Dry eye

Dry eye is a sore, gritty sensation caused by something affecting the quality of tears or the amount of tears being produced which affects the protective film on your eyes. The gritty sensation may be accompanied by pain, redness and vision problems. It may cause sensitivity to bright light or open air and wind.

Dry eyes are common as we get older, and are more common in women than men. It's associated with some conditions and medications, and with computer use (not blinking enough). It generally affects both eyes.

Tears are made up of 3 separate secretions – a sticky base layer, a watery mid layer and an oily top layer (which slows the evaporation of your tears). Normally tears form a protective film over the surface of the eye, lubricating movement and washing away debris and harmful material. 

Despite the name, the irritation of dry eye may trigger excessive tears. Dry eye may also redden the eyes, but it's not the same as allergic conjunctivitis or 'red eye'.

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The following factors increase your risk of dry eye:

• Increasing age – it affects 75% of people over 65 years of age.
• Being female – hormonal changes (eg, pregnancy, menopause, oral contraceptives).
• Blepharitis (inflammation or swelling of the eyelid) – you may have red eyelid margins and scaly eyelashes.
• Medicines, eg, decongestants, antihistamines, oral contraceptives, antidepressants, isotretinoin for acne, blood pressure medicines and anti-redness drops.
• Underlying health conditions, eg, Sjögren's syndrome, allergic eye disease.
• Other conditions to consider are rheumatoid arthritis, diabetes, asthma, thyroid disease, other immune diseases.
• Computer use – users tend to blink less.
• Wearing contact lenses.

Symptoms of dry eye may include any of the following:

• Stinging or burning of the eye.
• Sensitivity to light.
• A sandy or gritty feeling as if something is in the eye.
• Watery or teary eyes.
• Pinkness or redness of your eyes.
• Blurred vision that comes and goes.
• Heavy eyelids or tired eyes.
• Inability to cry when emotionally stressed.
• Discomfort when wearing contact lenses.
• Decreased tolerance of reading, working on the computer, or any activity needing ongoing visual attention.
• Problems driving at night.

Dry eye can also cause your eye to be red. If this occurs, it's best to check with your doctor or an optometrist in case something else is the cause and a different treatment is needed.

You should seek medical advice if:

• your eye is painful or red
• it's harder to see well or your vision is affected
• your eye has a coloured discharge or your eyelids are stuck together when you wake up
• you have glaucoma
• you have rheumatoid arthritis or diabetes
• your dry eye persists for 7 to 10 days, despite treatment.

Talk to your healthcare provider, who will examine your eyes, check your vision, and ask about your symptoms and anything you’ve tried to do yourself for your dry eyes. They will also consider any conditions you have and medicines you’re taking.

Your healthcare provider may recommend some self-care options for you to try (see below) or may refer you to see an optometrist or eye specialist.  If there is an obvious reason for dry eyes, they will treat the cause or refer you to another health professional who can.

• Often, oily tear glands (meibomian) in your eyelids become blocked, inflamed and produce irritant secretions that make dry eye symptoms worse. This gland inflammation is common and difficult to cure, but the following daily routine can help.
• Always try hot compresses and eyelid massage first. This is the same treatment that you would do for a stye. You can do this treatment at home. It involves applying a warm compress to your eyelid to heat your eyelid glands, followed by eyelid massage to squeeze oil out of your glands. Keeping your eyelids clean also helps.
  
  • Warm compresses: Place a hot flannel, a heated wheat bag or a heated eye mask (usually available at pharmacies) on your closed eyelids for 10 minutes. The temperature should be reasonably warm but not so hot that your skin can't tolerate it  – about 42^o C or the temperature you might do the dishes at. 
  • Eyelid massage: After heating, massage your eyelids. Use the tip, or side, of your finger to firmly push the skin of your eyelids at the area close to your eyelashes. Don't push so hard that it becomes painful. This will help unblock the eyelid oil glands by melting the oil and squeezing it out. This also helps with dry eye. Do this twice a day long-term.
    
    

Image credit: Kenny Wu

• Do blink exercises, especially when using screens (computer, tablet , phone and television). This involves taking 10 full blinks intentionally after about 20 minutes of screen time. We blink less, without knowing it, when using screens and this often leads to dry eyes.
    
• Get a good amount of sleep. Poor quality sleep and reduced hours of sleep have been related to dry eyes.
  
  
• Artificial tear eye drops, gels and ointments can be helpful for symptoms of dry eye. Get some advice from your optometrist about what might be the best option for you. Find out the best way to apply eye drops and eye ointment.
• Points to remember:
  • Don't touch your eye with the dropper or tube tip.
  • You should discard all drops, solutions and ointments 1 month after opening to avoid contamination. Note that some eye products can only be used for a few days, so check the packet instructions.
  • Single-dose lubricant eye drops remain safe until opened and should be discarded at the end of the day it was opened.
     
• If you wear contact lenses you can:
  • use preservative-free artificial tears
  • consider reducing the amount of time you wear them, or
  • change to a different contact lens type (with advice from an optometrist).
    
    
• Some people find supplements or dietary sources (eg, tuna fish) of omega-3 fatty acids (especially DHA and EPA) decrease dry eye symptoms. The use and dosage of nutritional supplements and vitamins should be discussed with your healthcare provider. 

If the self-care described above doesn't work, go back to your optometrist to review your diagnosis and discuss other treatment options. Depending on the cause of your dry eye, the following could apply:

• Blepharitis is the inflammation of your eyelids. You may see scaly eyelashes which can be a cause of grittiness and irritation. To help with this, use lid wipes from the pharmacy to gently rub away scales from the base of the eyelashes daily.
• Prescription medicines may cause dry eyes and there may be other options for you.
• Intense pulsed light therapy (IPL) may be done to stimulate and unblock the eyelid oil glands
• Surgery.

You can help prevent dry eye symptoms by:

• protecting your eyes from sun and wind by wearing wrap-around sunglasses
• avoiding irritants, eg, smoke, dust, cosmetics and chlorine
• limiting time spent in air conditioned or centrally heated spaces
• using a humidifier at home
• lowering your computer screen so you're looking slightly down at it to minimise the exposure of your eyes to computer glare
• blinking often – every 5 to 6 seconds
• drinking plenty of water to stay hydrated
• avoiding hair dryers or heaters blowing directly onto your eyes
• not leaving contact lenses in for too long
• using artificial tears or lubricant regularly
• increasing dietary intake of foods containing essential fatty acids (eg, salmon, linseed or flaxseed oil).