redness of the eyes. The most popular of them are VidisicR, Genteal Gel (GenTealCel). You may need drug therapy, warm massages, but all this is only on prescription.

Dry eye surgery

The main goal of surgical treatment methods offered in Israeli medical centers is to restore the moistened environment of the eye.