Dry eye syndrome

Overview

Dry eye syndrome, also known as keratoconjunctivitis sicca, is a common condition that occurs when the eyes do not produce enough tears or when the tears evaporate too quickly. This results in inadequate lubrication of the eye surface, leading to discomfort, visual disturbances, and potential damage to the cornea and conjunctiva. Dry eye syndrome can affect one or both eyes and ranges from mild irritation to severe inflammation and vision impairment.

Causes

Dry eye syndrome can result from a variety of factors that disrupt the normal tear film. Common causes include:

• Aging: Tear production naturally decreases with age, especially in individuals over 50.

• Hormonal changes: Common during menopause, which affects tear composition and volume.

• Autoimmune disorders: Such as Sjögren’s syndrome, rheumatoid arthritis, and lupus, which attack tear-producing glands.

• Medications: Including antihistamines, decongestants, antidepressants, beta-blockers, and diuretics.

• Environmental factors: Wind, dry climate, air conditioning, and prolonged screen time can increase tear evaporation.

• Contact lens use: Can disrupt the tear film and contribute to dry eyes.

• Ocular surgery: Such as LASIK, which can affect corneal nerves and tear production.

Symptoms

Symptoms of dry eye syndrome vary in severity and may worsen throughout the day. Common signs and symptoms include:

• Burning or stinging sensation in the eyes

• Grittiness or feeling of sand in the eye

• Redness and irritation

• Excessive tearing (a reflex response to dryness)

• Blurry or fluctuating vision

• Light sensitivity (photophobia)

• Eye fatigue or discomfort after reading, computer use, or watching screens

• Stringy mucus in or around the eyes

Diagnosis

Diagnosis of dry eye syndrome involves a detailed history and clinical evaluation to assess tear quantity and quality. Diagnostic methods include:

• Slit-lamp examination: Allows visualization of the tear film, corneal surface, and signs of inflammation.

• Schirmer’s test: Measures tear production using small filter paper strips placed under the eyelid.

• Tear breakup time (TBUT): Assesses tear film stability by timing how quickly tears evaporate after blinking.

• Ocular surface staining: Dyes like fluorescein or lissamine green highlight areas of damage on the cornea or conjunctiva.

• Questionnaires: Tools like the Ocular Surface Disease Index (OSDI) help quantify symptom severity.

Treatment

Treatment of dry eye syndrome focuses on relieving symptoms, restoring tear film stability, and preventing further damage. Options include:

• Artificial tears: Over-the-counter lubricating eye drops used regularly to maintain moisture.

• Prescription eye drops: Such as cyclosporine (Restasis) or lifitegrast (Xiidra) to reduce inflammation and increase tear production.

• Punctal plugs: Small devices inserted into tear ducts to reduce drainage and retain tears on the eye surface.

• Warm compresses and eyelid hygiene: Help manage associated conditions like blepharitis or meibomian gland dysfunction.

• Omega-3 supplements: May improve tear quality and reduce inflammation.

• Environmental modifications: Using humidifiers, avoiding wind or smoke, and taking breaks during screen use.

• Autologous serum eye drops: In severe cases, these are made from a patient’s own blood serum and contain natural growth factors to heal the ocular surface.

Prognosis

Dry eye syndrome is a chronic condition, but with proper management, most individuals experience significant symptom relief and prevention of complications. Mild to moderate cases often respond well to artificial tears and lifestyle adjustments. In more severe cases, ongoing treatment and follow-up are necessary to protect vision and maintain eye comfort. Although not usually sight-threatening, untreated or poorly managed dry eye can lead to corneal damage and visual disturbances, emphasizing the importance of early diagnosis and consistent care.