Dry eye disease is more common than you might think. It actually affects almost five million Americans. Women and those over the age of 50 are at greater risk, but with our reliance on computers, Smartphones, and video game players, even adolescents are becoming more susceptible to its symptoms, including fluctuation of vision, eye redness, and eye irritation. If left untreated, dry eye disease can even lead to blindness. To open your eyes to this growing epidemic, Healthline spoke to Miami-based ophthalmologist Dr. Carlos Buznego of the Center for Excellence in Eye Care, about the causes of irritating eye symptoms (which plague 48 percent of all Americans according to a recent survey) treatment options, the best eye drops, and even steps you can take today to prevent dry eye disease down the road.
What are the causes of dry eyes?
Dry eyes is a very common condition affecting men and women, but is more common in women than in men. For the most part it's an age-related condition often seen in elderly folks. But with the increasing use of computers and some environmental issues, we're seeing dry eyes occurring in more young adults and adolescents.
Dry eyes can have multiple causes but the main factor is ocular irritation. It's usually associated with a decreased amount of tear production, but the most common association is aging and one of the other causes is menopause, so the incidence goes up dramatically in menopausal women.
What happens physiologically when we're experiencing dry eyes?
The tear glands, due to age and the hormonal influence of menopause, decrease production of tears by the lacrimal glands of the eyes, and the dryness incites an inflammatory reaction on the surface of the eye and that ocular irritation can be manifested by multiple types of symptoms.
What are the symptoms?
Probably a sensation of dry eyes, a sensation of gritty eyes, or tired eyes. Even something as innocuous as blurred vision, where some patients will describe that they have good vision part of the time and bad vision other times, and that could be a manifestation of dry eyes.
The ocular surface, the surface of the cornea, is usually covered with a thin film of tears, which forms a beautiful, reflective surface on the eye. When the eye is dry we don't have that smooth uniform tear film and that will cause some blurred vision. Another thing that is atypical or might surprise you is that tearing may be a symptom of dry eyes. The eye has a basal level of tear secretion that keeps your eyes comfortable. But if your eye is not making the appropriate amount of tears, your eye will get irritated. If it gets irritated, it sends a message to the brain to produce a whole bunch of tears. Oftentimes patients with dry eyes will have periods where their eyes are too dry and there's reflex tearing and then the eye tears too much.
Does wearing makeup dry out eyes?
I would say that wearing makeup doesn't specifically dry out the eyes, but there are certain conditions that can cause your eyes to be more irritated. For example, one of the things with makeup is that you have a layer of tears that is covering the surface of the eye, and it's part of the eye's natural defense mechanisms against dust in the atmosphere. If the powder from the makeup landed on the surface of the eye, your eye, with a couple of blinks, the tears would clear that stuff away. But if your eyes don't have their natural protective tear layer, then having something like makeup in your eyes, would cause your eyes to be more irritated.
Can medications cause dry eyes?
Definitely, medications can be associated with dry eyes. Antihistamines that can cause dry mouth, certain antidepressant medications, and some medications used for urinary incontinence, oftentimes give us dry eyes. In addition patients who are on diuretic pills or water pills for high blood pressure… these pills dehydrate you and by dehydrating you, your body is not making its normal amount of tears.
What about the environmental factors?
There are a lot of environmental factors critical to dry eye: air conditioning, because by dehumidifying the air it oftentimes causes dry eyes to be worse. So low ambient humidity or low relative humidity, whether that's in the cabin of an airplane or sitting in Arizona, where there's low natural humidity. But even in humid places like Miami, having air conditioning all over the place creates a relatively dry internal environment. Fans are a fairly common cause of dry eyes. In Miami a lot of people have ceiling fans on, when they sleep, and another place where you have fans close to your face is when you're driving a car — you have the air vent 12 inches from your face.
The big one now is computers, and computers also means cell phones and video games. And what happens is that in our normal resting state, we're probably blinking every five to 10 seconds. But when we're staring at a computer screen or video game or at our iPhone or even at times staring at a book or at our TV screen, we tend to not blink very often, so there's been a tremendous increase among patients who are at a computer screen eight to 10 hours a day just at a work site, and if they go home, we have people who might be in front of a computer screen 16 -20 hours a day if you're a student or something like that. There is a definite decrease in blink rate, which is also a big situation that exacerbates dry eye syndrome.
What is the worst case you've seen?
It's not very common, but if a patient has severe, severe dry eyes, one of the body's normal protective mechanisms is the tear film… and as I mentioned before, the tear film protects the eye from bacteria that lands on the eye, flushing it away quickly. With patients with severe dry eye, the eye can get so dry that the surface of the cornea ulcerates and you can get an infection that can penetrate through the cornea and cause blindness. That would be a very severe case and most often you'd see it in someone with certain types of arthritis and severe rheumatoid arthritis, which is associated with dry eyes as well. Those conditions are called autoimmune conditions, where your body's immune system attacks itself, so in rheumatoid arthritis or with people with severely deformed joints, where the body is fighting against their joints. For some reason, with patients with autoimmune conditions, the body's immune response is directed against tear glands and those patients can have near total wipe out of their tear production.
How do patients know if they have allergies or dry eye?
First of all they can have overlapping symptoms, and a patient can have more than one condition… but a patient can have certain characteristics that suggest one over the other. The classic symptoms associated with allergies is itching; although patients who have dry eyes alone can also have itching, it's usually a minor symptom along with their irritation and grittiness. With allergies, your eyes are going to be redder. Oftentimes there's going to be some mucus discharge. The other thing that helps us determine what's going on is clinical history, asking patients about nasal allergies or asthma, and even skin disease.
What are the first steps of managing symptoms associated with dry eyes?
Usually we start the management of dry eyes by the use of artificial tears or with lubricating drops. It's important that patients read the labels to avoid overusing the most commonly used drops with vasoconstrictors like Visine or Clear Eyes to get the red out. It's important that patients not abuse drops that have vasoconstrictors, because they give temporary relief of red eye, but if you continually use them your body actually goes into a rebound and your eyes are always red and the drops just have a transient effect. So read the labels of what you're using. Usually we'll treat patients with over the counter artificial tears, which try to mimic the eyes' natural tears. That may work for mild symptoms, but within 15 minutes 90 percent of the drops are gone. So one of the issues we have with patients who use artificial tears is that it's often transient relief. To me, that's the big benefit of something like RESTASIS drops. They actually attack the root of the problem, which is ocular inflammation on the surface of the eye, which increases tear production and dramatically improves symptoms with lasting relief. People will use artificial tears up to six times a day but with RESTASIS, they only need to use it twice.
Are eye drops addictive?
The one thing that concerns me at times is the overuse of drops like Visine or Clear Eyes, the ones that have vasoconstrictors; that's the syndrome I was referring to before where people feel their eyes are a little red so they use Visine and three hours later, their eyes are red again, so they end up using Visine four-six-eight times a day. That's why I usually tell my patients if once a week you have a hot date or have to take a photo, a drop of Visine wouldn't be a bad idea. But on a regular basis, you only want to use an artificial tear or lubricating drop that doesn't have a vasoconstrictor.
Can people with dry eyes wear contacts?
They can wear contact lenses, but that's one of the main reasons that people have difficulty wearing them. I'll have patients who've worn contact lenses for years and years, but now that they're getting older and hitting their 30s and 40s, they're saying, 'Gee, I'm really not that comfortable in my contacts anymore.' They'll change contact lense brands and solutions trying to find the magic pill and often it's the dry eyes that's making them not able to tolerate their contact lenses. For those patients, RESTASIS, as most topical medications, should not be used when a patient has a contact lense in their eyes. They should use it first thing in the morning or in the evening. So RESTASIS can be used to increase tear production and increase their ability to tolerate their contact lenses.
How do you know when you need to see a doctor about dry eyes?
I think a patient with the classic symptoms of dry eyes should feel comfortable buying over the counter lubricating drops and using those anywhere from two to four times a day, and my impression is that if that doesn't significantly improve the problem, the patient should see an optometrist or ophthalmologist for further evaluation to make sure that it's nothing more serious than that. If the doctor confirms that it's dry eyes and the patient is not responding well to the use of artificial tears alone, then the patient is an excellent candidate for additional therapy such as RESTASIS and punctal occlusion.
Talk to me about punctal occlusion.
There is a procedure that can be performed that helps with dry eyes, and that surgery is called punctal occlusion or punctal plugs. The punctum is that little tiny hole in the inner corner of your lower eyelid, where tears disappear from the eye and go down the tear duct to the back of the nose. One procedure we can do to help dry eyes is use a tiny little plug to plug the punctum and that allows the tears to last longer in the eyes. And in some cases after numbing the edge of the eyelid, we can use an instrument to cauterize or burn that opening, and have it seal up or scar up closed. So punctal plugs or punctal occlusion with cautery can be used to increase the amount of tears on the surface of the eye as well.
Are there any natural remedies for dry eyes?
There's definitely an association between ocular irritation and poor production of tears that can be seen from a diet that doesn't have sufficient Omega-3, so that's a step on the ladder along the way. It's an easy first step and something a consumer can begin to do on their own before they see an optometrist or ophthalmologist.
Is there anything that we can do to prevent dry eyes altogether?
One is think about environmental situations… so try to make sure that if you're going to have an AC vent or a fan on, that it's not directly in your face, and if you're going to use a computer, or a TV, or even reading for long periods of time, make sure to take breaks and blink on a regular basis. Keep lubricating drops handy for situations where you're not going to blink, and wearing glasses or sunglasses to prevent wind and dust blowing directly in your eye, that also helps for dry eye.