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Dry Eye

  • Inadequate natural lubrication of the eye, causing irritation, blurriness, and excessive tearing
  • Symptoms include redness, irritation, and burning
  • Treatments include eye drops, medications, and in severe cases, procedure to unblock the tear ducts
  • Involves Ophthalmology

Overview

Every time you blink, you spread a teary film across your eye, nourishing the cornea and making the surface clear and smooth. If this natural process isn't working correctly, you'll know it. The likely culprit is a condition called dry eye that causes an irritated and watery sensation, making it hard to keep the eyes open.

“Some people have the sensation that something is scratching or that something is stuck in their eye,” says Jessica H. Chow, MD, a Yale Medicine eye specialist. Dr. Chow and other Yale Medicine specialists are experts in the conditions that cause dry eye and have access to the best resources to treat those conditions.

What are the symptoms of dry eye?

The most common symptoms of dry eye are irritation, redness and burning. Excessive tearing, in response to the lack of lubrication, can also be a sign of dry eye, as can discomfort wearing contact lenses.

What causes dry eye?

There are many causes of dry eye, which is also known as dysfunctional tear syndrome.

Blepharitis: This inflammation of the margin of the eyelid, the area near the edge of the eyelid and the eyelashes, is one of the most common causes of dry eye. “The eyelid margin contains a lot of the oil-producing glands,” says Dr. Chow. “When the eyelid margin becomes inflamed, the glands may not secrete oil properly and tears will evaporate too quickly.”

Climate: Low-humidity climates and indoor conditions can exacerbate the symptoms of dry eye.

Hormones: Changes in hormone levels can reduce the production of the watery layer of tears, especially in women after menopause.

Medications: Many medications, including antihistamines, decongestants and diuretic drugs (that rid the body of excess fluid), can lead to decreased tear production.

Medical conditions: Conditions, including the autoimmune diseases lupus, rheumatoid arthritis and Sjögren’s syndrome, cause dry eyes. Some eyelid conditions can also allow tears to evaporate too rapidly, leading to dry eyes.

What are the risk factors for dry eye?

Anyone is at risk for dry eyes, but the condition tends to develop with advancing age. People who have autoimmune diseases or other medical conditions may be predisposed to dry eye.

How is dry eye diagnosed?

Dry eye is usually easily diagnosed by its symptoms, and the cause can usually be determined during a thorough eye exam by an ophthalmologist, without the need for invasive tests.

How is dry eye treated?

The treatment for dry eye depends on the cause of the condition. 

Less severe dry eye: Blepharitis is typically treated with warm compresses placed on the eyes, which can reduce inflammation and improve secretion by the glands. Oral medications or anti-inflammatory eye drops may also be needed.

Over-the-counter artificial tears can help people who have a decrease in the watery layer. “People who tend to use artificial tears four times per day or more to keep their eyes comfortable may want to switch to a preservative-free variety, because the preservatives can become irritating to the eye,” says Dr. Chow. If dry weather or indoor conditions are causing dry eye, using a humidifier—especially while running central heating or air conditioning—can help.

Severe dry eye: Because severe dry eye can cause damage to the cornea (the transparent “window” at the front of the eye), more invasive treatments are sometimes necessary.

“We can block the tear-draining ducts, so that the patient’s own tears are kept in the eye longer before they drain out, and that keeps the eyes better lubricated,” Dr. Chow says. Drainage ducts can be blocked by either using cautery (an agent used to sear tissue) or by inserting tiny silicone plugs into some of the ducts. Both procedures are done in the office. (Cautery is a permanent solution, but the plugs can be removed.)

Dry eye that is caused by a turned-out eyelid can be relieved by an operation performed by a specialist in oculoplastic surgery to improve the position of the eyelid.

Another option for treating severe dry eye is a scleral lens device, which is special contact lens that does not touch the cornea. Instead, the scleral lens rests on the conjunctiva (the white part of the eye) and rises above the cornea. Fluid is placed in the chamber above the cornea, allowing a layer of soothing fluid to rest on the cornea, bathing the area.

What makes Yale Medicine’s approach to treating dry eye unique?

Patients seen at Yale Medicine have access to ophthalmologists and oculoplastic surgeons who are experts in treating many of the conditions that cause dry eye. 

Our staff includes an optometrist who specializes in fitting prosthetic scleral lens devices and other specialty lenses, which can provide relief for people with severe dry eye.