When you cry, your eyes release more than just tears. Your tear glands constantly release a mixture of oils, fluids, and mucus that lubricates and protects your eyeballs.
If your glands do not make enough tears, you may experience a condition called chronic dry eye.
One uncommon form of dry eye is called aqueous-deficient dry eye (ADDE), also known as aqueous tear-deficient dry eye. ADDE causes your tear glands to not make enough tears to keep your eyes moist. This can result in eye irritation or damage.
Read on to learn more about symptoms of ADDE to watch out for, what might be causing this condition, and how to seek a diagnosis and treatment.
Here are some of the most common symptoms of ADDE:
- pain in your eyes without a clear cause
- burning sensation, especially when you blink
- noticeable redness in your eyes
- eye itchiness
- a sensation that you have something stuck in your eye, like dirt or sand
- blurred vision, especially when reading
- eye fatigue after reading or looking at a screen for even short periods of time
- difficulty putting in contact lenses or wearing them for a long period of time
- a lack of tears when you cry
You may also notice some of the following symptoms if you have ADDE that results from Sjögren’s disease, a condition that affects salivary and lacrimal glands:
- dry mouth
- dry skin
- feeling exhausted with no clear cause
- unexplained rashes on the skin
- pain in your joints
ADDE happens when your tear glands (also known as your lacrimal glands) do not make enough fluid to properly lubricate the eye. There are two main types of ADDE, depending on their cause:
- Sjögren’s-related: Sjögren’s disease is an autoimmune condition that affects your body’s ability to produce fluids. This includes tears and saliva.
- Non-Sjögren’s-related: This type is not related to Sjögren’s disease. Age is one of the most common factors for ADDE in people who don’t have Sjögren’s.
Some other common risk factors for the second type of ADDE can include:
- other autoimmune conditions, such as lupus or rheumatoid arthritis
- undergoing hormone replacement therapy
- conditions that affect the eye, eyelids, or eyelashes, such as blepharitis or seborrheic dermatitis
- not blinking enough during long periods of using electronic devices
- being in very dry indoor environments, especially when running HVAC systems for long periods
- not getting enough vitamin A or omega-3 fatty acids in your diet
- using antihistamines or blood pressure medications that affect eye lubrication
- complications from an eye injury, especially from chemicals or damaging substances
- receiving orbital radiotherapy for treatment of cancer in the mouth or eyes
Get medical attention from a primary care physician or eye doctor if you experience any of the following:
- constant eye pain or irritation that makes it difficult to complete daily tasks
- extreme sensitivity to light
- redness in either eye
- vision that’s getting worse over time
- noticeable blurry vision
- symptoms that do not improve after 4 weeks, even after resting your eyes, using lubricants, or reducing electronic device use
- are diagnosed with Sjögren’s disease
Go to the emergency room if you experience a sudden onset of blindness or an eye injury that affects your ability to see.
Here are some of the most common methods that a doctor or eye doctor might use to diagnose ADDE:
- Blink frequency: A doctor examines how often you blink in 1 minute. You may have ADDE if you blink less than once every 30 seconds.
- Ocular surface staining: A doctor stains your eye’s surface with specialized sodium drops and looks at the eye through a slit lamp to see if there’s damage to any of the eye’s protective layers.
- Tear film breakup time: A doctor tracks
how long it takesfor the film of tear fluid to break up after you blink and lubricate your eye using the same specialized eye drops. You may have ADDE if the tear film breaks up in fewer than 8 to 10 seconds.
- Tear lake: A doctor looks at the amount of tears along the edges of your lower eyelid as they spill out onto the eye surface. You might have ADDE if this reservoir of tears is less than 0.2 mm across.
- Eyelid examination: ADDE often leads to eyelid symptoms and debris on the eyelids that can cause redness or eyelid thickening. A close examination of your eyelids can help diagnose ADDE.
- Tear analysis: A doctor takes a tear sample to analyze the tear fluid for high concentrations of blood or inflammation.
- Schirmer’s test: A doctor numbs your eyes with special eye drops and inserts a small strip of paper into each eye to see how much fluid fills up the paper. You might have ADDE if the paper comes out and measures less than 10 mm down a strip of paper.
Treatment of ADDE depends on the cause.
Speak with a doctor if you have ADDE that results from Sjögren’s disease or another autoimmune condition. Managing an autoimmune condition can help reduce the severity of the symptoms that it causes.
If you have ADDE that isn’t caused by an underlying condition, a doctor may recommend some of the following
- using eye drops or other lubricants to keep your eyes moist
- using lid wipes to reduce bacterial buildup on your eyelids that can lead to irritation or infection
- applying prescription topical treatments like corticosteroids
- applying warm compresses to your eyes to reduce irritation and swelling
- keeping your indoor environments at about 40% relative humidity (RH)
- reducing your usage of electronic devices like smartphones, computers, and TV
- taking regular breaks from activities that require visual focus, such as driving or using a computer (every 20 minutes, look away at something 20 feet away for 20 seconds)
- not using eye drops with preservatives, such as benzalkonium chloride, if you have especially severe dry eye
- asking a doctor if you can reduce medications that can cause dry eyes, such as antihistamines and certain kinds of antidepressants
- seeing a doctor if you experience eye infection symptoms to quickly address the cause of infection
In some cases, your tears dry up too fast because of a gland blockage that prevents enough oils from entering the tear mixture. This is known as evaporative dry eye (EDE), and it’s the most common type of dry eye.
EDE is different from ADDE. ADDE happens when your tear glands don’t make enough of the fluid that carries the oils and mucus that lubricates your eyes.
ADDE makes up
ADDE happens when your tear glands don’t produce enough fluids to keep your eyes moist. It often happens alongside autoimmune conditions like Sjögren’s disease or as you age.
Contact a doctor if you’ve been newly diagnosed with Sjögren’s or notice any long lasting symptoms of dry eye that keep you from accomplishing daily tasks — and try a variety of home treatments and prevention techniques to help keep your eyes moist.