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 a dry eye test, the doctor diagnosed me with dry eye syndrome and prescribed eye drops to relieve eye strain 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 consulted about 3 or 4 different eye doctors, and they all prescribed eye drops for relieving eye fatigue, artificial tears, and eye gels (additionally, I have been purchasing preservative-free single-dose artificial tears out of pocket).
The ophthalmologists all said my eyes looked fine, but they are indeed very dry.
My eyes are not red or swollen, and there are no visible blood vessels, but I feel a gritty sensation when moving my eyeballs, and they are often sore and very dry.
I also take lutein supplements daily (I've been taking them for about 4 months with no significant 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: 2018/09/12

Dr. Cai Wenyuan reply Ophthalmology

Hello, allowing your eyes to rest appropriately may yield good results.
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: 2018/09/12

More Info

Understanding Dry Eye Syndrome: Causes, Treatments, and Solutions
Dry Eye Syndrome (DES) is a multifactorial condition characterized by a loss of homeostasis of the tear film, resulting in ocular symptoms and potential damage to the ocular surface. It is essential to understand that while many patients experience chronic dry eye symptoms, the underlying causes can vary significantly from one individual to another.

Causes of Dry Eye Syndrome
1. Decreased Tear Production: This can be due to various factors, including age, hormonal changes (especially in women), autoimmune diseases (like Sjögren's syndrome), and certain medications (such as antihistamines, antidepressants, and isotretinoin).
2. Increased Tear Evaporation: Environmental factors such as low humidity, wind, and prolonged screen time can increase tear evaporation. Conditions like blepharitis (inflammation of the eyelids) can also contribute to this issue.

3. Imbalance in Tear Composition: The quality of tears is just as important as the quantity. An imbalance in the components of tears (lipids, water, and mucins) can lead to instability and dryness.

4. Other Factors: Contact lens wear, previous eye surgeries, and certain systemic diseases can also contribute to dry eye symptoms.

Symptoms of Dry Eye Syndrome
Patients often report a range of symptoms, including:
- A gritty or sandy sensation in the eyes
- Burning or stinging sensations
- Redness or irritation
- Blurred vision
- Increased sensitivity to light
- Eye fatigue

Treatment Options
1. Artificial Tears: The first line of treatment typically involves the use of artificial tears to lubricate the eyes. It's crucial to choose preservative-free options, especially for long-term use.

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

3. Punctal Plugs: These are small devices inserted into the tear ducts to block drainage and keep tears on the surface of the eye longer.

4. Lifestyle Modifications: Patients are encouraged to take regular breaks from screens, use humidifiers, and wear sunglasses outdoors to protect against wind and sun.

5. Dietary Supplements: Omega-3 fatty acids have been shown to improve dry eye symptoms in some patients.
6. Scleral Lenses: For severe cases, scleral lenses can provide a protective layer over the cornea and keep the eye moist.

Why Some Patients Experience Improvement
It is important to note that while dry eye syndrome is often described as a chronic condition, some patients may experience periods of relief. This can be due to several factors:
- Natural Fluctuations: Symptoms can fluctuate based on environmental conditions, stress levels, and overall health.

- Adaptation: Some patients may adapt to their symptoms over time, leading to a perceived improvement in their quality of life.

- Effective Management: Even if tear production does not return to normal, effective management strategies can significantly alleviate symptoms.

Conclusion
In your case, it seems that despite following standard treatment protocols, you are still experiencing significant discomfort. This could indicate that your dry eye syndrome may be more complex than initially thought. It might be beneficial to explore further evaluations, such as testing for underlying autoimmune conditions or assessing the quality of your tear film. Consulting with a specialist in dry eye disease or a cornea specialist could provide additional insights and treatment options tailored to your specific situation.
Remember, managing dry eye syndrome often requires a multifaceted approach and patience, as it may take time to find the most effective treatment for your individual needs.

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