Dry eye is a sore, gritty sensation caused by not enough tears being produced or something affecting the quality of tears to form a protective tear film.
Dry eye is common with ageing and is more common in women than men. It is associated with some conditions and medications, and with computer use (not blinking enough).
Tears are made up of three separate secretions: a sticky base layer, a watery mid layer and an oily top layer (which slows tear evaporation). Dry eye is a sore, gritty sensation caused by too little tear production or poor quality tears that form an inadequate film.
Normally tears form a protective film over the surface of the eye, lubricating movement and washing away debris and any toxins. Dry eye can be painful and cause sensitivity to bright light or open air and wind.
Despite the name, the irritation of dry eye may trigger excessive tears. Dry eye may also redden the eyes, but it requires different treatment from allergic conjunctivitis and 'red eye'.
Who is at risk?
The following factors increase your risk of dry eye:
- increasing age – it affects 75% of people over 65 years of age
- being female – hormonal changes (eg, pregnancy, menopause, oral contraceptives).
- lacrimal and meibomian gland dysfunction eyelid or inflammation – you may have red eyelid margins and scaly eyelashes (blepharitis)
- medications – eg, decongestants, antihistamines, oral contraceptives, antidepressants, isotretinoin, for acne, blood pressure tablets and 'red eye' drops
- underlying conditions such as Sjögren's syndrome
- other conditions to consider are: rheumatoid arthritis, diabetes, asthma, thyroid disease, other immune diseases
- computer use – users tend to blink less
- wearing contact lenses.
What are the symptoms of dry eye?
Symptoms of dry eye may include any of the following:
- stinging or burning of the eye
- a sandy or gritty feeling as if something is in the eye
- episodes of excess tears following very dry eye periods
- a stringy discharge from the eye
- pain and redness of the eye
- episodes of blurred vision
- heavy eyelids
- inability to cry when emotionally stressed
- uncomfortable contact lenses
- decreased tolerance of reading, working on the computer, or any activity that requires sustained visual attention
- eye fatigue.
Dry eye can also cause your eye to be red. If this occurs, it's best to check with your doctor or an optometrist in case something else is the cause and a different treatment is needed.
You should seek medical advice if:
- the eye is painful or red
- it is harder to see well or your vision is blurred
- the eye has a coloured discharge or your eyelids are stuck together on waking
- you have glaucoma
- you have rheumatoid arthritis or diabetes
- the dry eye persists for seven to 10 days, despite treatment.
What is the treatment for dry eye?
If there is an obvious cause, then treatment will aim to reduce or address this issue such as changing a medication, contact lenses or treating blepharitis. If you use a computer a lot, then you need to train yourself to blink more often!
If there is no simple solution, then 'artificial tears' or ointment can help. Many can be brought from a pharmacy. Others need a prescription from your doctor or an optometrist. These include:
- eye washes, eg, Optrex Eye Wash with eye bath
- artificial tears and lubricant eye drops or gels, eg, Bion Tears, Blink Intensive Tears, Celluvisc drops, Optive drops. Refresh Liquigel, Refresh Plus, Refresh Tears Plus
- eye ointments to soothe dry eyes - longer lasting and best used at night as may cause blurred vision, eg, Lacri-Lube (funded), viscotears
- eye drops to soothe irritated eyes which are slightly red, eg, Albalon Relief
- a wide range of Pharmacy only medications containing a decongestant (only use for 1 to 3 days), eg, Albalon, Albalon A Allergy Eye Drops Clear Eyes, Clear Eyes Allergy.
If these treatments don't work, see your doctor or optometrist to review the diagnosis and discuss other treatment options. In some patients with dry eye, supplements or dietary sources (such as tuna fish) of omega-3 fatty acids (especially DHA and EPA) may decrease symptoms of irritation. The use and dosage of nutritional supplements and vitamins should be discussed with your primary medical doctor.
How to apply drops:
- always wash your hands first
- open the container, and pull the lower eyelid gently down with your forefinger to form a pocket
- tilt your head slightly back and look up; and
- holding the bottle between the thumb and forefinger, gently squeeze the recommended number of drops in the lower eyelid pocket.
How to apply ointment:
- hold the tube between the thumb and forefinger
- rest your hand against your nose to position the tip of the ointment tube
- apply a small strip of ointment into the lower eyelid pocket.
Points to remember:
- do not touch the eye with the dropper or tube tip
- you should discard all drops, solutions and ointments one month after opening to avoid bacterial contamination [note: some eye products can only be used for a few days, check packet instructions]
- single-dose lubricant eye drops remain sterile until opened, if used before the expiry date.
Self-care for dry eyes
Unblocking tear glands & removing scales
Often, oily tear glands (meibomian) in the eyelids become blocked, inflamed and produce irritant secretions that make dry eye symptoms worse. This gland inflammation is common and difficult to cure, but the following daily routine can help:
- carefully warm your eyelids for two minutes using a wheat bag or hot shower
- using firm finger pressure, press on your upper and lower eyelids. This will squeeze the secretions out of the glands. The secretions are not visible.
Scaly eyelashes (blepharitis) sometimes occur as well. If the scales fall into the eye, they causes grittiness and irritation. To help with this, after the massage use a moist cotton pad to gently rub away scales from the base of the eyelashes.
These problems develop over years, so controlling them may mean months of this routine, but they will improve.
E-eye is a new treatment that uses special light pulses at a frequency that stimulates the Meibomian glands and early studies suggest this helps them recover their function.
How can I prevent dry eyes?
You can help prevent dry eye symptoms by:
- protecting your eyes form sun and wind by wearing wrap-around sunglasses
- avoiding irritants such as smoke, dust, cosmetics and chlorine
- avoiding air conditioners that dry the air
- avoiding hair dryers
- do not leave contact lenses in for too long
- using a humidifier at home
- using artificial tears or lubricant regularly.
- Craig JP, Chen Y-H, Turnbull PRK. Prospective trial of intense pulsed light for the treatment of meibomian gland dysfunction Investigative Ophthalmology & Visual Science 2015; 56(3):1965-1970.
Information for healthcare providers
A quick guide to dry eye (pdf) NZ Association of Optometrists, 2009