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 ophthalmology clinic, and the doctor followed the same treatment approach.
Since April, I have visited about three or four different eye clinics, and they all prescribed eye drops to relieve eye fatigue, artificial tears, and eye gels (additionally, I have been purchasing preservative-free single-use artificial tears out of pocket).
The ophthalmologists all said that my eyes looked 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 time?

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

Dr. Cai Wenyuan reply Ophthalmology

Hello, in addition to medication, it is important to ensure adequate eye rest and sufficient sleep.
Wishing you safety 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 multifaceted condition characterized by a decrease in tear production or an increase in tear evaporation, leading to ocular discomfort and potential damage to the ocular surface. Your experience of persistent dryness and discomfort, despite various treatments, is not uncommon among individuals suffering from this condition.

Causes of Dry Eye Syndrome
1. Aging: As we age, the production of tears naturally decreases. This is particularly common in individuals over 50.

2. Environmental Factors: Exposure to wind, smoke, or dry air can exacerbate dry eye symptoms. Prolonged screen time can also contribute to reduced blink rates, leading to increased evaporation of tears.

3. Medical Conditions: Certain diseases, such as Sjögren's syndrome, rheumatoid arthritis, and diabetes, can affect tear production. Hormonal changes, especially in women during menopause, can also play a significant role.

4. Medications: Some medications, including antihistamines, antidepressants, and certain blood pressure medications, can reduce tear production.

5. Contact Lens Use: Long-term use of contact lenses can lead to discomfort and dryness, as they can disrupt the tear film.

6. Surgery: Previous eye surgeries, such as LASIK, can alter the corneal nerves and affect tear production.

Treatment Options
1. Artificial Tears: These are the first line of treatment for dry eyes. It seems you have already tried various formulations, including preservative-free options, which are often better tolerated.

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

3. Punctal Plugs: These are tiny devices inserted into the tear ducts to reduce tear drainage, thereby increasing the availability of tears on the ocular surface.

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

5. Lifestyle Modifications: Implementing changes such as taking regular breaks from screens (the 20-20-20 rule), using humidifiers, and wearing protective eyewear in windy conditions can help alleviate symptoms.

6. Dietary Supplements: Omega-3 fatty acids have been shown to help some patients with dry eye symptoms, although results can vary.

Understanding the Chronic Nature of Dry Eye
It’s important to note that dry eye syndrome can be a chronic condition, and while some patients may experience significant improvement with treatment, others may find that their symptoms persist despite adherence to prescribed therapies. This can be frustrating, especially when multiple healthcare providers offer similar treatment recommendations without substantial improvement.

Why Some Patients Improve
In some cases, patients may report improvement in symptoms without a corresponding increase in tear production. This could be due to several factors, including:
- Adaptation: Over time, some individuals may adapt to their symptoms, leading to a perceived improvement in quality of life.

- Environmental Changes: Changes in environment or lifestyle, such as reduced screen time or improved humidity, can also contribute to symptom relief.

- Psychological Factors: Stress and anxiety can exacerbate the perception of discomfort. Addressing these factors through relaxation techniques or counseling may help.

Conclusion
Given your ongoing symptoms and the lack of improvement despite various treatments, it may be beneficial to seek a comprehensive evaluation from a specialist in dry eye disease. This could include a thorough assessment of your tear film, ocular surface health, and potential underlying conditions that may be contributing to your symptoms. Additionally, exploring alternative therapies or a multidisciplinary approach involving both ophthalmology and possibly rheumatology or neurology could provide further insights and treatment options.
Remember, managing dry eye syndrome often requires patience and a tailored approach, as what works for one individual may not work for another.

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