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Dry eye

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What is dry eye?

Dry eye is a condition where your eyes don’t contain enough tears or good quality tears to keep it lubricated and healthy.

All the time, the eyes are kept lubricated or wet by means of tears. The tears do this by forming a thin film called tear film that constantly covers the surface of the eyes. So, when there is decreased production or excessive evaporation of the tears, it leads to abnormal tear film, which produces several problems.

Dry eye produces symptoms of eye discomfort, redness, itching, or burning sensation in the eyes.It may also lead to blurry vision and, in advanced cases, damage to the surface of eyes leading to impaired vision.

Dry eye is a widespread condition worldwide.It is the number one reason why people visit to the eye specialist, accounting for 25% of the cases. It is said to be underestimated as many people are not able to identify the condition and get proper help.

Most of the cases of dry eye can be managed by lifestyle changes and eye drops. To manage the dry eye, it is important first to identify the condition correctly and then follow the treatment as advised.

How the tears work?

When we think of tears, we see them as a way of communicating our emotions. But tears have a more significant function. They are a great indicator of your eye’s health. Tears are what keep your eyes wet and protect them from drying.

To understand how the tears function and keeps our eyes healthy, we need to know how the tear film functions and how it protects the ocular surface.

 

Tear Film

Upon blinking, a thin layer of tears known as the tear film spreads across the cornea surface, which is made of the following three layers:

1. Inner, mucus layer (Mucin layer): this is the layer that is in direct contact with the eye and makes the tear spread and stick to the eye. Mucus is produced in the conjunctiva.

2. Watery, middle layer (Aqueous layer) keeps the eyes wet and provides nutrition to the tissues. This watery layer is formed in the lacrimal gland and eyelid.

3. Outer, oily layer (Lipid layer): prevents the tears from evaporating too quickly. It is formed in the meibomian glands.

Any condition that affects the formation of any of the above three layers leads to dry eyes.

 

Ocular surface

The ocular surface is the front portion of the eye that is essential for a smooth and clear vision. It consists of the cornea, conjunctiva, lacrimal gland, meibomian gland, and the eyelids.The tear film protects this ocular surface of the eyes. If the tear film is affected, it eventually lead to damage to the ocular surface affecting the vision.

Thus, tear is essential in keeping the eyes lubricated all the time and protecting it from the damage.

 

Other functions:

• Keep the eyes clean by washing away the dust and other debris.

• Protect your eyes from infective microbes and irritants.

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What are the causes of dry eye?

The dry eye has been classified based on the cause. Broadly, it is categorized into two types:

 

Decreased tear production (Aqueous Dry eye)

This type of dry eye occurs due to decreased production of the tear, which forms the watery aqueous layer of the tear film. The lacrimal glands produce the tear. Any condition that affects the lacrimal gland leads to this type of dry eye.

Aging: considered due to fibrosis, atrophy, or reduced blood supply to the glands.

Medical conditions: such as Sjogren’s syndrome, diabetes, rheumatoid arthritis, sarcoidosis, lymphoma and AIDS

Contact lenses: is considered to decrease the sensitivity of the cornea leading to reduced tear production.

Laser eye surgery (LASIK): this surgical method, which is used to treat refraction error, is also considered to reduce reflex tearing.

Certain medicines: such as anti-allergic (antihistamines), anti-depressant drugs, b-blockers, diuretics, and topical anesthetics.

Obstruction of the ducts of lacrimal gland: Trachoma, burns (chemical or heat burns)

 

Increased tear evaporation (Evaporative dry eye)

This type of dry eye occurs due to increased evaporation of the tear from the eye. This may occur due to intrinsic and extrinsic factors that may have.

Meibomian gland dysfunction: this is most frequent cause of evaporative dry eye.

Here, the meibomian gland that secretes the oil to form the outer layer of the tear film is affected. This leads to faulty tear film, which gets exposed to the air and dries off quickly. There are several conditions that can affect these glands and cause a dry eye.

Blepharitis: is the inflammation of the eyelids.This condition causes clogging of the meibomian glands leading to defective tear film.

Skin and hair conditions: seborrhoeic dermatitis, atopic dermatitis, and acne rosacea etc.

Retinoid treatment: treatment of acne using retinoids can cause temporary atrophy of the glands causing dry eye.

Reduced blink rate: can occur in certain tasks where you need to focus longer on a particular object reducing your blink rate. This can be seen at

• Working on a computer or using mobile screens for long.

• Looking through a microscope for long

• Parkinson disease also reduces the blink rate.

Contact lens use: are found to cause thinning of the outer oily layer of the tear film, which tends to disrupt the tear film causing dry eye.

Windy or dry environment: being exposed to extremely windy and dry conditions can also cause dry eye.

Increased exposed surface of the eye: this can be seen in conditions such as

• Thyroid ophthalmopathy- where the eyes protrude out more than usual.

• Craniosynostosis- where the exposed surface of the eye is more extensive.

• Upward gaze- if you keep your eyes longer in upward direction, e.g., while playing pool.

Eyelid problems: conditions that affect eyelids such as outward turning called ectropion and inward-turning called entropion.

Vitamin A deficiency: vitamin A deficiency or any disease that affects the ocular surface of the eye can cause dry eye. Here, the condition causes improper wetting of the surface and premature tearing of the eye.

Allergic conjunctivitis: this condition produces surface irregularities on the conjunctiva and the cornea, which leads to abnormal functioning of the tear film.

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What are the symptoms of dry eyes?

The symptoms are considered to be due to the stimulation of the pain receptors at the ocular surface. This occurs due to breakage of the tear film, friction along the ocular surface and reduced mucin at the surface leading to following signs and symptoms:

• Burning and stingy sensation in the eyes

• Foreign body sensation

• Red-eye

• Mucus in and/or around the eye

• Light sensitivity

• Blurred vision

• Difficulty in driving at night

• Difficulty in wearing contact lenses

• Inflamed eyelid

How the dry eye is diagnosed?

Dry is one of the most conditions to affect the human eye, for which hundreds of individuals seek diagnosis and treatment every year. Dry eye can be diagnosed through a series of questionnaires and tests. You will be asked questions about your health, whether you have any diseases and deficiencies which might be causing dry eye.

What is the treatment for dry eye?

After performing tests, if your doctor concludes that you are suffering from a dry eye, he/she will begin your treatment. The cause of your dry eye will most likely lay down the grounds for your dry eye treatments. Some of the ways to treat a dry eye as follows:

End word

Dry eye is a very common eye condition that affects almost every other person. Though dry eye is not an urgent medical issue,but if ignored for long, it can cause damage to the ocular surface of the eye. In advanced stages,it can affect the vision and the quality of life. It is, therefore, important not to ignore the slightest symptoms of dry eye. Getting regular eye evaluation every few months should be considered, especially if you face any eye-related problem.

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