Understanding Dry Eye Syndrome: Symptoms, Causes, and Management

By Dr. Adeline Goh, Buckhead Eyecare

Dry Eye Syndrome (DES), also referred to as keratoconjunctivitis sicca, is a common yet often underdiagnosed condition affecting millions of people worldwide. Many cases remain undiagnosed because symptoms can overlap with other eye conditions, such as allergies or infections, leading to misdiagnosis and sometimes mismanagement. Additionally, patients may dismiss symptoms as minor irritations or signs of aging rather than seeking medical evaluation. Routine eye exams frequently emphasize visual acuity, overlooking tear film stability unless patients specifically report discomfort. As a result, mild cases may go untreated until symptoms become more severe.

After years of clinical experience in diagnosing and managing ocular surface disorders, I frequently encounter patients experiencing symptoms of dry eye. Many patients do not come in with this as their chief complaint. It's only after targeted questions and diagnostic testing that we are able to uncover the source of their discomfort and decrease in their visual acuity. 

Due to environmental and genetic factors, I too am personally affected by dry eye so I can empathize with the frustration and quest to seek relief. This blog post outlines the symptoms, causes, and evidence-based strategies for managing dry eye. Disclaimer: This excerpt is intended to educate and provide helpful knowledge; it does not replace a full comprehensive evaluation and examination. 

Symptoms of Dry Eye

The symptoms of dry eye can vary in severity, but common complaints include:

1. A stinging, burning, or scratchy sensation in the eyes

2. Redness or irritation, especially in windy or dry environments

3. Sensitivity to light (photophobia)

4. Blurred vision or difficulty focusing, which is sometimes worse at the end of a long workday. 

5. A sensation of something being in the eye (foreign body sensation)

6. Excessive tearing (paradoxical response to dryness)

7. Discomfort while wearing contact lenses, some patients even stop using their contact lenses all together 

What Causes Dry Eye?

Dry eye occurs when there is an imbalance in the tear film, which consists of three layers: oil, water, and mucus. Disruption in any layer can lead to tear instability and evaporation. Common causes include:

1. Aging – Tear production tends to decrease with age, particularly in individuals over 50 (Lemp, 2008).

2. Hormonal Changes – Women are more prone to dry eye, especially during pregnancy, menopause, or while using oral contraceptives.

3. Environmental Factors – Exposure to wind, smoke, and dry climates can accelerate tear evaporation.

4. Screen Time – Prolonged use of computers, smartphones, and tablets reduces blink rates, leading to insufficient tear distribution (Rosenfield, 2011). And in this day and age, who isn't on their screens for an unusually long period of time?

5. Medications – Antihistamines, decongestants, antidepressants, and blood pressure medications can reduce tear production.

6. Medical Conditions – Autoimmune diseases such as Sjögren’s syndrome, rheumatoid arthritis, and lupus often contribute or make one more prone to dry eye.

7. Contact Lens Use – Long-term use of contact lenses can disrupt tear production and eye surface integrity. This is exacerbated if patients overwear or improperly use their contact lenses. 

Management Strategies for Dry Eye

1. Artificial Tears and Lubricants

   Over-the-counter artificial tears can help supplement natural tear production. Preservative-free formulations are recommended for frequent use. I always have a conversation with patients on the specific type of over-the-counter drops that will be the most helpful, as there is often a lack of information out there on which eyedrops to choose. 

2. Lifestyle Modifications

   Take regular breaks during screen time to reduce eye strain (20-20-20 rule: every 20 minutes, look at something 20 feet away for 20 seconds).

   • Use a humidifier to maintain moisture in indoor environments.

   • Wear wraparound sunglasses to protect against wind and sun exposure.

   • Some patients suffer from mild corneal exposure at night due to a lack of lid rigidity. This exposure can desiccate the eyes as well, so I recommend a night mask to provide additional coverage and physically keep the eye lids closed all the way. 

3. Nutritional Supplements

   • Research suggests that omega-3 fatty acids can improve tear quality. A 2019 meta-analysis (Liu & Ji, 2019) found that omega-3 supplementation significantly reduced symptoms in dry eye patients.

   • Also ensuring one is properly hydrated can be a simple and impactful way to help reduce dryness. 

4. Prescription Medications

   • Immunomodulator eye drops, such as cyclosporine (Restasis) and lifitegrast (Xiidra), target inflammation and enhance tear production. 

   • Tear production enhancers like Tryvaya nasal spray can also specifically trigger and target increased tear production by activating the nerve responsible for tearing. 

   • Anti-inflammatory eye drops such as loteprednol (Eysuvis or Lotemax) can sometimes be used for the short term after careful examination to help kickstart relief for a patient suffering from dry eye.  

5. Punctal Plugs

   • For severe cases, punctal plugs can be inserted into tear ducts to reduce drainage, preserving moisture on the eye surface.

6. Thermal Therapy and LipiFlow

• For patients with Meibomian Gland Dysfunction (MGD), thermal therapies like LipiFlow help unclog oil glands, improving tear film stability (Lane et al., 2012).

Prognosis and Clinical Recommendations

Left untreated, chronic dry eye can lead to complications such as corneal ulcers and scarring, impacting vision and quality of life. Timely intervention, supported by evidence-based treatments, ensures better outcomes and long-term ocular surface health and overall better comfort and clarity. 

If you’re experiencing symptoms, schedule an appointment today to receive a comprehensive evaluation.

References

• Lemp, M. A. (2008). Advances in understanding and managing dry eye disease. American Journal of Ophthalmology, 146(3), 350-356.

• Rosenfield, M. (2011). Computer vision syndrome: a review of ocular causes and potential treatments. Ophthalmic and Physiological Optics, 31(5), 502-515.

• Liu, A., & Ji, J. (2019). Effects of omega-3 fatty acids on dry eye syndrome: A systematic review and meta-analysis. Cornea, 38(6), 765-773.

• Lane, S. S., et al. (2012). A new system, the LipiFlow, for the treatment of Meibomian Gland Dysfunction. Cornea, 31(4), 396-404.