Dry Eyes

Symptoms of dry eyes can include irritation and redness, itchy eyes, burning eyes, blurred vision (that improves with blinking), excessive tears (eye tries to over compensate) and the sensation of grit in the eyes.

People can find that dry eye symptoms are fine in the morning (as the eyelids have been closed overnight and tears do not evaporate) but gets worse as the day goes on as the eyes are exposed to the elements and evaporation of tears increases. The most common treatment for dry eyes is artificial tears that are available over the counter in pharmacies.

 Causes

Some medical conditions cause dry eye including hayfever, arthritis, thyroid conditions, vitamin A deficiency, Parkinson's disease and Sjögren syndrome.

Ageing

Dry eye mostly occurs as a part of the natural ageing process. It affects about a third of people over 65 and is 50% more common in women than men.  Hormonal changes during menopause can also cause eyes problems in women.

Physical problems

Eyelid issues can include blocked meibomian glands which produce the protective oily layer of the tear film or damage to the tear producing glands. Blepharitis which is inflammation of the eyelids can cause blockage of the oil producing glands. Causes of blepharitis include dry skin conditions like seborrhoeic dermatitis (similar to dandruff) and rosacea.

 Medication

Some medicines can cause dry eyes including oral contraceptives, decongestants (used to unblock the nose), diuretics (used to reduce blood pressure and reduce fluid), anti-histamines, beta blockers (used for heart problems and high blood pressure), some older anti-depressants (eg tri-cyclic antidepressants) and anti-inflammatory medicines.

Contact lenses

Contact lenses increase the risk of dry eyes, especially if kept in too long. Water-based lenses tend to absorb moisture from the tear film; this reduces the quantity of remaining tears. Using higher moisture or silicone hydrogel contact lenses reduces dry eye issues.

Sjögren syndrome

Sjögren syndrome is an autoimmune inflammatory condition in which the body’s white blood cells attack other cells in the body. Dry eyes and mouth occur in 95% of cases. Most people with Sjögren syndrome need artificial tears on a regular basis.

 Other causes

People working on screens for long periods at a time tend to blink less frequently. This allows tears to evaporate more readily which can lead to dry eyes. Smoking or exposure to smoke from a smoker can irritate the eyes and cause dryness. Similarly, air pollution (eg. exhaust fumes) can cause the problem.

 Tips for easing dry eyes

 Avoid constant exposure to air conditioning and central heating. Avoid draughts. Humidifiers may help. Blink more frequently if you work on a computer screen or read for long periods.

Treatment

 Many cases of dry eyes is caused by medication (both prescription or over the counter) such as anti-histamines, blood pressure medication, some anti-depressants anti-inflammatory medicines. Where medicines are causing severe dry eye problems, you can discuss with your doctor or pharmacist if there are alternative options that do not cause the problem (eg. newer anti-depressants do not cause as many dry eyes issues). In some cases there is no safe alternative. In these cases, artificial tears are the only effective treatment option.

 Artificial tears

Your GP, pharmacist or optician can advise on drops, ointments and gels. They are available without prescription at your pharmacy. They replicate the role of natural tears. Drops are often used during the day (eg. three times daily) and an ointment or gel is used at night as they are thicker and tend to last for longer while you sleep. There is no evidence that one brand is any more effective than the next; though preservative free versions are recommended by some eye specialists to reduce the risk of preservative causing irritation (though these are more expensive). Contacts lens should not be used with artificial tears; if they must be used, use preservative free artificial tears and hold off inserting contact lens for 30 minutes after using the artificial tears. Always use artificial tears at a different time from other prescribed eye drops (eg. glaucoma drops, antibiotic eye drops) as the artificial tears will dilute or wash away the other drops. Artificial tears are available on the Medical Card Scheme and the Drug Payment Scheme with doctor’s prescription.

 Punctal occlusion

This is done by a specialist and involves reversible blocking of the punctual ducts to block the release of excess tears (which occurs due to the eye trying to over compensate). The tear duct plugs used can be either semi-permanent (silicone) or dissolvable. Punctal occlusion does not work for everyone and should only be considered when artificial tears fail to work. 

Can omega 3 or omega 7 help?

Studies indicate that a diet rich in Omega 3 oils can reduce ease dry eye symptoms. I have seen cases of omega 3 supplements helping people suffering from dry eyes. For people who do not eat sufficient oily fish, I recommend a fish oil supplement called MorEPA^® as it contains the highest level of pure omega 3 fatty acids (EPA and DHA) of any fish oil supplement. Some people find and there is some evidence that Omega 7 supplements relieve dry eyes; I will discuss Omega 7 in more detail next week in my blog. Supplements are not meant as a substitute for medical assessment and should not replace prescription medication.

This article is shortened for my blog. More detailed information and leaflets is available in Whelehans or www.whelehans.ie