Dry Eyes

Diagnosis

To diagnose the underlying cause of dry eyes, various tests and procedures may be employed by your eye care specialist. These evaluations aim to provide a comprehensive understanding of your eye health and overall health. Here are some key methods used:

• Comprehensive eye exam: Your eye care specialist will conduct a thorough eye examination that includes a detailed history of your overall health and eye health. This comprehensive assessment aids in identifying the root cause of your dry eyes.
• Tear volume measurement:
  • Schirmer tear test: In this procedure, strips of paper are placed beneath your lower eyelids for five minutes. Afterward, your specialist measures the amount of paper soaked by your tears.
  • Phenol red thread test: This test involves a thread filled with pH-sensitive dye, which is placed over the lower eyelid. After 15 seconds of contact with your tears, the thread is examined to determine tear volume.
• Tear quality assessment: Special dyes in eye drops are used to assess the quality of your tears. Your eye care specialist will examine your corneas for staining patterns and measure the rate at which your tears evaporate.
• Tear osmolarity test: This diagnostic test measures the composition of particles and water in your tears. In cases of dry eye disease, there is typically a lower water content in your tears.
• Tear sample analysis: Your specialist may collect tear samples to detect markers of dry eye disease, such as elevated levels of matrix metalloproteinase-9 or reduced lactoferrin.

These tests and procedures are essential in determining the cause and severity of your dry eyes, allowing your eye care specialist to develop an effective treatment plan tailored to your specific needs.

Treatment

Dry eye symptoms can range from occasional discomfort to persistent issues. Treatment options depend on the underlying cause and severity of the condition.

Treating the underlying cause: In some cases, addressing the root cause of dry eyes can alleviate symptoms. For example, if a medication is responsible, your eye care specialist may recommend an alternative drug without this side effect. Eyelid conditions, such as ectropion, may require referral to an oculoplastic surgeon.

Medications: Prescription medications can be employed for dry eye treatment, including:

• Eyelid inflammation reduction: Inflammation along the eyelid’s edge can hinder oil gland function. Antibiotics may be prescribed to reduce inflammation.
• Cornea inflammation control: Prescription eye drops containing cyclosporine or corticosteroids can manage corneal inflammation. Corticosteroids are not ideal for long-term use due to potential side effects.
• Eye inserts: For moderate to severe dry eyes, hydroxypropyl cellulose inserts can be used daily to release lubricating substances gradually.
• Autologous blood serum drops: These drops, made from your blood, may be an option for severe dry eye cases.
• Nasal spray: Varenicline is an FDA-approved nasal spray for increasing tear production.
• Tear-stimulating medications: Cholinergic drugs like pilocarpine and cevimeline can boost tear production, available as pills, gels, or eye drops. Sweating may be a side effect.

Procedures to treat dry eyes include:

• Special contact lenses: Scleral or bandage lenses can protect the eye’s surface and maintain moisture.
• Oil gland unblocking: Warm compresses, eye masks, or thermal pulsation devices can unclog blocked oil glands.
• Tear duct closure: Partial or complete closure of tear ducts can prevent tears from draining too quickly. Silicone punctal plugs or thermal cautery can be used.
• Light therapy and eyelid massage: Intense-pulsed light therapy followed by eyelid massage may help severe dry eye sufferers.

Self-care: Managing dry eyes through self-care involves frequent eyelid washing and nonprescription products like artificial tears, gels, or ointments. Factors to consider when choosing these products include preservative vs. nonpreservative options, drops vs. ointments, and avoiding drops that reduce redness.

Eyelid washing for inflammation control: For conditions like blepharitis causing eyelid inflammation, follow these steps:

• Apply a warm washcloth to your eyes for five minutes.
• Gently rub the washcloth over your eyelids, including the base of your eyelashes.
• Use a mild soap (e.g., baby shampoo) on your eyelids and gently massage near the base of your eyelashes. Rinse thoroughly.

Alternative medicine: While further research is needed, some alternative approaches may help alleviate dry eye symptoms, including:

• Castor oil eye drops: These drops could reduce tear evaporation and improve symptoms.
• Fatty acids: Omega-3 supplements and foods rich in these fatty acids, such as flaxseed, salmon, and sardines, may provide relief.
• Acupuncture: Some individuals have reported improvements in dry eye symptoms after acupuncture therapy. Discuss the potential benefits and risks with your eye care specialist.