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Common dry eye symptoms

Because the symptoms are described so differently from one person to the next diagnosis is not always easy. It is made even more tricky because some people have dry eye disease but no symptoms at all!

In the UK the incidence of dry eye is estimated at around 30% or 1-in-3.

 

Dry eye symptoms include:

 

• Scratchy eyes, like there’s something in your eye

• Stinging or burning feelings in your eye

• Red or blood shot eyes

• Itchy eyes

• Sore eyes

• Watery eyes

• Sensitivity to light

• Heavy, tired eyes

 

Many people also experience changes in vision quality such as a temporary blurring immediately after blinking.

 

The frequency and severity of the symptoms can vary significantly from one person to another.

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What is dry eye?

Put simply dry eye is a condition in which the quantity or quality of your natural tears becomes compromised. Your tears are there to lubricate, protect and nourish your eyes (among other things). If you are suffering from dry eye your tears become saltier, more concentrated, which triggers an inflammatory response. This increase in tear concentration is known as hyperosmolarity.

 

The World Health Organisations (WHO) have described dry eye disease as a condition which should not to be ignored. The reason dry eye is taken so seriously is because it does not go away and if left untreated it will get gradually worse. Your eye care professional describes such conditions as ‘chronic’ and ‘progressive’.

 

A global panel of dry eye experts has developed a definition of dry eye which has been adopted by eye care professionals everywhere:

 

‘‘Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface.’’

 

Inflammation is part of your body's natural defence mechanism. In the case of dry eye it is a response to changes in the ocular environment, such as increased evaporation which causes your tears to become hyperosmolar (too salty). This then triggers a process by which the immune system recognises and attempts to rebalance these potentially harmful changes.

 

The chemicals released by the inflammatory response result in many of the symptoms which dry eye sufferers experience such as itchy, gritty, red, irritated eyes. However, some people do not experience any of these and they are known as ‘asymptomatic’ sufferers.

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More about your tears

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The composition of your tears is complex. They are made up of three layers: a base mucin layer, a central aqueous layer and an outer oily layer, together they form an advanced piece of liquid engineering to keep your eyes healthy and your vision sharp. The latest thinking suggests these layers are not rigidly divided but instead are in a state of flux and mix with one another. The role of your tears is multifaceted and ranges from simple lubrication to providing nutrition and fighting infection.

 

Where do your tears come from?

 

Your tears are produced by a series of special glands in and around the eyes and eye lids. There are 3 types of tears: basal, reflex and emotional, each has a different function. The lacrimal glands, found above each eyeball, are responsible for the watery reflex and emotional tears produced when we cry or our eyes become irritated such as when we cut up onions. The basal tears are produced continuously by glands on the surface of the eye their function includes lubricating and protecting.

 

The oily component of basal tears comes from a separate set of glands called the meibomian glands which are located along the edge of the eyelids. The oil or meibum flows into the eye to provide a protective outer layer.

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Your tears are spread over the surface of the eye with each blink, the eyelid acting like a small windscreen wiper. Eventually, your tears either evaporate or drain out via the small tear duct at the corner of your eye near your nose – it is called the punctum.

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Beware - there is more than one type of dry eye

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Although the symptoms are pretty much the same the reasons for them can vary. Essentially, there are two main types of dry eye – you could just have one type or a combination. That is why a visit to your eye care professional is so important.

 

ADDE or Aqueous Deficient Dry Eyes – is caused by a reduction in the production of the watery component of your tears. You just do not have enough natural moisture. The second type of dry eye is EDE or Evaporative Dry Eyes – this means you are not producing enough of the outer protective lipid layer of your tears. This layer reduces the rate of evaporation, without it your eyes will soon start to feel dry.

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The type of dry eye you have will influence the treatment recommended by your eye care professional. Just to keep them on their toes - we now know dry eye is a continuum with both types present, to a greater or lesser extent, as opposed to just one or the other.

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What causes dry eye?

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More people suffer from dry eye than asthma, diabetes, back pain or even high blood pressure. So what are the causes of this increasingly common ailment which affects so many lives?

 

Getting older

 

The UK, like many developed nations, has an aging population. We are all aging, and with age the quantity and quality of the tears we produce diminishes. This is due to irreversible changes to the surface of eye’s microenvironment, many important cell types no longer function as they used to, resulting in a significant increase the incidence of dry eye. You might not be surprised to learn that the number of dry eye patients doubles in the over 80s compared to 20 years earlier.

 

Being female

 

If you are female you are 2.4 times more likely to be diagnosed with dry eye disease than if you are male. This is because of the impact of the female sex hormones such as oestrogen. Surges in the level of these hormones, during normal monthly menstrual cycles and at the menopause, can bring disruption to the production of tears. There have been many scientific studies linking changes in hormonal levels with shifts in the severity of dry eye symptoms.

 

Lifestyle

 

It is not just older people who are at risk. The digital world in which we work and live is resulting in dry eye symptoms appearing even in children! This is due to long hours spent looking at screens, these extended periods of concentration cause your blink rate to slow. Every time you blink you are washing the surface of the eye with fresh tears. Less tears means your eyes are more likely to dry our and digital eye strain result.

Prolonged periods (four-hours or more) of outdoor time, either for leisure or work, also increases your risk of developing dry eye symptoms. This was due to exposure to the elements such as wind, sun, heat and air pollution.

 

Not enough sleep

 

The role of sleep in both physical and mental health is increasingly becoming a focus. Dry eye is no exception with those getting less than 6-hours a night putting themselves at increased risk of dry eye. Interestingly, dry eye itself can lead to disrupted sleep so make sure you get those Zzzzzzs in.

 

Certain medications

 

If you are taking medication for another condition then it is essential you follow your doctor’s instructions. But also be aware that some widely used medicines will also make dry eye worse. So, if you are taking HRT, isotretinoin (acne), antihistamines, antidepressants, Parkinson's medications and even ibuprofen you may be making your dry eye worse. You might want to mention this to your doctor and eye care professional

 

Other medical conditions

 

Many diseases, which as well as being a problem in their own right, also make you more likely to experience dry eye. This includes hypertension, asthma, eczema, any allergy, rheumatoid arthritis, migraine and irritable bowel syndrome. The physiological reasons for these links will vary from one condition to the next – but the bottom line is you need to take extra care of your eyes too. If in doubt ask your eye care professional for advice.

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Can dry eye be cured?

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Dry eye is a chronic progressive condition, which means it will not go away, and if unmanaged will worsen.

 

The first step in successful management is to get an accurate diagnosis from your eye care professional. That way, they can ensure the recommended care routine addresses your type of dry eye and, as far as possible, the underlying causes. Eye care practitioners take dry eye seriously and will recommend a management routine, this will often follow the steps included in the Dry Eye Zone Circle-of-Care.

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The importance of not ignoring dry eye cannot be overstated as it can lead to significant levels of damage to the surface of the eye, which will compromise both eye health and vision quality. One of the reasons why your eye care professional will want to get this under control is that dry eye will make it more difficult to get the best vision possible either with glasses or contact lenses.

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Living with dry eye can take its toll emotionally too. There is an established link between dry eye and increased risk of anxiety and depression. For some people dry eye can also mean poor sleep quality.

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Managing dry eye - the Circle-of-Care

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The Circle-of-Care illustrates the essential steps needed to take control of dry eye and help halt its progression. Not every step is necessary for everyone, and your eye care professional will select the best routine for you.

 

Following the recommended routine and attending regular review appointments will help keep your dry eye symptoms in-check and help your eyes stay healthy. The Dry Eye Zone is there to help support your eye care professional recommendations for the best outcomes.

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