It is estimated that 49 million Americans have dry eyes, and the number continues to rise.

Dry eye is a progressive and chronic condition that can cause severe permanent damage if untreated. As our society becomes more dependent on digital screens, the prevalence of dry eye is increasing as well. Fortunately, dry eyes can be managed and controlled.

Symptoms

The severity of symptoms can range from mild to moderate to more severe. Some symptoms of dry eyes include

• Grittiness in your eyes
• Watery eyes
• Foreign body sensation
• Eyes may feel scratchy
• Irritation in eyes
• Difficulty/ discomfort wearing contact lenses
• You may have excessive tearing and watering
• You may experience decreased vision and your vision may fade in and out of focus because the front surface of your eye is not properly lubricated.

Causes

Dry eyes can be caused by many different factors, including:

• Computer & Phone Use: Staring at a computer screen for too long and not blinking enough. As a result of not blinking enough, the front surface of your eye is not as lubricated, making it feel dry.
• Weather: If you are exposed to extreme weather conditions, or particularly in the winter when the wind is blowing, it may cause your eyes to feel dry. If you are in a dry environment, it may also cause your eyes to feel dry.
• Heater & Air Conditioning: When the heaters are on, the air really dries out, causing your eyes to dry out as well. Furthermore air conditioning works by reducing the humidity in the air, which may contribute to dry eye symptoms if the cause of your symptoms is evaporative dry eye.
• Medical Conditions: If you suffer from conditions like menopause, sjogren's syndrome, rheumatoid arthritis, lupus, scleroderma, graft vs. host disease, sarcoidosis, thyroid disorders or vitamin A deficiency
• Medications: Certain medications can cause dry eyes, such as accutane, anti anxiety, antidepressants such as Adapin and Paxil, Acne medication, Allergy Medication, birth control, pain killers, beta blockers, birth control pills, proton pump inhibitors such as prilosec and nexium, and diuretics. Consult your primary care physician before stopping any of these medications because the benefits may outweigh any potential side effects of dry eyes.
• Eye Conditions: Dry eye can be caused by blocked meibomian glands, which are the oil glands that provide the lipids for our tear film. Another cause of dry eye symptoms is blepharitis which are mites in the lashes.

How is Dry Eye Diagnosed?

A thorough dry eye evaluation usually detects dry eyes. You would be examined by your eye doctor by going through a detailed symptoms worksheet discussing your symptoms, if you experience any of the symptoms associated with dry eyes, before you'd be put under a microscope to assess the front surface of your eyes. In addition to your lid, your lid margin is also examined, since on your lid margin are the oil glands that produce the oil that forms the outermost film of your tears, and it protects the aqueous layer of your tear film. In some cases,some of your glands may not produce enough oil, which could result in your tears evaporating faster, causing dry eyes. Different stains are used to examine the front part of your eye. The most common one is sodium fluorescein stain, which is an orange dye that reflects green light. It allows your eye doctor to see the front surface of your eye clearly, checking the breakup time of your tears and if there are any dry spots. There are various tests available to determine the volume of your tear layer and film, and if any of those values are unusual, then you may have dry eyes.

How is Dry Eye Treated?

Dry eyes are treated differently depending on the type of dry eye, either aqueous or evaporative, as well as the severity of the dry eyes.

Treating Mild Dry Eye

In milder cases, it is recommended that patients start applying warm compresses over their eyes twice daily for about 10 minutes followed by gentle massage and eye lid scrubs. This works by freeing up the clogged meibomian glands (heat and massage) as well as cleaning any debris or mites (scrubs).  A common eye mask is the bruder eye mask, however there are many options available. In addition to the warm compresses your eye doctor will recommend the type of drops that you should use. It is important that you use the right type of eye drop depending on the type of dry eye that you have.  You should also lubricate your eyes with some over-the-counter artificial tears two to four times a day.

Treating Moderate to Severe Dry Eye

If this initial treatment does not work, a prescription of eye drops called Restasis, or Xiidra, might be given. This is because dry eyes are a multifactorial disease process that causes instability in the ocular surface. In addition to the symptoms of dry eye, the condition causes inflammation which can lead to ocular damage to the front part of your eye. Restasis and Xiidra are prescription eye drops that tackle the inflammatory component of your dry eyes to help alleviate the symptoms and reduce risks of damage.

Punctal plugs are another treatment option. There are four drainage systems in our eyes, two on the bottom and two on top, which help drain our tears. These Punctal plugs partially block your drainage areas. The plugs are usually placed on the two bottom drainage ducts so that your tears can flow to the front surface of your eye and remain lubricated.

In the event, none of these treatments help, or if you're not so consistent with using those warm compresses every morning and night, there are other in-office treatments that remove the blockage in your meibomian glands, such as LipiFlow, iLux, Miboflow, and TearCare.

For more severe dry eye there is a specialized treatment called Amniotic Membranes which are ethically derived stem cell based ocular bandages that transfer regenerative nutrient rich tissue to the front surface of your eye. This treatment is often recommended when other treatment has been tried and is not effective or if the patient has severe corneal scarring in addition to their dry eye symptoms.