Overview

Dry eyes cause discomfort by impairing normal vision, when using the computer, reading or driving a vehicle.¹Dry eyes are divided into many types; aqueous deficient dry eye, evaporative dry eye, and mixed dry eye.¹

Aqueous dry eye is caused by a lack of liquid water secretion in tears by the lacrimal glands within the eye, leading to the film coating of the eye becoming dry.^1,2 Evaporative dry eye is caused by a lack of oil secretion by the Meibomian glands leading to tear dissipation.^1,2 This oil prevents dehydration of the eyes by retaining water usually secreted in tears.^1,2

This article seeks to; 

• Discuss dry eye signs and symptoms, determinants, and diagnosis
• Discuss treatment options (home remedies, prescribed and over-the-counter treatments) 
• Discuss prevention methods 

Dry eyes signs and symptoms

Signs and symptoms of dry eyes include;^1,2

• Burning sensation
• Sharp tingling sensation
• Red, bloodshot appearance 
• Itchiness (pruritus)
• Sensitivity to light (photophobia)
• The feeling of a foreign object lodged inside the eye
• Eyelid margin pain with swelling (edema), burning, redness, and itchiness (blepharitis)
• Blurred vision

Dry eyes risk factors

Risk factors which predispose individuals to dry eyes include;^1,2

• Overuse of electronic devices due to blue light emitting from the screens 
• Having undergone a stem cell transplant 
• Allergen exposure (e.g. pollen, dust, animal fur, urine, shredded skin and saliva)
• Diseases such as collagen vascular disease, diabetes, Sjögren’s syndrome, hepatitis C virus, sarcoidosis, and HIV/HTLV1
• Individuals who were assigned female at birth (AFAB)
• Older/Elderly individuals
• Having undergone corneal refractive, cataract surgery with a large slit made in the eye, or corneal transplant surgery
• Deficiency of vitamin A
• Deficiency of androgen in menopause 
• Oestrogen therapy after menopause 
• Radiation therapy and chemotherapy for cancer treatment
• Prescribed medications such as antihistamines, isotretinoin, beta-blockers, antidepressants, and diuretics
• Less moisture in the air
• Ovary dysfunction 
• Smoking 

Diagnosis methods 

To diagnose dry eyes, medical health professionals will sequentially; 

Lifestyle modifications to reduce dry eyes

• Decreasing electronic device screen time use and taking regular breaks in between
• Consuming vitamin A-rich foods (e.g. cantaloupe, kale, broccoli, spinach, carrots, sweet potatoes)³
• Consuming omega-3 fatty acid-rich foods (e.g. fish, nuts, and seeds) to reduce eye inflammation in dry eyes¹
• Taking fish oil liquid/oral supplements¹ 

Over-the-counter treatments to relieve dry eyes

• Eye drops containing lipids, vitamin E, and glycerine which moisturise and soothe dry eyes^1,2
• Artificial tears ( gel or ointment)^1,2
• Eye sprays and mists (key ingredients to moisturise and soothe dry eyes include lipids and lubricants)^1,2

Prescribed treatments for dry eyes

An ophthalmologist, pharmacist and/or optician may prescribe;

• Anti-inflammatory medications such as topical corticosteroids to treat redness, swelling, pain, and loss of function¹
• Intense pulsed light (IPL) therapy improves Meibomian gland oil secretion by increasing tear production and reduces inflammatory immune molecules by raising the temperature of the skin in the eyelid and around the eye which increases the secretion of oil-containing lipids, to rehydrate dry eyes⁴
• Collagen/silicone plugs block or decrease the flow of tear drainage in the eyes, to retain tears for hydration¹
• LipiFlow® treatment provides safe heat temperatures and mechanical stimulation to inner eyelids to unclog and improve the Meibomian glands' function, and allow oil secretion for retaining tear film stability which reduces tear evaporation⁵
• Eye drops tailored to patient severity of signs, symptoms, medical history, and type of dry eye^1,2

Home remedies to reduce dry eyes

• Using warm compresses on your eyes - soak a clean cloth in warm water, wring out extra water and place the compress on the eye for as long as it is warm²
• Adding moisture to the air with a humidifier²
• Blinking exercises²
• Thermal and massage treatments stimulate the Meibomian gland to secrete oils to prevent tear evaporation and promote hydration, lubrication, and moisturisation of dry eyes^5,6

Prevention strategies

• Visiting opticians frequently for regular eye checkups 
• Taking regular breaks and blinking frequently when using screens (i.e. phones, computers, tablets and televisions)²
• Drinking 6-8 glasses of water a day to ensure sufficient hydration of the eyes
• Managing diagnosed medical conditions which may cause dry eyes as a symptom by scheduling regular appointments with the doctor^1,2
• Staying inside when pollen levels are higher in spring and washing hands after exposure to pet or plant allergens 
• Quit smoking⁷

FAQs

What are the two main causes of dry eyes?

There are multiple causes of dry eyes which include but are not limited to; environment/pet-based allergen exposure, excessive air flow/air conditioning, excessive use of electronic devices without regular breaks, taking certain medications, being diagnosed with diseases in which dry eyes may occur as a symptom and lower androgen levels during menopause.^1,2

How do you reduce dry eye symptoms? 

Eating a balanced diet will ensure adequate macronutrients and micronutrients are consumed (vitamin A and omega-3 fatty acid-rich food is great for eye health), quitting smoking, limiting electronic device use, blinking regularly and taking frequent breaks when using electronic devices, using a humidifier, and managing conditions which cause dry eyes by visiting a doctor/optician/pharmacist regularly will help.^1,2 Secondly, using non-prescription lubricating eye drops, eye mists, and sprays also helps to soothe dry eyes.^1,2

Summary

To summarise, a range of risk factors can cause dry eyes. Diagnosis of dry eyes is determined via visits to the optician, ophthalmologist and/or pharmacist, who conduct a series of eye tests to elucidate the severity and type of signs and symptoms. The tests usually involve examining water and oil secretion levels in tears, the stability of the tear film, and checking whether the Meibomian and lacrimal glands' function may be blocked/limited in their secretory ability. Treatments combine home remedies, over-the-counter medications, and prescribed treatments by medical health professionals. Prevention methods include regular eye health examinations, managing health conditions that may cause dry eyes as a symptom, reducing electronic device use, blinking frequently, and quitting smoking amongst many options.