Dry Eye Syndrome

Dry eye syndrome can be broadly classified as follows:

• Evaporative dry eye is caused by problems with the lipid layer, often due to the dysfunction of the oil-producing glands in the eyelids (meibomian glands).
• Aqueous-deficient dry eye which occurs when tear production is reduced, sometimes linked with ageing or specific systemic conditions that affect tear production.

• Eye irritation, including itchiness, dryness, and general discomfort.
• Redness and a burning, stinging, or gritty sensation in the eyes.
• Temporary episodes of blurry vision, which usually improve after blinking or a short time.
• Excessive watering in some cases.
• Eyes do not produce tears during crying or when cutting onions.

Several causes of dry eye syndrome have been identified: 

• Natural ageing process
• Blinking problems
• Dysfunction of tear-producing glands, such as meibomian gland dysfunction.
• Some drugs, such as antihistamines and oral contraceptives, can cause dry eye.
• Using contact lenses may exacerbate (worsen) dry eye.
• Underlying systemic conditions, particularly autoimmune diseases such as Sjogren's syndrome or arthritis.

Ophthalmologists may use a combination of tests because no single can confirm dry eyes:

• Comprehensive eye examinations to assess ocular  and general health.
• Schirmer tear test or phenol red thread test is used to measure tear volume.
• Staining tests with dyes to check tear quality and the corneal surface.
• Tear osmolarity tests to evaluate water and particle levels in tears.
• Assessment of markers such as lactoferrin or matrix metalloproteinase-9 levels.

Treatment options for dry eye syndrome include the following:

• Artificial tears or tear substitutes help mild to moderate cases. However, patients with severe dry eye disease need to use eye drops frequently (more than 6 times a day). Contact lens users are recommended preservative-free eye drops.
• Eye ointments provide lubrication but are best used at night because they can cause temporary blurred vision.
• LipiFlow is an FDA-approved procedure to treat meibomian gland dysfunction.
• Lacrimal punctal plugs may be used for severe cases to help retain tears.

You should seek medical attention if:

• Symptoms persist despite using artificial tears.
• Vision becomes consistently blurred or fluctuates.
• There is persistent eye redness, pain, or discharge.
• Dry eye is accompanied by other symptoms of autoimmune disease (e.g., joint pain, dry mouth).

Certain lifestyle and environmental measures can help reduce the risk of developing or worsening dry eye:

• Blink frequently, especially when using digital devices.
• Use humidifiers in dry environments.
• Wear wraparound sunglasses outdoors to reduce tear evaporation.
• Stay hydrated and maintain a balanced diet; omega-3 fatty acids may help.
• Avoid smoke, wind, and prolonged exposure to air conditioning.
• Limit contact lens use when possible.
• Review medications with a doctor if they worsen dry eye.

Patients with persistent or severe symptoms should consult an ophthalmologist, who can diagnose and manage the condition. In cases linked to systemic autoimmune disease, referral to a rheumatologist may be appropriate.