Managing Dry Eyes: Causes, Symptoms, and Effective Treatments

Eye strain and fatigue issues?

Hello doctor, I have high myopia of about -8.50 diopters and have been experiencing floaters for over three months.
Recently, I've felt that my eyes are very dry and fatigued, so I visited an ophthalmologist who diagnosed me with dry eye syndrome.
Initially, I was prescribed artificial tears and eye drops to relieve eye fatigue, which I used for nearly a month, but there seemed to be no improvement (my eyes still feel very sore and uncomfortable).
I then consulted another ophthalmologist, who also diagnosed me with dry eye syndrome.
Since I mentioned that the artificial tears didn't seem effective, the doctor prescribed me an eye gel.
I have been using it for over a month, but the situation remains the same (my eyes are dry and sore! When I press above my eyebrows, there is a noticeable soreness, and sometimes pressing around the eye socket also causes soreness).
I have been taking lutein for about four months and have not worn contact lenses for over three months.
Besides using artificial tears and eye gel, I also apply warm compresses and use my fingers to massage the acupressure points around my eyebrows.
Can dry eye syndrome cause soreness when pressing on the eyebrows? What can be done to improve this? It is really uncomfortable to feel this way continuously.

Zhizhi, 20~29 year old female. Ask Date: 2018/06/21

Dr. Cai Wenyuan reply Ophthalmology

Hello, it may be time for your eyes to take more rest and to reduce the use of electronic devices.
Wishing you safety and health.
Sincerely, Dr.
Tsai Wen-Yuan, Director of the Department of Ophthalmology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2018/06/21

More Info

Managing dry eyes can be a complex issue, especially for individuals with underlying conditions like high myopia or those who have experienced prolonged symptoms. Dry eye syndrome, or keratoconjunctivitis sicca, is characterized by insufficient tear production or poor tear quality, leading to inflammation and damage to the ocular surface. The symptoms can range from a gritty sensation, burning, and redness to more severe discomfort that can affect daily activities.

Causes of Dry Eyes
Several factors can contribute to dry eyes, including:
1. Environmental Factors: Exposure to wind, smoke, or dry air can exacerbate dry eye symptoms.

2. Medical Conditions: Conditions such as rheumatoid arthritis, Sjögren's syndrome, and thyroid disorders can affect tear production.

3. Medications: Certain medications, including antihistamines, antidepressants, and isotretinoin (Accutane), can lead to dry eyes as a side effect.

4. Age: Tear production tends to decrease with age, making older adults more susceptible to dry eyes.

5. Screen Time: Prolonged use of computers or digital devices can reduce blink rates, leading to increased evaporation of tears.

Symptoms of Dry Eyes
Common symptoms include:
- A gritty or sandy sensation in the eyes
- Redness and irritation
- Blurred vision, especially after prolonged reading or screen time
- Sensitivity to light
- Eye fatigue or discomfort, particularly after focusing for extended periods

Treatment Options
Given your situation, where artificial tears and gels have not provided relief, it may be beneficial to explore additional treatment options:
1. Punctal Plugs: These are small devices inserted into the tear ducts to block drainage, helping to retain moisture on the eye's surface.

2. Prescription Medications: Medications like cyclosporine A (Restasis) or lifitegrast (Xiidra) can help increase tear production and reduce inflammation.

3. Scleral Lenses: As you mentioned, scleral lenses can create a reservoir of fluid over the cornea, providing relief for severe dry eye symptoms.

4. Warm Compresses and Eyelid Hygiene: Regularly applying warm compresses can help unclog meibomian glands, improving oil secretion and reducing evaporation of tears. Eyelid scrubs can also help manage blepharitis, which can exacerbate dry eye symptoms.

5. Dietary Supplements: Omega-3 fatty acids may help improve tear production and reduce inflammation. However, consult with your healthcare provider before starting any new supplements.

Addressing Pain and Discomfort
The pain you experience when pressing on the area above your eyebrows may be related to muscle tension or strain from prolonged eye discomfort. This can be exacerbated by dry eyes, leading to muscle fatigue and discomfort. Here are some suggestions to help manage this pain:
- Frequent Breaks: Follow the 20-20-20 rule: every 20 minutes, look at something 20 feet away for at least 20 seconds to reduce eye strain.

- Eye Exercises: Simple eye exercises can help relieve tension. Try rolling your eyes or focusing on different distances.

- Stress Management: Techniques such as mindfulness, yoga, or gentle stretching can help alleviate overall tension, including in the facial muscles.

When to Seek Further Help
If your symptoms persist despite trying these interventions, it may be beneficial to consult with a specialist, such as a cornea specialist or an ophthalmologist with expertise in dry eye disease. They can conduct a thorough evaluation, including tests to assess tear production and quality, and recommend a tailored treatment plan.

In summary, managing dry eyes involves a multifaceted approach that includes lifestyle modifications, appropriate use of medications, and possibly more advanced treatments. It's essential to work closely with your eye care provider to find the most effective strategy for your specific situation.

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