Dry eye is a common condition associated with dryness and irritation

“My eyes are so dry today”

Whoever speaks these words mostly attributes external factors to the dry eye. For example, the heating in a room is often blamed for dry eyes, and often rightly so. But what many do not know, is that “dry eye” also exists as a disease, and it has nothing to do with outside influences. The disease is not serious. Nevertheless, it can be very bothersome.

To understand dry eye, you must first understand the surface of the eye.

The eye’s surface consists of the conjunctiva and cornea, which is covered by a thin layer of fluid called the tear film. The eyelids act as cleaners; they wipe foreign objects out of the eye. The tear film protects the eye from drying out. The tear film has three layers. Each layer has its own task. The first layer consists of water which keeps the eye moist. The second layer is produced by the mucous glands and helps hold the first layer in place. The third layer consists of fat which allows tear fluid to evaporate slowly and reproduce tears.

With every blink, your eye spreads the freshly formed film of liquid over the surface of the eye, on average 12 to 15 times per minute. Excess fluid in the eye drains into the nose through two microscopic openings on the lower and upper eyelids, which we call teardrop holes.

The tear film and its function

The tear film has three tasks. The first task is to protect the eye from foreign objects such as dust, pollen, spores, viruses and bacteria. It also helps guard the eye against changes in temperature, wind and any trauma to the eye. The tear film intercepts all these factors, and the blink of an eye sweeps them away. Fluid is also responsible for ensuring that the outermost surface of the eye is smooth. This, in turn, helps to provide good quality vision.

The third task of the tear film is to moisturize and nourish the cornea. Without the film, the blinking of an eye would rub directly on the conjunctiva and cornea and injure them over time. Thus, the tear film also has the function of a lubricant. It also contains nutrients that it supplies to the surface of the eye.

“Dye eye” and its causes

The technical term for dry eye is “conjunctivitis sicca”. Dry eye occurs when the wetting of the surface of the eye is disturbed. Many factors contribute to this disorder, both physical and emotional. Visual disturbances can also lead to this disease. Inflammation and a tear fluid that is too concentrated usually play the main role. But what are the causes? Two reasons are considered essential:

Low production of tears

This can have several causes. The tear gland tissue recedes in old age, and certain diseases can also occur. External factors also come into question, such as drugs such as beta-blockers or atropine inhibit tear formation. Serious eye diseases often lead to scars on the lacrimal gland. Postmenopausal women are often affected. This is because of the depletion of certain hormones that have a direct effect on the tear film.

Ineffective production of tears

Sometimes there are enough tears, but they don’t do their job well. This may be because the tears are unable to adhere to the tear film or the evaporation is too weak or too strong. This is often because there is not enough mucus due to a lack of vitamin A, inflammation, scarring, burns or chemical burns.

A disorder of the meibomian glands

A disorder in the meibomian glands (the tiny oil glands which line the margin of the eyelids) can also mean that the fat film is not sufficiently strong. Atopic dermatitis, certain mites and bacteria sometimes cause inflammation on the edge of the eyelid.

Sensory disturbances

Sensory disturbances of the eye, paralysis of the face or an eyelid closure disorder can sometimes cause “dry eye”. Certain medications that are responsible for the instability of the tear film may also affect it.

External influences

Last but not least, permanent external influences are often the reason for the disease. This includes:

• Rooms with low humidity,
• Excessively heated rooms
• Constant drafts
• Smoke
• Contact lenses
• The blower in the car
• Infrequent blinking, which happens from time to time when working on the computer or reading frequently.

The less tear fluid there is, the higher the concentration of the substances present, such as mucilage and salts. If this is the case, patients usually feel stickiness in the eye or as if there is a foreign body in it. There is also often a violent stinging or burning sensation. Simultaneously, the body releases more and more substances that signal to the eye that it is inflamed. The eye becomes red and swollen and can feel hot and sometimes painful. All this leads to blurred vision. Blinking and eye drops can help.

An unusual symptom of dry eye can be increased tears and eye-watering. This can happen when the tear film no longer adheres to the surface of the eye. This can indicate a disorder in the fat or mucus layer, which causes the tear fluid to run out.

Another reason for excessive eye watering may be that the dryness has progressed so much that the eye becomes very irritated. The eye produces more tears In an attempt to soothe the eye. This can lead to chronic inflammation of the cornea, which can cause the top layer of the eye to become cloudy.

Diagnosis of dry eye

To diagnose dry eye, the doctor colours the surface of the eye with special substances, which determines the sensitivity of the cornea. If this indicates “dry eye” disease, the doctor will conduct further investigations.

With a strip of filter paper, which is hung in the lower eyelid, the amount of tears can be measured (the so-called umbrella test). If necessary, there are other methods to confirm the diagnosis to rule out the possibility that another form of the disease is present, which, after all, would have to be treated differently.

There are almost always several causes for “dry eye”, which is why there is no single method that always works. Patients must be aware of this, and the ophthalmologist should be frank from the outset. Sometimes it takes several attempts by the doctor to get the problem under control. In the same way, patients should learn that it is always a matter of a treatment effect that lasts for a certain period of time. Dry eye” is chronic, and the symptoms will return at some point. Health insurance companies also no longer cover the costs of the therapy. Discussing this with the doctor may be understandable from the patient’s point of view, but it does not help.

Artificial tears

We can use artificial tears to treat dry eye. The artificial tears protect the eye’s surface by forming a lubricating film and strengthening the tear film. There are many types of artificial tears, but they all contain similar ingredients, such as water and salts. Sometimes they include thickening agents and preservatives.

If preservatives are not included, the artificial tears usually have to be used up within a day.

The thicker they are, the better the tears adhere to the eye’s surface and the better moistened they are. However, a thick substance temporarily impairs vision because it covers the eye like a veil. The ophthalmologist cannot predict how each patient will react to each solution. You may need to try numerous solutions until you find one that works well for you.

If possible, you should try and use solutions without preservatives to reduce the chance of an allergic reaction. Anyone who wears soft contact lenses should always get artificial tears without preservatives.

How much artificial tears should you use? The principle “a lot helps a lot” applies here, so you should use them regularly.

Lid edge care

If inflammation of the lid edges is the trigger for the watering eyes, we may need to improve the drainage of the flat film. The fat film is produced in the Meibomian glands. This is done by peeling off skin flakes and crusts on the edges of the eyelids. Often this detachment is only possible by first massaging an eye ointment into the appropriate areas. As long as the inflammation continues at the edges of the eyelids, you should discontinue the use of cosmetic products such as eye shadow.

Eye drops

There are two variants: human blood serum drops and anti-inflammatory drops. There are numerous substances in the human blood serum that reduce inflammation. This can also have a positive effect on eye surface diseases. We can make these drops from your blood.

If you choose to use drops created by the pharmaceutical industry, they must contain anti-inflammation. For short-term use, cortisone is usually included to help with inflammation. For long-term use, only drops without cortisone are suitable.

Contact lenses

Lenses are a problem when patients have “dry eye” because they often make symptoms worse. However, there are some forms of this disease that benefit from soft and thin lenses. They can stabilize the surface of the eye and reduce discomfort.

Seal the teardrop spots

If the tears run out of the eye too quickly, the teardrop points are often letting in too much fluid. For a certain period of time, it then helps to close these teardrop points. We can use a plug for this, which works like a plugin in a bathtub. In rare cases, the ophthalmologist may force the closure permanently. They can do this by scarring the tear points.

Food

Sometimes the human body is unable to manufacture certain substances that it needs. For example, humans can be deficient in specific vitamins such as omega-3 and omega-6 fatty acids. These are important for eye health. Fatty acids help to create healthy glands on the edge of the eyelid. They also help to secret tears and messenger substances that signal inflammation.

Often we can obtain these vitamins through food or supplements. Omega-3 fatty acids are mainly found in oily fish or linseed oil. There are also drugs on the market to promote secretion, but some have serious side effects. That is why we only recommend them in severe cases.

We also offer e-eye tratment IPL (Intense Pulse Light treatment). This is a pain-free and effective way to treat dry eye conditions.

Other measures

In the case of “dry eye”, we rarely perform surgery. Only when a case is particularly severe.

If we think surgery is a necessary course faction, we will need to discuss the consequences with you in great detail.

If the tear fluid evaporates faster than it should, we may prescribe special glasses with side protection. This should protect from the wind.

Knowledge about the “dry eye” is getting better and better. This means that we expect drugs in the future to work very well and have no side effects.

What else can patients do?

It can be a good idea to use a room humidifier, especially in winter when there is a lot of heating. Hanging damp clothes over the heating is another helpful way of bringing moisture to a room.

In the car, you should avoid using AC or the blower. If you need to use it, direct it away from the eyes.

Avoid rooms where people smoke and avoid cigarette and alcohol consumption as these substances can dry out eyes. Plenty of sleep and a balanced diet with lots of vitamins are just as important as a good supply of water – two litres a day is the minimum.

If you want to swim, we recommend using swimming goggles. Anyone who works on a monitor should take many breaks and be conscious of their blinking. Contact lens wearers are encouraged to take them out every now and then and frequently wet their eyes with the appropriate liquids. You should only use cosmetics with great caution. Try to use only products with low-irritation content.

Preparations for cleaning the eyelid are important.

Last but not least, you should have regular examinations by an ophthalmologist.