Dry Eye Syndrome: Causes, Treatments, and Solutions

Treatment for Dry Eye Syndrome

Hello doctor, I have been experiencing dry eyes frequently since early March.
At first, I didn't think much of it, but after a few weeks, it became increasingly uncomfortable, so I visited an ophthalmologist.
After conducting tests for dry eye syndrome, the doctor diagnosed me with dry eyes and prescribed eye drops for relaxation and artificial tears (and advised me to stop wearing contact lenses).
After using them for over half a month, I saw no improvement! So, I went to another ophthalmologist, and the treatment was the same.
From April until now, I have seen about three or four different eye specialists, and they all prescribed eye drops for relieving eye fatigue, artificial tears, and eye gels (additionally, I have been purchasing preservative-free single-use artificial tears out of pocket).
The ophthalmologists have all said that my eyes look fine, but they are indeed very dry.
My eyes are not red or swollen, and there are no visible blood vessels; however, I feel a gritty sensation when moving my eyeballs, and they are often sore and dry.
I have also been taking lutein supplements daily (for about four months now, but there hasn't been much improvement).
Could you please advise what might be causing this issue? Or does it require a longer treatment period?

Junn, 20~29 year old female. Ask Date: 2018/09/11

Dr. Cai Wenyuan reply Ophthalmology

Hello, lutein does not help with dry eye syndrome.
Wishing you peace and health.
Sincerely, Dr.
Tsai Wen-Yuan, Director of the Ophthalmology Department, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2018/09/11

More Info

Dry Eye Syndrome (DES) is a common condition that can significantly impact the quality of life. It occurs when the eyes do not produce enough tears or when the tears evaporate too quickly, leading to inflammation and damage to the ocular surface. Understanding the causes, symptoms, and treatment options is crucial for managing this condition effectively.

Causes of Dry Eye Syndrome
1. Decreased Tear Production: This can be due to various factors, including age, hormonal changes (especially in women), certain medical conditions (like Sjögren's syndrome, rheumatoid arthritis, or diabetes), and medications (such as antihistamines, antidepressants, and isotretinoin).

2. Increased Tear Evaporation: Environmental factors such as dry air, wind, smoke, and prolonged screen time can contribute to increased evaporation of tears. Additionally, conditions like blepharitis (inflammation of the eyelids) can disrupt the tear film.

3. Meibomian Gland Dysfunction: The meibomian glands in the eyelids produce oils that help prevent tear evaporation. Dysfunction of these glands can lead to dry eyes.

4. Contact Lens Use: Wearing contact lenses, especially for extended periods, can exacerbate dry eye symptoms.

5. Underlying Health Conditions: Conditions affecting the immune system, such as lupus or thyroid disorders, can also lead to dry eyes.

Symptoms of Dry Eye Syndrome
Common symptoms include:
- A gritty or sandy sensation in the eyes
- Burning or stinging sensations
- Redness of the eyes
- Sensitivity to light
- Blurred vision or fluctuating vision
- Eye fatigue, especially after prolonged reading or screen time

Treatment Options
1. Artificial Tears: Over-the-counter artificial tears can provide temporary relief. It's essential to choose preservative-free options if you need to use them frequently.

2. Prescription Medications: If artificial tears are insufficient, doctors may prescribe medications like cyclosporine A (Restasis) or lifitegrast (Xiidra) to help increase tear production.

3. Punctal Plugs: These are tiny devices inserted into the tear ducts to block drainage, helping retain tears on the surface of the eye.

4. Lifestyle Modifications:
- Environmental Adjustments: Use humidifiers, wear sunglasses outdoors, and take regular breaks from screens (the 20-20-20 rule: every 20 minutes, look at something 20 feet away for 20 seconds).

- Dietary Changes: Omega-3 fatty acids may help improve tear production. Foods rich in omega-3s include fish, flaxseeds, and walnuts.

5. Scleral Lenses: For severe cases, specialized contact lenses, such as scleral lenses, can provide a protective layer over the cornea and keep it moist.

6. Warm Compresses and Eyelid Hygiene: Regularly applying warm compresses can help unclog meibomian glands, and maintaining eyelid hygiene can reduce inflammation.

Why Some Patients Improve
It's important to note that while dry eye syndrome can be chronic and challenging to manage, some patients may experience periods of improvement. This can be due to various factors, including:
- Changes in environmental conditions
- Improved eyelid hygiene
- Adjustments in treatment plans
- Natural fluctuations in tear production

Conclusion
If you have been experiencing persistent dry eye symptoms despite treatment, it may be beneficial to revisit your eye care provider for a comprehensive evaluation. They may consider additional tests to assess tear production and quality, evaluate for underlying conditions, or explore alternative treatment options. Remember, managing dry eye syndrome often requires a multifaceted approach, and patience is key as you work towards finding the most effective solution for your symptoms.

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