Dry Eyes, The Whole Story

When patients say “I have dry eye syndrome” I take a couple of steps back.

Most people with dry eyes don’t say I have dry eyes, they mention irritated eyes, redness, watery eyes, mucous in the morning, light sensitivity, and other symptoms. The truth is, dry eyes will (for most people) come and go. But when you acknowledge that you have dry eyes, chances are you’ve already tried a few (failed) treatment options.

“What causes dry eyes?” Is the hardest question I have to answer all day. What doesn’t cause dry eyes? Even allergy medication causes dry eyes, your laundry detergent could be the culprit, hormonal changes maybe? Even subtle eye misalignment can trigger the corneal sensory nerves and give you the feeling of dry eyes. 

Here is a list of things that can trigger dry eyes:
 

Mechanical Causes 

If I had a penny for every time I told somebody “you don’t close your eyes all the way.” I would have ,well, many pennies. A lax or incomplete blink causes end of day dryness. Most of the time it’s a habit that we subconsciously develop when we stare at moving screens, and sometimes it’s a result of cosmetic procedures such as lid lift. Bell’s palsy is another reason for that type of dry eyes.

The simplest solution: intentional breaks, intentional blinks, sleeping mask, and sometimes we utilize scleral contact lenses to keep the eyes shielded between blinks. 
 

Inflammation

Inflammatory food groups such as dairy, sugar, red meat, and gluten can trigger dry eye flare up. So pay close attention to how your eyes react to those food groups. 

Inflammatory autoimmune diseases are notorious for causing dry eye flare ups as well, so you could have a subtle lupus flare up that is (almost) asymptomatic aside from that darn stubborn red eye that won’t go away. Antinuclear antibodies test (ANA blood test)  testing will help with the diagnosis of autoimmune diseases. And controlling the underlying inflammatory condition typically results in relief from dry eye symptoms and overall feeling better .
Overexposure to the sun, stress and lack of sleep also increase inflammation and make dryness worse. 
 

Anti-inflammatory eye drops specially steroids are often prescribed for that type of dry eye flare up. Topical steroids can only be used temporarily as it can eventually increase the pressure inside the eyes. Oral anti-inflammatory agents help long term keep dry eyes at bay. My favorite is Eye-promise EZ tears.
 

Lack of Tears

Surprisingly this is a rare cause of dry eyes. Most dry eye patients produce enough tears and their lacrimal glands are working well. Lack of tears is typically a result of sjogran syndrome, chemotherapy or radiation therapy.

The best treatment for aqueous deficient dry eyes is addressing sjogran syndrome, use of lubricating drops on a schedule, scleral contact lenses, and punctal plugs to allow the tears to linger on the surface of the eye longer. 
 

LASIK

Dry eye syndrome is one of the most common side effects of LASIK. I always tell my patients if your eyes are dry prior to LASIK, it will probably get a lot worse after the procedure. The best treatment is to consult with your optometrist prior to LASIK to see if you’re truly a good candidate. If you’ve already done LASIK and now suffer from dry eyes, there isn’t one good solution. Typically a mix of lubricating drops and occasional steroids do the trick. Other medicated drops such as restasis, cequa, and xiidra also help in managing post-LASIK dryness. 
 

Meibomian Gland Dysfunction

The most common cause of dry eyes; over 80% of dry eye sufferers have MGD to a degree. 
The problem with the meibomian glands is that they can only take so much neglect then they “drop out.”
Tackling MGD while we still have intact glands is key. Hot compresses improve the function of the meibomian glands temporarily, radio frequency treatment penetrates the eyelid deeper to clear up the glands while IPL targets inflammatory agents, broken capillaries and hyper pigmentation to provide long lasting relief from dry eyes.
 

RF and IPL also have excellent cosmetic benefits as they both stimulate collagen production and even out skin tone.

There are many other causes for dry eyes but those are the top 5. Schedule your dry eye consult with Dr. Wells to get long-lasting relief from dry eyes.