If you suffer from burning, watery, red, tired eyes, or have blurry vision that worsens at the end of the day, or that clears when you blink, you may be one of the millions of Americans who suffer from Dry Eye Syndrome (DES).
DES is exacerbated by our modern lifestyle, especially aspects that increase screen time both at work and leisure. The condition is twice as common in women than men, especially after menopause. Other diseases, such as autoimmune diseases like rheumatoid arthritis, lupus and thyroid conditions, can also be associated. Environmental factors include smoky, windy or excessively dry climates that can also make it worse.
Many patients who go to the eye doctor have DES, but may not associate the problems they are having with the condition. They report fatigue at the end of a long work day, or inability to wear their contact lenses for more than a few hours. Other symptoms include grittiness, foreign body sensation, tearing or redness. Luckily, recent advances in the diagnosis and treatment of DES have made it easier to educate, diagnose and care for patients with this annoying condition.
There are two main types of dry eye: aqueous deficient and evaporative. Your own natural tears are not just water or saline but in fact a complicated biofilm made up of different layers. The two main layers are the aqueous inner layer (tears) and the lipid outer layer (oil). In the first type of DES, the patient doesn’t produce enough tears. More commonly, people suffer from the evaporative form of DES. This occurs when the meibomian glands in the lids become blocked and don’t make enough of the outer oil layer and the tears evaporate too quickly as a result. Some people have a combination of the two, and there can also be a component of inflammation with either type.
It is important to tell the difference between the types of DES, because the treatment will be different for the two conditions. I often examine patients who are frustrated with their progress simply because they are being treated ineffectively for the wrong type.
A good dry-eye center will take a careful history, including a detailed questionnaire to assess the severity of patient symptoms. They then perform noninvasive testing of the tear film by taking a small sample of tears and testing it for its concentration and for the presence of inflammatory markers. More importantly, Lipiscan testing images the glands in the lid and identifies damaged or missing glands. All of this information creates a customized treatment plan.
Initial treatment of DES may include the use of over-the-counter lubricant drops and environmental modifications like turning the car vents away from your face and installing a humidifier in your home heating system. Omega-3 fatty acid oral nutritional supplements such as fish and/or flaxseed oil have also been shown to be very helpful. If an inflammatory or aqueous-deficient condition is noted, prescription drops are available that can be very effective in many patients. Punctal plugs, tiny silicone or collagen devices, can be placed in the tear ducts in an attempt to maintain the natural tears for a longer period.
Dry-eye centers performing the Lipiscan test have noticed a large number of patients who have severely damaged oil-producing glands, even if they have no symptoms. I have been amazed in the degree of loss, even in preteens. The thought is that the modern lifestyle of increased screen time results in blocked glands, since studies have shown that people don’t blink with enough frequency or force while staring at a screen. Blinking pumps the glands in the lid to produce oil. With less blinking, the glands become blocked and begin to die out.
Fortunately, there is a treatment that we can now perform in the office to heat and express the eyelid glands to both treat the evaporative form of DES, and prevent further gland damage, even in patients with no symptoms. Lipiflow is an FDA-approved, 12-minute, in-office treatment that heats the eyelid glands from the inside out and massages the glands to cause the oil to be free flowing again. We have had great success in both alleviating symptoms and maintaining gland health. Patients have told me that after the Lipiflow treatment, their contacts have never been more comfortable.
While DES is common and can be very uncomfortable and annoying, with the proper diagnostic tests and treatment, it has become a very treatable condition.
By Dr. Michael Farbowitz
Dr Michael Farbowitz is a member of Short Hills Ophthalmology Group, 551 Millburn Ave, Short Hills, NJ 07078. For information, contact Joy Saah at [email protected].