Dealing with Dry Eyes

Is it an allergy or something else? What could be the cause of those dry, irritated eyes — and when you should see your doctor.

Poets and proverbs say the eyes are the mirror to your soul, but a medical profession may see something else. We often blame dryness, itching and irritation on allergies, but the eyes can reflect other more serious conditions too.

Chronic dry eyes or dry eye syndrome (DES) is a common complaint — but not all dry eyes are alike.

Sometimes the problem is not enough tears are being produced. Sometimes it’s a question of quality rather than quantity — there isn’t the right balance of mucus, oils, antibodies and proteins in tears to get the job done. (People suffering from DES can have watery eyes because their body is overcompensating.) In other cases, tears evaporate too quickly and aren’t replenished fast enough — like when we don’t blink enough, can’t close our eyes properly or faced environmental conditions like dry air and wind.

Symptoms aren’t just a feeling of dryness or itching — they can include redness, blurred vision, pain, a gritty sensation or feeling that something is in the eye. While most people experience these symptoms at some point, their chronic presence can be more than mere annoyance. Without proper treatment, the discomfort can get worse over time and even cause permanent damage.


Causes of dry eyes

Benign causes like allergies or the environment are usually behind chronic dry eyes, but these conditions can also have the same symptoms:

Aging. While not technically a disease, aging affects our eyes because our ability to produce tears can decline. Hormonal changes are another culprit, so it’s not surprising that women are more likely than men to experience dry eyes, and the problem often shows up after menopause.

While there isn’t much we can do to treat this cause, any changes to your eyes deserve a mention to your doctor.

Contact lenses. Soft contact lenses float on the tear film covering the cornea and can absorb tears from the eye. Experts estimate that half of contact lens wearers suffer from dry eye, but many find relief by switching the kind of lens they wear, using rewetting drops or simply wearing glasses instead. Dry eyes make contacts uncomfortable to use.

Should you just get corrective laser surgery instead? Weigh the benefits and risks — procedures such as LASIK can make dry eyes worse — at least temporarily.

Medications. Dry eyes are a common side effect of certain medications including diuretics, antidepressants, beta-blockers, hormone replacement therapy and oral contraceptives. These medications can impair the body’s ability to produce tears.

If you’re attempting to treat “allergy eyes” with anti histamines beware: they can also cause dry eyes.

Computer vision syndrome. Our eyes weren’t meant to stare at computer screens eight to 10 hours a day. In addition to eye strain — which can lead to headaches, blurred vision and fatigue — we tend to blink less often. (The same thing can happen when we’re focussed on a task like reading or hobbies.) Blinking is an essential process for lubricating our eyes with precious moisture.

Don’t worry: no permanent harm will be done. You can alleviate symptoms by giving your eyes frequent rest breaks, using proper lighting and making sure your eyewear prescription is up to date. (For more information, read Computer vision syndrome: What you need to know.)

Rosacea. It isn’t just a skin condition that causes flushing, redness and “bumps” on the face — it can cause eye symptoms too. The resulting inflammation of the eyelids can disrupt the flow of natural oils that help keep moisture in. While it doesn’t happen often, ocular rosacea can occur without any skin symptoms. If you suffer from rosacea, make sure to monitor your eyes as well as your skin. The condition can get worse and inflammation can spread to the cornea.

Autoimmune diseases.. When the immune system starts attacking healthy tissues, it can cause inflammation in just about any part of the body — including in the tear-producing glands in the eye. Dry eyes can be a sign of connective tissue diseases like lupus, rheumatoid arthritis and scleroderma. One particular condition, Sjoren’s syndrome, is characterized by dry eyes and dry mouth. (See Autoimmune diseases: A primer.)

Structural problems. When people can’t open and close their eyes normally, it’s easy for tears to evaporate and harder for moisture to be spread across the surface of the eye. Sometimes an abnormality is at fault, but people who have suffered a stroke or Bell’s palsy can also experience difficulties.

Infections like conjunctivitis (or pink eye), injury or burns can also cause dry eye.

While dry eyes can often be treated with over the counter products, that doesn’t mean you should skip a trip to your doctor and eye doctor. You’ll want an expert to accurately diagnose the problem and suggest treatment — and have someone keep tabs on your overall health and changes to your eyes.


Relieving dry eyes

If you’re experiencing dry eyes, don’t panic: usually it’s due to a harmless cause and there are many ways to get some relief. Your doctor or eye doctor may recommend steps like:

Give them a wash or warm compress. If you have a condition that causes inflammation to the eye lids, doctors often recommend washing them or using a warm compress a couple times a day. You can do this by placing a warm wash cloth over your eyes as a compress or gently washing using baby shampoo or gentle soap. (Ask your doctor for recommendations.)

Use lubricating eye drops or ointments. Give your eyes a little help with eye drops — but make sure you buy the right kind. Experts say to look for artificial tear drops or ointments. Some contain preservatives, which irritate some people.

Unless you’re sure allergies are the cause, avoid eye drops that contain antihistamines. Also, experts advise to forgo drops that promise to reduce redness — these products contain substances called vasoconstrictors which contract the blood vessels in the eyes. You might find some temporary relief, but you won’t be treating the cause.

Give your eyes a break. You can’t force yourself to blink more while reading or looking at computer, but you can give your eyes a rest. Try the 20-20-20 rule: Every twenty minutes focus on something at least twenty feet away for twenty seconds.

If you spend all day on a computer, here’s another tip: experts advise for every hour you use it, spend 5-10 minutes away from your screen. Get up, stretch and move around — the break will be good for the rest of your body too. (See Too much sitting can be deadly.)

Adapt your indoor environment. A humidifier can help keep moisture in the air during dry months, and an air filter or purifier can help reduce dust and other indoor air pollutants.

Eat right. While vitamin A deficiency can affect eye health, think beyond the carrots. Studies have shown that foods rich in omega-3 fatty acids — like salmon, herring and flaxseed — are a help for dry eyes. Have trouble getting them in your diet? Supplements will also do the trick, but talk to your doctor first so you’re aware of the risks (like potential drug interactions).

Stay hydrated. Not getting enough liquids? Dehydration can make dry eyes worse.

Don sunglasses. Not only you reduce the risk of eye diseases from UV rays, they also provide a physical barrier against dust, wind and other irritants. A wrap-style frame can provide better coverage — especially if it’s close-fitting or has foam seals.

Take prescription medications. Your doctor may prescribe antibiotics either in pill form or prescription eye drops to bring down inflammation. For more serious inflammation, eye drops containing immune-suppressing medications or corticosteroids may be used (such as Restasis).

Consider closing the tear ducts. If tears are leaving your eyes too quickly, doctors may try to slow them down by partially or fully closing off the tear ducts. Doctors may insert tiny silicon plugs either temporarily or permanently, or cauterize the tear ducts for a more permanent solution (a procedure known as thermal cautery).

Go for regular check-ups. Even if you aren’t experiencing any eye-related symptoms, an annual eye check up can help spot any eye troubles and track changes to your eye health. If you suffer from a health condition that affects the eyes, more frequent visits may be required.

Remember, don’t try to treat chronic dry eyes on your own — talk to an expert first. Otherwise, you could be using the wrong remedies or overlooking an underlying condition.

Want to know more about dry eyes? Here’s where you can find more information:
All About Vision: Dry Eye Syndrome
The Mayo Clinic: Dry eyes
eMedicineHealth: Dry Eye Syndrome

Additional sources: Canadian Association of Optometrists, CNIB, National Rosacea Society, PubMed Health, WebMD

Photo © dardespot

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