Dry Eye Syndrome: What You Need to Know

You know the scene: you wake up in the morning and your eyelids are gunked up with sleep crusties. They’re as irritating as they are common—but could it be more than just eye goop? Perhaps dry eye syndrome?

Before we talk about keratoconjunctivitis sicca—also known as dry eye syndrome—let’s differentiate between that and basic eye gunk.

What are “Sleep Crusties”?

During sleep, we do not blink and eye discharge collects in the corners of our eyes and along the eyelash line. This normal eye discharge can be hard and crusty or sticky and wet.

These are the infamous Sleep Crusties: a generally harmless mixture of mucus, tears, and skin cells that accumulate while you are sleeping.

Our eyes are kept moist and healthy by a tear film while we are awake. When we blink, normal mucus produced by the conjunctiva^?A thin mucous membrane that lines the inside of the eyelids and covers the sclera (the white of the eye), oil from the meibomian glands^?glands along the rims of the eyelid, and other debris from the front surface of the eye are flushed out.

What is dry eye syndrome and what are its causes?

Dry eye syndrome is a common condition that affects millions of people around the world. It occurs when your eyes do not produce enough tears or when the quality of your tears is poor. This can cause discomfort, irritation, blurred vision and increased risk of eye infections.

There are many factors that can contribute to dry eye syndrome, such as:

Ageing

As you get older, your tear production and quality tend to decline, especially after menopause for women.

Environmental conditions

Dry, windy, dusty or smoky environments can evaporate your tears faster and irritate your eyes.

Medications

Some antihistamines, antidepressants, blood pressure medications and oral contraceptives can reduce tear secretion or alter tear composition.

Medical conditions

Diseases such as rheumatoid arthritis, Sjögren’s syndrome, thyroid disease, diabetes and lupus can affect your tear glands or cause inflammation of your eyes.

Eye problems

Eye conditions such as blepharitis (inflammation of the eyelids), meibomian gland dysfunction (blockage of the oil glands in the eyelids), allergies, conjunctivitis (infection of the eye surface) and eyelid malposition (turning in or out of the eyelids) can interfere with your tear film or expose your eyes to more air.

Contact lenses

Wearing contact lenses for too long or not cleaning them properly can reduce tear quality and quantity and cause irritation.

What are the symptoms of dry eye syndrome?

The symptoms of dry eye syndrome may vary from person to person, but they usually include:

• A burning, stinging or scratchy sensation in your eyes
• A feeling of having something in your eyes
• Redness and inflammation of your eyes
• Sensitivity to light
• Difficulty wearing contact lenses
• Blurred vision or eye fatigue
• Watery eyes (as a reflex response to dryness)

How is dry eye syndrome diagnosed?

If you have persistent or severe symptoms of dry eye syndrome, you should see an eye doctor for a diagnosis. Your doctor will ask you about your medical history, medications, lifestyle and environmental factors that may affect your eyes.

They will also examine your eyes using a slit lamp (a microscope with a bright light) and special drops that highlight any abnormalities or damage on your eye surface.

Your doctor may also perform some tests to measure the quantity and quality of your tears, such as:

• Schirmer test: A small strip of filter paper is placed under your lower eyelid to measure how much tears you produce in 5 minutes.
• Tear breakup time test: A drop of dye is placed on your eye and you are asked to blink normally. Your doctor will observe how long it takes for your tear film to break up under a slit lamp.
• Osmolarity test: A device is used to measure the salt concentration of your tears. Higher osmolarity indicates more evaporation and inflammation.

How is dry eye syndrome treated?

The treatment for dry eye syndrome depends on the severity and cause of your condition. The main goals are to relieve your symptoms, restore your tear film and prevent further damage to your eyes. Some of the common treatments include:

Artificial tears

These are over-the-counter eye drops that mimic the natural tears and lubricate your eyes. You may need to use them several times a day depending on your needs.

Prescription eye drops

These are eye drops that contain medications that reduce inflammation, stimulate tear production or prevent tear evaporation. Some examples are cyclosporine, lifitegrast and xiidra.

Punctal plugs

These are tiny devices that are inserted into the openings of your tear ducts (puncta) to block the drainage of tears and keep them on your eyes longer.

Meibomian gland expression

This is a procedure that involves applying gentle pressure on your eyelids to squeeze out any clogged oil from your meibomian glands and improve the quality of your tears.

LipiFlow

This is a device that uses heat and massage to unclog your meibomian glands and restore their function.

Intense pulsed light (IPL)

This is a treatment that uses pulses of light to reduce inflammation and stimulate blood flow in the eyelids and meibomian glands.

Scleral lenses

These are large contact lenses that cover the entire eye surface and create a reservoir of fluid between the lens and the eye, keeping it moist and protected.

Surgery

In some cases, surgery may be needed to correct any eyelid problems that cause dry eye syndrome, such as ectropion (outward turning of the eyelid) or entropion (inward turning of the eyelid).

How can you prevent dry eye syndrome?

There are some steps you can take to prevent or reduce the risk of dry eye syndrome, such as:

• Avoiding dry, windy, dusty or smoky environments or wearing protective eyewear when exposed to them
• Using a humidifier or artificial tears to add moisture to the air and your eyes
• Blinking frequently and taking breaks from staring at screens or reading
• Drinking plenty of water and eating a balanced diet rich in omega-3 fatty acids
• Avoiding rubbing or touching your eyes
• Cleaning your eyelids and lashes daily with warm water and a gentle cleanser
• Removing your contact lenses before sleeping and following the instructions for cleaning and replacing them
• Having regular eye exams and following your doctor’s advice for treating any underlying conditions that may cause dry eye syndrome

Dry eye syndrome is a common and chronic condition that can affect your vision and quality of life. However, with proper diagnosis, treatment and prevention, you can manage your symptoms and keep your eyes healthy and comfortable.