Dry Eye

Dry eye occurs when the lubrication of the surface of the eye is compromised due to decreased quantity and/or quality of tears. This is because our eyes need tears to stay healthy. If the eyes do not produce enough tears or tears evaporate too quickly, it leads to dry eye. Dry eye also occurs when your eyes do not produce the right type of tears or tear film.

This makes your eyes red and feels gritty.

Aqueous Tear-Deficient Dry Eye The eyes’ lacrimal glands fail to produce enough of the middle aqueous layer of tears, resulting in low tear production.

Evaporative Dry Eye The eyes’ meibomian glands don’t produce a strong outer lipid layer of tears, resulting in tears that evaporate too quickly.

When we blink, a film of tears spreads over the eye and keeps the surface of the eye smooth and clear. This tear film is important for good vision.

The tear film is made of three layers:

• An oily layer
• A watery layer
• A mucus layer

The oily layer is the outermost layer of the tear film. It makes the tear surface smooth and keeps tears from drying up too quickly. This layer is produced in the meibomian glands of the eye.

The watery layer is the middle layer of the tear film. It makes up most of what we see as tears. This layer cleans the eye and washes away particles that do not belong in the eye. This layer is produced by the lacrimal glands in the eyelids.

The mucus layer is the innermost layer of the tear film. It helps spread the watery layer over the eye’s surface, keeping it moist. Without mucus, tears would not stick to the eye. Mucus is produced by the conjunctiva. Conjunctiva is the clear tissue covering the white of your eye and inside your eyelids.

Normally, our eyes constantly make tears to stay moist. If the eyes are irritated, or when a person cries, the eyes make a lot of tears. But, sometimes the eyes don’t make enough tears or something affects one or more layers of the tear film. In such cases, we end up with dry eyes.

There are few major Symptoms of Dry Eye:

A burning or stinging feeling in the eyes

A scratchy or gritty feeling like something is in your eye,

Eyelids feel heavy.

Strings of mucus in or around your eyes

Eyes that are red or irritated. Especially when you are in the wind or near cigarette smoke

It is painful to wear contact lenses

You have lots of tears in your eyes. Having a lot of tears in your eyes with “dry eye” might sound odd. But your eyes make more tears when they are irritated by dry eye.

Dry eye can occur when basal tear production decreases, tear evaporation increases, or tear composition is not balanced.

Factors that can contribute to dry eye include the following:

• Age and gender: 
  • Advancing age is a risk factor for declines in tear production. Dry eye is more common in people age 50 years or older.
  • Women are more likely to develop dry eye. Hormonal changes during pregnancy and after menopause have been linked with dry eye. Women also have an increased risk for autoimmune disorders.
• Using a computer: People who use a computer tend to blink less frequently than normal. This can cause increased evaporation of tears, and hence dry eyes. Positioning your monitor below eye level can help, as it allows the upper eyelid to cover more of the eye’s surface. Being aware of blink rate, air circulation and glare can also help.
• Wearing contact lenses: Dry eye is most common among soft contact lens wearers, and can cause irritation, protein deposits and red eyes.
• Use of some medications: Medications like decongestants, antihistamines, oral contraceptives, antidepressants or eye drops for ‘red eyes’, these may contribute to dry eye symptoms.
• Diseases: Some diseases like arthritis, diabetes, asthma, Vitamin A deficiency, thyroid disease and lupus are associated with dry eye. Sjögren’s Syndrome is the name given to the combination of symptoms that includes dry eyes, dry mouth and arthritis.
• Inflammation of eyelid glands & eyelash follicles: Inflammation of the eyelid glands (called meibornian glands) and eyelash follicles can compromise the quality of the tear film, which causes tears to evaporate more quickly. This is sometimes caused by over-growth of bacteria normally found on the eyelids.
• Environmental conditions :  Windy, smoky, or dry environments increase tear evaporation.
• Seasonal allergies can contribute to dry eye.

At Shroff Eye Centre, Dry eyes are diagnosed through a comprehensive eye examination.

Testing, with emphasis on the evaluation of the quantity and quality of tears produced by the eyes, may include:

• Patient history to determine the patient’s symptoms, any general health problems, medications or environmental factors that may be contributing to the dry eyes.
• External examination of the eye.
• Evaluation of the eyelids and cornea.
• Measurement of the quantity and quality of tears for any abnormalities.
  • Special dyes may be put in the eyes to better observe tear flow and to highlight any changes to the outer surface of the eye caused by insufficient tears.
• Lipiview II
  

  What is Lipiview II? How long does it take to get tested?

  LipiView® II Ocular Surface Interferometer with Dynamic Meibomian Imaging™ (DMI)

  Lipiview II is a state of the art device to detect dry eye. It is a non-invasive device that is used to get an accurate digital picture of a patient’s tear film and Meibomian glands.

  It tells us about:
  A) How you blink.
  B) The oil layer in your tears
  C) The health of your tear glands ( Meibomian glands)

  

  At Shroff Eye Centre, LipiView is done as an outpatient procedure after your initial workup and only takes about 5 minutes. You simply look into a camera and blink normally. You will be able to see pictures of your own glands, and your doctor will be able to determine whether you have Meibomian Gland Dysfunction.

  LipiView can also evaluate your blinking function by assessing if your blinks are complete. Partial or Incomplete blinking results in a poor quality tear film which can increase dry eye symptoms.