Dry Eye Syndrome: Causes of Pain and Redness Despite Tears

Dry Eye Syndrome?

Doctor, I am a patient with dry eye syndrome.
Why do I have a small amount of tears in my eyes, yet still experience pain and have bloodshot eyes?

Zi Ping, 30~39 year old female. Ask Date: 2013/07/12

Dr. Zhuang Yamin reply Ophthalmology

Dear Ziping,
Hello! The so-called "dry eye syndrome" does not mean that the eyes are completely dry and devoid of moisture! Simply put, there are many types of tears secreted by the eyes, such as tears produced when crying, or those that flow out in response to irritation.
Additionally, there are basic tears that coat the ocular surface to protect and maintain the health of the cornea and conjunctiva under normal conditions.
These different types of tears have distinct functions and are secreted from various glands.
Generally, dry eye syndrome refers to insufficient basal tear secretion, while other types of tear production remain normal.
In fact, due to dryness, the corneal surface may become more sensitive, leading to excessive tearing in response to stimuli such as light and wind.
Symptoms like stinging and the presence of blood vessels are common manifestations of dry eye, reminding you to use appropriate eye drops in a timely manner!
Wishing you good health,
Changhua Hospital, Department of Health

Reply Date: 2013/07/12

More Info

Dry Eye Syndrome (DES) is a common condition that affects many individuals, leading to discomfort and a range of symptoms, including pain, redness, and the presence of blood vessels in the eyes. It is essential to understand that having some tears does not necessarily mean that your eyes are adequately lubricated or healthy. In fact, the tears produced in dry eye syndrome may not have the right composition or quantity to provide sufficient moisture and protection to the ocular surface.

Causes of Pain and Redness in Dry Eye Syndrome
1. Insufficient Tear Production: In dry eye syndrome, the lacrimal glands may not produce enough tears to keep the eyes moist. This can lead to a sensation of dryness, irritation, and discomfort, even if there are some tears present. The tears that are produced may also evaporate too quickly, leading to further dryness.

2. Tear Film Instability: The tear film is composed of three layers: an oily layer, a watery layer, and a mucous layer. If any of these layers are deficient or unstable, it can lead to inadequate lubrication of the eye surface. This instability can cause the eyes to feel painful and appear red, as the underlying tissues become irritated.

3. Inflammation: Chronic dryness can lead to inflammation of the ocular surface, which can exacerbate symptoms. Inflammation can cause blood vessels in the eyes to dilate, leading to redness. This inflammatory response can also increase sensitivity, making the eyes feel painful even in the presence of tears.

4. Sensitivity to Environmental Factors: Individuals with dry eye syndrome often have heightened sensitivity to environmental factors such as wind, smoke, or bright lights. These factors can trigger discomfort and lead to excessive tearing as a reflex response, which may not provide adequate relief.

5. Meibomian Gland Dysfunction: The meibomian glands, located in the eyelids, produce the oily layer of the tear film. If these glands are blocked or not functioning correctly, it can lead to evaporative dry eye, where the tears evaporate too quickly, resulting in dryness, pain, and redness.

Management Strategies
1. Artificial Tears: Using preservative-free artificial tears can help provide temporary relief from dryness and discomfort. These lubricating drops can help maintain moisture on the ocular surface.

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

3. Warm Compresses: Applying warm compresses to the eyes can help unclog blocked meibomian glands, improving oil secretion and tear stability.

4. Medications: In some cases, anti-inflammatory medications or prescription eye drops, such as cyclosporine A (Restasis) or lifitegrast (Xiidra), may be recommended to reduce inflammation and improve tear production.

5. Consultation with an Eye Care Professional: If symptoms persist, it is crucial to consult with an eye care professional. They can conduct a thorough examination, assess tear production, and recommend appropriate treatments tailored to your specific condition.

Conclusion
In summary, dry eye syndrome can lead to pain and redness despite the presence of tears due to insufficient tear production, tear film instability, inflammation, and sensitivity to environmental factors. It is essential to manage the condition proactively through lifestyle changes, the use of artificial tears, and consultation with an eye care professional for tailored treatment options. By addressing the underlying causes of dry eye syndrome, you can improve your comfort and overall eye health.

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