What is a dry eye disease, and why must it be treated?

Dry eye disease is a condition defined by a lack of tear production. As a result, the eyes are insufficiently lubricated. Dryness on the ocular surface is an open invitation for bacterial infections, inflammation and corneal scarring.

Common symptoms of dry eye disease include:

  • Burning in the eyes
  • Eye pain
  • Red eyes
  • Eye fatigue
  • Watery eyes
  • Hazy vision

Dry eyes occur when your eyes are unable to secrete tears, or the quality of tears is poor. Dry eyes may occur for a number of reasons, such as prior health-related conditions such as rheumatoid arthritis, a hormonal imbalance and thyroid disorders. Certain prescription medications (antidepressants, birth control, medication for acne and painkillers) can also cause dry eyes.

How will I be aware I have dry eye disease?

By undergoing a comprehensive eye exam, your doctor can diagnose the cause of dry eyes. For example, a Schirmer test is an exam that involves placing strips underneath the lower eyelids to catch and measure the number of tears your eyes are able to produce. Then, there are tests to assess your tear quality which are done by analysing corneal staining patterns and recording the time it takes for tears to disappear.

An osmolarity tear test traces the number of particles and water in your tears. Usually, if there is very little water present, this could be a strong indication of dry eye disease.

How do you treat dry eye disease?

There are several treatment modalities for dry eye disease, which include prescription medication such as:

  • Medication (antibiotics, eye drops and ointments) to treat eye inflammation that prevents the secretion of tears.
  • Eye drops (immune-suppressants and corticosteroids) to reduce corneal inflammation.
  • Eye/hydroxypropyl cellulose inserts function like tears and can be placed between the bottom eyelid and eyeball. Afterwards, the insert dissolves and releases fluid used in eye drops to water the eye.

When these treatments do not work and fail to relieve eye pain, your doctor will suggest corrective eye surgery.

Corrective procedures include:

  • Surgery to seal the tear ducts and prevent water loss. The tear ducts can be partially or completely blocked, depending on the diagnostic report. Small silicone plugs can be used to clog the tear ducts, but this is only a temporary solution. Otherwise, surgeons can permanently seal the ducts with heat (thermal cautery).
  • Intense-pulsed light therapy treats eye inflammation and stimulates the meibomian glands that are responsible for producing oil and lubricating the eyes sufficiently.
  • Unclogging oil glands using thermal pulsation applies light-based heat to soften the gland and stimulate the release of oil.

Sjogren's syndrome is a life-long illness that arises from a suppressed autoimmune system which affects glands producing saliva and tears. Treating an underlying condition such as this can prevent uncomfortable symptoms such as dry eyes. Treatment for Sjogren's syndrome includes prescription eye drops, immunosuppressants and, in some cases, eye surgery.



Why are dry eyes worse at night?

Open eyelids during the night can lead to further exposure to irritants and air that last for hours. Our eyes produce much fewer tears in the evening, causing symptoms to worsen at night.

What predisposes us to dry eye disease?

Certain factors lead us to a greater susceptibility to dry eye diseases, such as increased use of topical medications, inflammation, autoimmune diseases, hormonal changes and lid laxity.

Dr Philip and Dr Precious Phatudi
are skilled ophthalmologists based in Sandton