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Introduction to Dry Eye – A Beginner’s Guide

It’s important to remember that every dry eye case is unique

Dry Eye Disease can burn you out in more ways than one. According to the Dry Eye Workshop, Dry Eye Disease (DED) is defined as “a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface.”

The two main types of dry eye are aqueous deficient and lipid deficient. Aqueous deficient is when the eyes aren’t making enough tears. Lipid deficient is when the tears evaporate too quickly. In my profession, I see several patients who suffer from either one, or a combination of both on a daily basis.

Symptoms and Diagnosis:

The main symptoms of dry eye include:

  • Burning or stinging
  • Redness of the eyes or eyelids
  • Itching
  • Light sensitivity
  • Watery eyes
  • Fluctuations in vision
  • Eye fatigue (worse towards the end of the day)
  • Mucous discharge in the corners of the eyes
  • Foreign body sensation
  • Sandy or gritty feeling in the eyes
  • Contact lens irritation (even the inability to wear contact lenses)

There are several ways to diagnose dry eye, and naturally, every doctor has his or her own preferences in doing so. When I receive a new consultation, I start by asking several relevant questions. This helps me paint a picture of the patient’s daily activities and overall eye awareness while performing these activities. I also discuss home and work settings because often times a patient’s physical environment may be contributing to their symptoms.

The goal of treatment is for the patient to lose awareness of eye problems as much as possible. Therapy typically requires a few changes in daily routine to help minimize symptoms and slow the progression of the disease. When dry eye treatment is introduced early, relief is never far behind. When the disease progresses unchecked, long-term complications tend to occur.

The following are some useful tests to assess dry eye:

  • Best corrected vision – a measurement of visual acuity that notes how well each eye can see
  • Eyelid assessment – to check for abnormalities in structure and/or function
  • Tear film assessment – noting the amount of healthy tears and watching how quickly tears evaporate, which is called the tear break up time
  • Diagnostic dyes – orange and green colored strips used to assess ocular surface damage on the cornea and/or conjunctiva
  • Schirmer’s test – measures the amount of tears produced
  • TEARLAB – measures osmolarity (or concentration of tears)

Normal tear osmolarity numbers are typically less than or equal to 300 mOsm/L. The higher the tear osmolarity, the more severe the dry eye tends to be.

Finding An Answer:

It’s important to remember that every dry eye case is unique. Once data is gathered from the above tests, a plan of treatment can be formulated. From personal experience, I’ve learned that many patients are afraid to mention their symptoms because they don’t want to lose their contact lens privileges. On a positive note, once the underlying cause of dry eye is identified, the solution to the problem is in sight.

When the symptoms of dry eye are treated correctly, contact lens use can be resumed, and the patient typically feels better than he/she did before.

If you’re experiencing symptoms of dry eye, make sure you’re upfront and honest with your eye doctor. Try to clearly state your short and long term goals. For example, you could say, “I want my eyes to appear less red”, or “I’d like to wear contact lenses while playing sports or exercising.” Proper diagnosis and management is the result of good teamwork between you and your doctor.