Understanding Dry Eye

Dry eye is mainly caused by a chronic lack of sufficient lubrication and moisture on the surface of the eye. The effect of dry eye range from subtle to constant eye irritation to significant inflammation and even scarring of the front surface of the eye. If left untreated, severe forms of dry eye may even damage the vision. It is usually addressed as dry eye syndrome, dry eye disease, or 'dry eye', alternate medical terms used to describe dry eyes during an eye care consultation in Singapore include:

• Keratitis Sicca: Generally used to describe dryness and inflammation of the cornea.

• Keratoconjunctivitis Sicca: Used to describe dry eye that affects both the cornea and the conjunctiva. 

• Dysfunctional tear syndrome: Used to emphasize that inadequate quality of tears can be just as important as inadequate quantity.

In dry eye, there is usually a lack of production in tears or when the composition of tears is abnormal and cannot adequately cover the surface of the eye or the eye produce low-quality tears.

Dry Eye Symptoms:

You may have dry eye syndrome if you are having:

• Burning Sensation

• Itchy eyes

• Aching sensations

• Heavy eyes​

• Fatigued eyes

• Sore eyes

• Dryness sensation

• Red eyes

• Photophobia (light sensitivity)

• Blurred vision

• Foreign body or sandy sensation in the eyes

• Intermittent blurring of vision

• Reflex tearing: Due to the insufficient protection of the front surface of eye, the body produces excessive tear to wash away harmful irritants (smoke or foreign bodies). However, the reflex tearing doesn't adhere to the eye long enough to correct the underlying dry eye condition

Causes and Risk Factors:

We have to first understand how does a healthy tear film behaves in the eye. A healthy eye with adequate and consistent layer of tears on the front surface of the eye is essential to keep your eyes healthy, comfortable and seeing well. The tears immerses the eye's surface to keep it moist and wash away irritants, debris and micro-organisms that could potentially damage the cornea and lead to eye infection. 

A healthy tear film consists of three important components:

• An oily (lipid) component

• A mucous-like (mucin) component

• A watery (aqueous) component

Each component of the tear film serves a critical purpose. The lipid layer, produces by the meibomian gland, is on the outer most layer, it helps to prevent the underlying (mucin & aqueous layer) from evaporating too quickly and increase lubrication. Mucin layer, produces by the goblet cells of the conjunctiva, helps to anchor the tear film and spread the tears across the surface of the eye. Aqueous layer, produces by the lacrimal gland, provide the moisture the eye needs. 

A problem with any of these components results in a instability of tear film and dry eye. It is best to see a Singapore Optometrist to find out which of your components is affected and receive the best management for your dry eyes. 

Factors Associated with Dry Eye:

• Computer use: When working at a computer or using a smartphone or other portable digital device, we tend to blink our eyes less fully and less frequently, which leads to greater tear evaporation and increased risk of dry eye symptoms.

• Contact lens wear: Though it can be difficult to determine the exact extent that contact lens wear contributes to dry eye problems, dry eye discomfort is a primary reason why people discontinue contact lens wear.

• Aging: Dry eye syndrome can occur at any age, but it becomes increasingly more common later in life, especially after age 50.

• Menopause: Post-menopausal women are at greater risk of dry eyes than men of the same age.

• Indoor environment: Air conditioning, ceiling fans and forced air heating systems all can decrease indoor humidity and/or hasten tear evaporation, causing dry eye symptoms.

• Outdoor environment: Arid climates and dry or windy conditions increase dry eye risks.

• Frequent flying: The air in the cabins of airplanes is extremely dry and can lead to dry eye problems, especially among frequent flyers.

• Smoking: In addition to dry eyes, smoking has been linked to serious eye problems, including macular degeneration, cataracts and uveitis. (For details, see our infographic about why smoking is bad for your eyes.)

• Health conditions: Certain systemic diseases — such as diabetes, thyroid-associated diseases, lupus, rheumatoid arthritis and Sjogren's syndrome — contribute to dry eye problems.

• Medications: Many prescription and nonprescription medicines — including antihistamines, antidepressants, certain blood pressure medications and birth control pills — increase the risk of dry eye symptoms.

Also, dry eye associated to post LASIK and other corneal refractive surgery can sometimes cause dry eyes. It is best to have a discussion with your LASIK surgeon or Optometrist to find out what are the best options available for any corneal refractive treatment.

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