Chronic Dry Eye

Overview

Chronic dry eye is an inflammatory disorder of tears and the surface of the eye, also called the ocular surface. It encompasses a group of disorders, which typically cause symptoms of dryness and overall eye discomfort. It may also cause stinging, burning, a gritty feeling or episodes of blurred vision.

The condition affects an estimated 5 percent to 30 percent of the population age 50 and older in the United States. In addition, tens of millions of Americans experience less severe symptoms of the disorder.

Chronic dry eye is one of the most common reasons people visit an eye health professional. It occurs most often in the elderly.

The exact cause of chronic dry eye is unknown. External factors may aggravate dry eye symptoms, including conditions common in many workplaces such as prolonged computer use and exposure to air conditioning, heating, dust and allergens.

But chronic dry eye should not be confused with eye allergies, an even more pervasive problem. Eye allergies are reactions to substances in the environment that can result in some of the same types of discomforts associated with eye dryness.

There are two major types of chronic dry eye: aqueous tear-deficient and evaporative. Both can cause your eyes to sting or burn, feel scratchy, become irritated and tear excessively.

Treatment

The mainstays of dry eye treatment are over-the-counter artificial tears in the form of eyedrops. Eye care professionals generally recommend you use them as often as needed to relieve symptoms, provided they don’t contain preservatives. If you use a drop that does contain preservatives, you can use it up to four times a day. How often you use the drops can depend upon how bothersome your symptoms are, how dry your immediate environment is and even how humid the weather is. Some people with chronic dry eye may find that on a rainy day, they need only a drop of artificial tears for the entire day. On a dry, sunny and windy day, they may use a drop every hour.

Artificial tears primarily provide symptomatic relief and do not address the underlying causes of dry eye; however, they may be adequate for treating mild or episodic dry eyes. Further, they are a “foundation” therapy for all levels of severity and are recommended as a treatment component as additional therapies are added. As a general rule, if you use artificial tears three or more times a day to manage your symptoms, you should visit an eye care professional to discuss additional treatments.

If you are using artificial tears frequently but find they don’t seem to relieve symptoms, the preservatives in the drops may be irritating the eye or creating an allergic reaction. In such cases, preservative-free eyedrops may be better for you.

Over-the-counter sterile eye ointments sometimes are recommended for nighttime use to lubricate the eye during sleep and to treat the scratchy eye feeling that many people experience when they wake up. Such ointments are primarily used to coat the eye when it is exposed while sleeping. This occurs in cases of nocturnal lagophthalmos, which involves the inability to close the eyelids while sleeping.

In addition, avoiding anything that can exacerbate eye dryness—such as hair dryers, rooms with low humidity, air conditioning or heat in cars (especially when vents are positioned directly at your face), wind and cigarette smoke—is recommended.

If these measures don’t relieve your symptoms, your doctor may prescribe cyclosporine ophthalmic emulsion 0.05 percent (Restasis). It is approved by the U.S. Food and Drug Administration for people whose tear production is presumed to be suppressed due to ocular inflammation. Topical cyclosporin A helps increase the eyes’ natural ability to produce tears, which may be suppressed by inflammation due to chronic dry eye. It is generally recommended to people who use artificial tear eyedrops frequently without getting long-term symptom relief. It should not be used by anyone with an active eye infection.

Another option for people with moderate to severe chronic dry eye is prescription eye inserts that work like artificial tears. The hydroxypropyl cellulose inserts (Lacrisert) are placed between the lower eyelid and eyeball once a day. They dissolve slowly, releasing a lubricating substance into the eye.

In some cases, your doctor may also prescribe steroid drops to help reduce inflammation or antibiotics in the form of drops or pills.

In the case of chronic dry eye due to eyelid problems, such as an anatomical problem or an incomplete blink, your eye care professional may refer you to a plastic surgeon who specializes in the eyes. If your eyelids are inflamed due to blepharitis, your eye care professional may recommend that you regularly clean your lids with a diluted baby shampoo solution.

People with dry eyes who wear contact lenses may benefit from special lenses that rest on the white part of the eye, creating a fluid-filled layer over the cornea that prevents it from drying out.

In cases of moderate to severe chronic dry eye, a temporary or permanent plug about the size of a sesame seed can be inserted into some of the tear draining channels, or puncta, at the inner corner of the eyelids. Here tears normally drain through the tear duct into the nose and down the throat. Blocking these exit channels helps to keep the tears on the surface of the eye longer. Plugs are inserted by your eye care professional in the office setting in minutes using a magnifying instrument to best see the puncta. These plugs may be made of silicone or collagen, are reversible and are usually a temporary measure. In cases of severe dry eye, permanent plugs may be considered. Some people with silicone plugs initially may have a sensation that something is in the eye, but the feeling usually disappears over a few hours to a few days. Many people don’t feel them at all after they’ve been inserted. Plugs can be dislodged by rubbing the eye, so your eye care professional may recommend you refrain from doing so.

In severe cases, irreversible surgical closure of the puncta may be recommended.

Prevention

There is no cure for chronic dry eye and no way to prevent it. But, you can help prevent evaporation of your tears by avoiding anything that can cause dryness, such as hair dryers, environments with low humidity and wind. Placing a humidifier in the room when indoor heat is used and wearing wrap-around glasses when outside may provide some relief from the symptoms of chronic dry eye. Smoking is especially bothersome to some people and should be avoided. Additionally, symptoms can be aggravated by a number of external factors, many of which are common in workplace environments. These external factors include prolonged screen use (with computers, tablets and smartphones) and exposure to air conditioning, heating, dust, allergens and wind. If you cannot find relief from your dry eye symptoms, make an appointment with an eye care professional to discuss your symptoms.

Facts to Know

  1. Chronic dry eye is a group of disorders affecting the tear film.
  2. The exact prevalence of chronic dry eye in the United States is not known, but it is estimated to affect 5 percent to 30 percent of the population age 50 and older and is expected to increase as the population ages. In addition, tens of millions of Americans experience less severe symptoms of dry eye.
  3. Chronic dry eye tends to occur most often in the elderly, especially women.
  4. Although chronic dry eye can affect vision, it rarely produces permanent vision loss.
  5. Early symptoms of chronic dry eye may include eye redness, blurry vision, burning, stinging or gritty sensation in the eye, especially in an environment with low humidity; a feeling that something is in the eye; trouble wearing contact lenses; a gritty feeling that can be persistent and painful; eye dryness; and excessive tearing.
  6. As chronic dry eye worsens, symptoms become more persistent. People with severe cases may also have eyes that are unusually sensitive to light and may experience severe eye pain or notice changing or fluctuating vision.
  7. Chronic dry eye can be a symptom of an autoimmune disease called Sjögren’s syndrome that attacks the body’s lubricating glands.
  8. Chronic dry eye has no cure but can be treated.
  9. Over-the-counter artificial tears in eyedrop form are the main treatment for dry eye. Anyone experiencing dry eye symptoms or using artificial tears regularly without relief should see an eye care professional for a diagnosis.
  10. Punctal plugs that block tear drainage channels can help conserve tears for chronic dry eye sufferers who get little or no relief from artificial tears.