Dry eye is a common and often chronic problem, particularly in older adults.
The natural aging process can lead to a range of ocular problems, affecting both the quantity and quality of your tears and causing the uncomfortable dry eye symptoms you may be experiencing.
Certain medical conditions causes dry eyes including autoimmune disease Sjogren’s syndrome, allergic eye disease, rheumatoid arthritis, lupus, scleroderma, graft vs. host disease, sarcoidosis, thyroid disorders or vitamin A deficiency.
Certain medications, including antihistamines, decongestants, hormone replacement therapy, antidepressants, and drugs for high blood pressure, acne, birth control and Parkinson’s disease.
Some of the age-related co-morbidities alters ocular surface homeostasis secondary to the systemic or ocular therapies that are required to control the original morbidity and some of these medications may have secondary ocular drying effects.
For example, anti-hypertensive, anti-histamins and antidepressants are some of well-recognized classes of drugs that have a dry eye effect.
Another frequent age-related disorder is conjunctivochalasis, a condition where the conjunctiva folds and becomes redundant and may obstruct the puncta and cause ocular discomfort.
What is dry eye?
Dry eyes often mean your tear system is out of whack.
Dry eye is common — it affects millions of Americans every year.
Dry eye happens when your eyes don’t make enough quality tears to stay wet, or when your tears don’t work correctly.
This can make your eyes feel uncomfortable, and in some cases it can also cause vision problems.
Dry eye is characterized by ocular damage.
Although the degree of visual acuity loss in dry eye patients is usually mild-to-moderate in the aged population, this minimal shift in visual status is likely to reduce visual functions in the age group.
Healthy eye surfaces require adequate tearing production and tear filtration, so deficiencies in this delicate balance can result in dry eye.
What is dry eye syndrome?
Dry eye syndrome (DES) is a common condition that results from insufficient tear quantity or inadequate tear quality.
Dry eyes affect the quality of life of up to 30 percent of adults over 50
Damage to the surface of your eyes. If left untreated, severe dry eyes may lead to eye inflammation, abrasion of the corneal surface, corneal ulcers and vision loss.
Decreased quality of life.
Dry eyes can make it difficult to perform everyday activities, such as reading.
Dry eyes occurs because of an imbalance of tears quantity or quality.
Our tears lubricate and hydrate the eyes.
A hydrated tear contains three elements – oils, mucus and water.
Several essential components are affected by the imbalance between tear film, thus causing the formation of tears which leads to the development of tear film.
Overview
Tears provide lubrication, reduce the risk of eye infection, wash away foreign matter in the eye and keep the surface of the eyes smooth and clear.
Dry eye disease is a common affliction that can be caused by the absence of proper eye protection.
Tears can become inadequate or unstable in several ways.
Dry eye is usually caused by not shedding tears or a lack of tears.
This tear instability causes irritation of eye surface areas and damage.
Dry eyes sensation is painful.
If your eyes become wet when you have dry eyes, it can cause stinging and burning.
Sometimes dry eyes appear in certain environmental situations.
Treatment of the dry eyes can help to ease the symptoms.
Risk factors
Risk factors Factors that make it more likely that you’ll experience dry eyes include:
- Being older than 50. Tear production tends to diminish as you get older.
- Dry eyes are more common in people over 50.
- Being a woman. A lack of tears is more common in women, especially if they experience hormonal changes due to menopause.
Causes
Dry eye is a natural aging process, especially menopause.
Healthy tears consist of three elements: oil, mucus, and water.
A problem within any of these essential elements can cause an imbalance within the tear film and affect tear production— consequently leading to dry eyes.
Each component protects and nourishes the front surface of the eye.
A smooth oil layer helps prevent evaporation of the water layer, while the mucin layer spreads the tears evenly over the surface of the eye.
If the tears evaporate too quickly or do not spread evenly over the cornea due to deficiencies with any of the three tear layers, dry eye symptoms can develop.
A problem within any of these essential elements can cause an imbalance within the tear film and affect tear production— consequently leading to dry eyes.
Fundamental reasons for dry eyes are:
- Decreased tear production – Your tear glands don’t make enough tears to keep your eyes wet.
- Your tears dry up too fast Your tears just don’t work well enough to keep your eyes wet.
Tear glands
The tear glands (lacrimal glands), located above each eyeball, continuously supply tear fluid that’s wiped across the surface of your eye each time you blink your eyelids.
The majority of patients with dry eye have chronic inflammation (swelling) in the tear glands (lacrimal glands) that line the eyelid and in the conjunctiva (the thin lining on the inside of the eyelids and the front part of the eye).
Various factors cause dry eyes to break down.
Lack of Tear flow
Dysfunction of any component of the lacrimal gland, ocular surface, eyelids, and nervous system can cause dry eyes.
There’s a lack of balance in your tear-flow system.
Our body sends a flood of tears to try to make up for the dryness.
It’s a lot like what happens when you get sand in your eye you get watery eyes.
Excess tears in the eyes flow into small drainage ducts in the inner corners of the eyelids, which drain into the back of the nose.
These tears are mostly water, called reflux tears – they are not normal tears, – not thick enough to coat your eyes.
They can wash debris away, but they are not thick enough to coat your eye’s surface.
Environment such as air conditioner, heater, or other things around you could dry out your tear film.
A problem within any of these essential elements can cause an imbalance within the tear film and affect tear production— consequently leading to dry eye disease.
Lack of oil
Meibomian gland degeneration.
Lacrimal gland function As we age, the amount of tears produced by the lacrimal gland naturally reduces. This can lead to insufficient water (aqueous) production, and significantly affect the eye’s ability to maintain moisture.
The meibomian glands in the eyelids produce the essential oil and lipids required to lower the evaporation rate of the tears.
As we age, these meibomian glands become blocked more easily, and can even begin to degenerate.
This can lead to reduced or inadequate oil production and meibomian gland dysfunction (MGD).
The most common type of MGD is called obstructive MGD.
This occurs when the meibomian glands become blocked or clogged by thick secretions.
Obstructive MGD prevents the oil from reaching the eye’s surface and results in quicker tear evaporation.
Menopause and other causes
Menopause is a common cause of DES in women above the age of 50. Approximately 61 percent of perimenopausal and menopausal women are affected by dry eye syndrome.
Furthermore, around 38 percent of post-menopausal women in the U.S. use hormone replacement therapy (HRT) to manage their menopausal symptoms— a treatment that has been closely linked to dry eye syndrome.
The natural aging process, especially menopause.
Drugs
Side effects of certain drugs like antihistamines
Diseases
Diseases that affect your ability to make tears, like Sjogren’s syndrome , rheumatoid arthritis , and collagen vascular diseases.
Diseases that has problems that don’t allow your eyelids to close at night.
Environment
Environmental conditions, such as wind and dry climates, can also decrease tear volume due to increased tear evaporation.
Exposure to smoke, wind and dry climates can increase tear evaporation resulting in dry eye symptoms.
Failure to blink regularly, such as when staring at a computer screen for long periods of time, can also contribute to drying of the eyes.
You may experience dry eyes in certain situations, such as on an airplane, in an air-conditioned room, while riding a bike or after looking at a computer screen for a few hours.
Eye surgery
Corneal nerve de-sensitivity caused by contact lenses use, nerve damage or that caused by laser eye surgery, though symptoms of dry eyes related to this procedure are usually temporary Increased tear.
Dry eye Symptoms
Dry Eye Symptoms: Burning, dry or scratchy feeling, blurred vision, red eyes, burning in the eyes, itchy eyes, excessive tearing/watery eyes, sensitive or sore eyes, eyelid inflammation and discomfort, foreign body sensation.
Sometimes, dry eyes create too many tears. This confusing condition is called reflex tearing.
It happens because the lack of moisture irritates your eye. It sends a distress signal through your nervous system for more lubrication.
Your body sends a flood of tears to try to make up for the dryness.
Diagnosis
Your eye doctor will do a dilated eye exam, measuring amount and thickness of tears.
Treatments
artificial tears
If you have chronic dry eyes, your eye doctor will prescribe you to use eyedrops even when your eyes feel fine to keep them well lubricated -use artificial tears regularly.
This is the most common treatment. Many types of drops are available over the counter.
Over-the-counter (OCT) remedies , such as artificial tears eye drops, gels and ointments can provide relief for mild to moderate symptoms.
Your eye doctor will also prescribe warm compresses and lid massage, or eyelid cleaners to help decrease inflammation around the surface of the eyes.
If your symptoms are more severe or persistent, there is a wide variety of effective dry eye treatments that can significantly reduce or eliminate your symptoms.
Preservative-free artificial tear solutions are recommended because they contain fewer additives, which can further irritate the eyes.
Many types of drops are available over the counter.
No one product works for everyone, so you might have to try a few to figure out the one that’s right for you.
If your eyes dry out while you sleep, you can use a get drop that is thicker.
Conserving tears
Punctal Plugs
Keeping natural tears in the eyes longer can reduce the symptoms of dry eyes.
Your eye doctor will put punctal plugs in your tear ducts to prevent tear drain.
The tear ducts can be blocked with tiny silicone or gel-like plugs that can be removed if needed.
Thus increase your tear level by blocking the “drainpipe” through which tears usually go from your eye to your nose.
Tear plugs are easy to remove, but sometimes they come out on their own or fall down the tear drain.
They can make your eyes feel better and lower your need for artificial tears.
Surgery
surgical procedure can permanently close the tear ducts. In either case, the goal is to keep the available tears in the eye longer to reduce problems
LipiFlow
Lipiflow. This medical device uses heat and pressure to unclog blocked glands on your eyelids. These glands produce the oil in your tears. It keeps your eye moist and prevents your tears from evaporating.
Testosterone cream
Testosterone cream. Dry eye can be related to a lack of testosterone in the oil glands on
Prescription eye drops
A problem within any of these essential elements can cause an imbalance within the tear film and affect tear production— consequently leading to DES.
a prescription for medicines called cyclosporine (Restasis) or lifitegrast (Xiidra). These medicines are both types of eye drops that can help your eyes make more tears.
Varenicline ( Tyrvaya ) . This is a nasal spray that can be taken twice a day in each nostril to increase tear production which can relieve dry eye.
Other medications and nutrition :
You can use steroid eye drops, for short periods, along with long-term measures. Adding fish oil or omega-3 to your diet or can also help
Ocular Rosacea
If you have ocular rosacea associated with dry eye, then newer artificial tears contain lipid to help prevent tear evaporation.
References
Dry eye syndrome — Preferred Practice Pattern. American Academy of Ophthalmology. 2018; doi:10.1016/j.ophtha.2018.10.023. Dry eye. American Optometric Association. https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/dry-eye. Accessed Aug. 4, 2020.
Dry Eye Topics Today on WebMD All About Pinkeye Learn about causes, symptoms, and treatments.
National Eye Institute. University of California, Berkeley. Review of Ophthalmology : “A Stepwise Approach to Treating OSD.” Follow us Follow on Facebook Follow on Twitter Follow on Instagram Follow on Tiktok © 2022 WebMD, LLC. All rights reserved
Dry eye. National Eye Institute. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/dry-eye. Accessed Aug. 4, 2020.
Aqueous Tear Deficiency Increases Conjunctival Interferon-gamma (IFN-gamma) Expression and Goblet Cell Loss. Invest Ophthalmol Vis Sci. 2015; 56 :7545–7550.
Causes Tear glands and tear ducts Open pop-up dialog box Close Tear glands and tear ducts Tear glands and tear ducts
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Dry eye disease. In: Ophthalmology. 5th ed. Elsevier; 2019. https://www.clinicalkey.com. Accessed Aug. 4, 2020.
Martin E, et al. Effect of tear supplements on signs, symptoms and inflammatory markers in dry eye. Cytokine. 2018; doi:10.1016/j.cyto.2018.02.009.
Flow cytometric analysis of inflammatory markers in conjunctival epithelial cells of patients with dry eyes. Invest OphthalmolVisSci. 2000; 41 :1356–1363.
Lam H, Blieden L, de Paiva CS, Farley WJ, Stern ME, Pflugfelder SC. Tear Cytokine Profiles in Dysfunctional Tear Syndrome. Am J Ophthalmol. 2009; 147 :198–205.
Chia EM, Mitchell P, Rochtchina E, Lee AJ, Maroun R, Wang JJ. Prevalence and associations of dry eye syndrome in an older population: the Blue Mountains Eye Study. Clin Exp Ophthalmol. 2003; 31 :229–232.
