Why is Dry Eye So Prevalent?
Question answered by:
Gregory K. Harmon, MD
Chairman, The Glaucoma Foundation Associate Professor of Ophthalmology, Weill Medical College of Cornell University/New York Presbyterian Hospital
Dry eye disease is a common eye disorder in which the eyes don’t make enough tears, or the tears evaporate too quickly. It can make your eyes feel dry, scratchy, and irritated, or watery, and it can cause vision fluctuation and a heavy, tired feeling of the eyes.
At least 16 million people in the United States have dry eye syndrome and that number includes from 40 to 50 percent of people who are being treated for glaucoma.
One reason for this correlation is that like open-angle glaucoma, dry eye syndrome becomes more common with aging. That’s also why, as the result of hormonal changes, women are more likely than men to have dry eye syndrome.
Another factor is glaucoma patients’ long-term use of pressure-lowering eye drops, many of which contain the preservative benzalkonium chloride (BAK). BAK is known to damage cells on the ocular surface, resulting in dry eye signs and symptoms. Dry eye is further aggravated and probably becoming more prevalent because of a greater reliance on computer and video screens for both work and play and more time spent in air-conditioned environments.
Normally, tears are produced by several glands. The lacrimal glands produce the watery tears through openings in the upper eyelids. Meibomian glands in both the upper and lower eyelids just behind the eyelashes produce the oily smooth outer layer of tears that stops the watery tears from evaporating.
Because most dry eye disease patients have eyes that don’t make enough tears, and they also lose their tears too quickly, treatment often addresses both issues.
There are different treatment options your eye doctor may suggest, depending on the type and severity of your condition. Among them:
Artificial tears are eye drops used as a replacement for watery tears. Gels and ointments are also available. They usually last longer in the eye and need to be put in less frequently, but can blur the vision. There are many different types of artificial tears available without a prescription.
Tear production can also be increased with several prescription eye drops for dry eye (Restasis, Cequa, Xiidra) and very recently the FDA approved a nasal spray.
Punctal plugs are sometimes used in dry eye treatment to help tears remain on the surface of the eye longer.
To express natural oily tears to the eye surface, at-home hygiene techniques such as eyelid cleansing and daily warm eyelid compresses can help to minimize clogged glands and inflammation of the eyelids. In-office procedures may also be suggested. LipiFlow, also known as thermal pulsation, is aimed specifically at meibomian gland dysfunction-related evaporative dry eye, as is iLUX, a procedure that allows individualized targeted treatment of evaporative dry eye.
Your doctor may suggest switching to preservative-free glaucoma eye drops.
Addressing lifestyle factors can also help manage dry eye associated with glaucoma. Some studies have found that supplements and foods containing omega-3 fatty acids can decrease dry eye symptoms. Your eyes may also feel better if you:
- Limit screen time and take frequent breaks from staring at screens
- Remember to blink often when you are reading or viewing a computer screen.
- Wear wraparound sunglasses when you’re outside
- Try to avoid smoke, wind, and air conditioning
- Use a humidifier to keep the air in your home from getting too dry
- Drink 7- 8-ounce glasses of water daily
- Get 7-8 hours of sleep per night
Like glaucoma, dry eye disease is chronic. But today, eye care professionals have a growing number of effective treatments to manage the condition and improve quality of life.