Dry Eye

What is Dry Eye?

What is Dry Eye?

Dry eye syndrome is a common condition that affects millions of people around the globe—women more often than men. It is characterized by dry, irritated eyes when the tears are not able to provide adequate lubrication for the eyes. Surprisingly, it can also be a result of excessively watery eyes due to tears lacking the proper balance of mucin, water and oil to coat the eyes properly. Chronic dry eye can lead to damage of the eye’s surface, an increased risk of eye infections, and, if left untreated, severe forms of dry eye can even deteriorate your vision

Dry Eye Symptoms When to see a doctor?

Causes of Dry Eye

There are a variety of reasons that cause the disturbance of the natural healthy tear film. This tear film is made of three layers: fatty oils, water, and mucin. Its natural combination normally keeps the surface of our eyes lubricated, smooth, and clear. Any problem with any of these layers can cause dry eyes. Reasons for this tear film dysfunction can be categorized as either decreased tear production or increased tear evaporation

Tear Production

Decreased Tear Production may be due to:

  • Aging
  • Certain medical conditions such as: Sjorgen’s syndrome, allergic eye diseases, rheumatoid arthritis, lupus, scleroderma, graft vs. host disease, sarcoidosis, thyroid disorders or vitamin A deficiency
  • Certain medications including antihistamines, decongestants, hormone replacement therapy, antidepressants, and drugs for high blood pressure, acne, birth control and Parkinson’s disease
  • Contact lens usage, history of laser eye surgeries, though symptoms may be usually temporary
The Tear Film

Increased Tear Evaporation may be due to:

  • Blocked Meibomian Glands
  • Blinking less often like in Parkinson’s disease or due to excessive concentration during certain activities such as, reading, driving or working at computer or any digital gadgets
  • Eyelid problems, such as turning in or out of the lids
  • Eye Allergies
  • Preservatives in topical eyedrops
  • Wind, smoke or dry air
  • Vit A deficiency

Risk Factors for Dry Eye


People who have dry eyes may experience these complications

Eye Infections

Eye Infections

Your tears protect the surface of your eyes from infection. Without adequate tears, you may have an increased risk of eye infection

Damage to the Surface of your Eyes

Damage to the Surface of your Eyes

If left untreated, severe dry eyes may lead to eye inflammation, abrasion of the corneal surface, corneal ulcers and vision loss

Damage to the Surface of your Eyes

Damage to the Surface of your Eyes

Dry eyes can make it difficult to perform everyday activities, such as reading

20-20-20 Rule Dry Eye Prevention


Tests and procedures that may be used to determine the cause of your dry eyes include:

Digital Phoropter

Comprehensive Eye Exam

An eye exam that includes a complete history of your overall health and your eye health can help your doctor diagnose the cause of your dry eyes

Filter Paper

Measuring the Volume of Your Tears

Your doctor may measure your tear production using the Schirmer test. In this test, blotting strips of paper are placed under your lower eyelids. After five minutes your doctor measures the amount of strip soaked by your tears

Another option for measuring tear volume is the phenol red thread test. In this test, a thread filled with pH-sensitive dye (tears change the dye color) is placed over the lower eyelid, wetted with tears for 15 seconds and then measured for tear volume

Fluorescein Dye

Determining the Quality of Your Tears

Other tests use special dyes in eyedrops to determine the surface condition of your eyes. Your doctor looks for staining patterns on the corneas and measures how long it takes before your tears evaporate

Corneal Analyzer

Dry Eye Analysis Tools

A state of the art corneal analyzer instrument comes with an extensive collection of tools to analyze dry eyes

  • TBT (non-invasive tear break-up time - NIBUT)
  • Blink analysis
  • Meibomian Gland analysis (area of loss)
  • Tear Meniscus height measurement
  • Fluo imaging (Conjunctival and corneal staining)

Tear Osmolarity Test

This type of test measures the composition of particles and water in your tears. With dry eye disease, there will be less water in your eyes


Tear Samples

Tear samples to look for markers of dry eye disease, including elevated matrix metalloproteinase-9 or decreased lactoferrin

Treatment and Management of Dry Eye

Treatment and Management

  • Artificial tears - These can be used as often as needed to supplement natural tears production. Preservative free artificial tear solutions are more recommended since they have no or fewer additives that could further irritate the eyes
  • Artificial tear ointments - Using an ointment right before bed will keep the eye lubricated during the night. Ointments will blur the vision, hence it is not recommended on daytime
  • Warm Moist compresses - Using a warm moist compress will help open up tear producing glands in the eyelids which allows you to produce better quality tears
    • Wet washcloth with warm water (you may need to reheat the washcloth)
    • ThermalOn eye mask - a microwavable eye mask
  • Lid massage - After the warm moist, roll your finger towards the lid margin to help clear the clogged tear glands in the eyelids
  • Omega 3 supplements - Some studies show that these can help improve the dry eye symptoms
  • Lid hygiene - A mild baby shampoo or an OTC lid scrub may be used with a cotton pad in cleaning/washing the lid margin at the base of the lashes. Then rinse well