Wednesday, July 24, 2024

Tears Are Not Enough: Understanding Dry Eye Disease And How To Tackle It

Many of us expect that the quality of our vision will change as we grow older. We’re more likely to need reading glasses and face the potential of developing a variety of troublesome eye ailments. One of the most common is dry eye disease.

“Dry eye is a condition that occurs when either the quality or quantity of tears is insufficient to keep the surface of the eye lubricated,” says Dr. Judy Brisson, an optometrist with a practice in Guelph, ON.

Regular eye exams can help diagnose dry eye disease and cataracts.

Dry eyes equal discomfort
She explains that we are continuously producing a flow of tears. While we’re familiar with the large quantity of tears that we shed when we cry, we are also constantly producing a much lower level of tears in order to keep our eyes lubricated. “Tears are a mix of water, oils, proteins and mucus,” she notes. “Dry eye is most often the result of an imbalance in the mix of the constituents of the tears, which results in poor quality tears that evaporate too quickly.” More rarely, tears are a good quality but there are not enough being produced. This too-rapid evaporation or insufficient quantity of tears can leave us with eyes that are red, irritated and itchy.

Most people will occasionally experience dry eyes throughout their lifetime, but as we age it can become a nearly daily occurrence. Dry eye syndrome, also known as dry eye disease, develops for a variety of reasons. “There a number of different glands along the lids and in the transparent covering of the eye that produce the constituents of tears. Various problems with those glands can cause poor quality tears and can be due other medical diseases (like diabetes, auto immune disease), aging, allergies, smoking, poor air quality, medications and the environment,” says Dr. Brisson.

Our ever-increasing reliance on computers and smartphones is also responsible for dry eye disease. Reduced blinking is common when we concentrate. For example, people don’t blink as often when reading, working on the computer or driving. Since every blink wipes old tears away from the eye surface and replaces them with fresh new ones, a reduced blink rate will result in poorer quality tears, and more time between blinks allows for more evaporation.

Fortunately, there are steps you can take to reduce dry eye syndrome, including using eye drops, warm compresses and cleaning your eye lids. Omega 3 supplements may also help improve tear quality, as will a healthy diet with leafy greens and fruit. It’s also important to not smoke and avoid second-hand smoke and very dry environments. And, if you spend hours a day at a computer, be sure to take frequent breaks away from the screen.

Our dependency on smartphones and computers increase the incidence of dry eye disease. Photo: Flickr/Creative Commons, eltpics.

Contrary to what some might think, dry eye disease does not cause cataracts. The main causes of cataract are issues like smoking, UV light exposure, trauma to the eye and some medications – all of which may cause a clouding of the lens inside the eye. This clouding can become so intense that vision becomes severely impaired and interferes with normal everyday tasks like driving and reading. In these cases, the cataract should be removed and replaced with an artificial plastic lens.

Dr. Brisson says that even though cataracts are not caused by dry eyes, blurred vision due to dry eye disease can be mistakenly attributed to cataracts. “Most cataract surgeons will also assess patients referred for surgery for dry eye disease and treat that disease before considering surgery because in some cases dry eye treatment improves vision and surgery will not be needed.”

Prepping for cataract surgery
The fact that an improvement in vision may render surgery unnecessary isn’t the only reason it’s important to treat dry eyes before cataract surgery emphasizes Dr. Brisson: “Cataract surgery puts stress on the corneal epithelium (the top layer of the cornea) due to the time the eye is kept open during surgery. A cornea that is already dry and inflamed due to poor tears will be slower to heal after surgery and will be more likely to become infected. Furthermore, a dry eye and dry cornea will result in blurred vision, which can sometimes make people think the surgery was not successful. Surgeons may insist that patients have treatment for dry eyes before cataract surgery as there will better healing and visual outcome post surgery.”

Surgeons may insist that patients have treatment for dry eyes before cataract surgery as there will better healing and visual outcome post surgery.

Dr. Brisson says that, if you do have cataracts removed, it’s essential to follow the directions the surgeon provides. “This will include when and how long to wear an eye shield, when to resume showering, what activities should be avoided and for how long. Also, be sure to take all the prescribed drops according to instructions and wear sunglasses outdoors. When to resume driving is dependent upon individual factors.  Recovery times vary, but most people will resume activities or go back to work about a week after surgery and will be back to normal routines within approximately six weeks later.”

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