Dry Eye Syndrome: Symptoms, Diagnosis, and Treatment Options

Corneal issues?

Hello Doctor: Since the beginning of last year, I have been experiencing a foreign body sensation and dryness in my eyes.
I visited an ophthalmology clinic where I was prescribed steroids and artificial tears.
After using them for two weeks, my eye condition worsened with a stinging sensation.
Later, I was diagnosed with dry eye syndrome at a hospital.
I have been intermittently using Vidisic gel, but it causes discomfort; however, I have continued to use it.
In October of last year, I experienced stinging in my eyes and consulted multiple clinics.
All the prescribed eye drops, including artificial tears and steroid drops, as well as ointments, caused stinging and did not relieve the dryness, making my eyes feel even worse.
I also tried preservative-free eye drops, but they were uncomfortable as well, leaving me with almost no usable medication.
Currently, I apply Alcon Tear Film ointment before bed, and I can tolerate it as I go to sleep immediately afterward.
In the morning, my cornea feels well-lubricated due to the ointment, but by the afternoon and evening, I feel dryness again.
I have tried many types of artificial tears, but they still cause discomfort.
Could I have dry eye syndrome, or is there another condition? Which specialty should I consult? Besides the dry eye test strips, what other examinations can be performed in ophthalmology to address my eye issues?

Mei, 50~59 year old female. Ask Date: 2016/07/11

Dr. Gao Pilin reply Ophthalmology

Hello, your condition appears to be dry eye syndrome.
Currently, testing is being done using test strips.
If there is any corneal abrasion, applying eye drops may cause some discomfort, but treatment is still necessary.
However, if you also experience insufficient saliva production and dry mouth, you should consider whether you have Sjögren's syndrome.
It would be advisable to consult a rheumatologist for further evaluation.
The ophthalmology department at Puzi Hospital in Taiwan is available Monday to Friday from 8:00 AM to 12:00 PM and Wednesday from 1:00 PM to 4:30 PM.
Please note that online responses are for reference only; it is essential to seek medical attention at a healthcare facility if needed.
I hope to have the opportunity to assist you.
Dr.
Gao Pilin

Reply Date: 2016/07/11

More Info

Understanding Dry Eye Syndrome (DES) is crucial for both patients and healthcare providers, especially given the increasing prevalence of this condition in our technology-driven society. Dry Eye Syndrome is characterized by a decrease in tear production or an increase in tear evaporation, leading to symptoms such as dryness, irritation, and a sensation of grittiness in the eyes.

Symptoms of Dry Eye Syndrome
The symptoms of DES can vary widely among individuals. Common complaints include:
1. Dryness and Grittiness: A persistent feeling of dryness or the sensation of having something in the eye.

2. Burning or Stinging: Many patients report a burning sensation, which can be exacerbated by environmental factors like wind or smoke.

3. Redness: The eyes may appear red and inflamed.

4. Sensitivity to Light: Increased sensitivity to bright lights or glare can occur.

5. Blurred Vision: Fluctuating vision, especially when reading or using screens, is common.

6. Excessive Tearing: Paradoxically, some individuals may experience excessive tearing as a response to irritation.

Diagnosis of Dry Eye Syndrome
Diagnosing DES typically involves a comprehensive eye examination, which may include:
1. Patient History: A detailed history of symptoms, duration, and any exacerbating factors (like prolonged screen time) is essential.

2. Tear Break-Up Time (TBUT): This test measures the stability of the tear film. A shorter TBUT indicates a higher likelihood of dry eye.

3. Schirmer Test: This test measures tear production by placing a small strip of paper in the lower eyelid for a few minutes.

4. Ocular Surface Staining: Dyes like fluorescein or lissamine green can be used to highlight areas of dryness or damage on the eye's surface.

5. Meibomian Gland Evaluation: Assessing the function of the meibomian glands, which produce the oily layer of tears, is crucial for understanding evaporative dry eye.

Treatment Options
Treatment for Dry Eye Syndrome is multifaceted and may include:
1. Artificial Tears: Over-the-counter lubricating eye drops can provide temporary relief. It's essential to choose preservative-free options if you need to use them frequently.

2. Prescription Medications: In some cases, medications like cyclosporine A (Restasis) or lifitegrast (Xiidra) may be prescribed to increase tear production.

3. Punctal Plugs: These tiny devices can be inserted into the tear ducts to reduce tear drainage and keep the eyes moist longer.

4. Lifestyle Modifications: Reducing screen time, using humidifiers, and taking regular breaks (the 20-20-20 rule: every 20 minutes, look at something 20 feet away for 20 seconds) can help alleviate symptoms.

5. Warm Compresses and Eyelid Hygiene: Regularly applying warm compresses can help unclog meibomian glands, improving oil secretion in tears.

When to Seek Further Evaluation
If you have been diagnosed with dry eye syndrome but continue to experience significant discomfort, it may be necessary to seek a second opinion or further evaluation. Conditions such as autoimmune diseases (like Sjögren's syndrome), allergies, or even certain medications can exacerbate dry eye symptoms.
In your case, since you have experienced persistent discomfort despite various treatments, it would be advisable to consult with an ophthalmologist who specializes in dry eye disease or a cornea specialist. They may recommend additional tests, such as:
- Ocular Surface Disease Index (OSDI): A questionnaire that helps assess the impact of dry eye on your quality of life.

- Tear Film Osmolarity Testing: This test measures the salt concentration in your tears, which can indicate dry eye severity.

Conclusion
In summary, Dry Eye Syndrome is a complex condition that requires a thorough understanding of symptoms, accurate diagnosis, and a tailored treatment approach. If you continue to experience discomfort despite treatment, don't hesitate to seek further evaluation. Your eye health is paramount, and finding the right specialist can make a significant difference in managing your symptoms effectively.

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