Dry eyes are a common cause of presentation for MECS (Minor eye conditions service) appointments, with a wide variation in patient symptoms.
Mostly but not exclusively: gritty or foreign body (something in the eye),
Itching, burning or red eyes worsening throughout the day,
Blurred vision – more frequently when reading or concentrated tasks,
Watery eyes – worse during windy or air-conditioned environments,
Generally, in both eyes – usually one eye is worse than the other.
There are a wide range of factors that predispose a person to dry eyes; women are more likely to be affected by dry eyes more than men and is also more common in the later decades.
Systemic illnesses such as thyroid disease or arthritis and other inflammatory conditions can make a person more likely to struggle with dry eyes, other atopic conditions such as psoriasis, rosacea and eczema may also increase symptoms in some patients. Along with contact lens wear – particularly in patients who over wear their lenses.
Patients under treatment with topical eye medications long term may have also experience an increase in dry eye symptoms over time, where possible patients should be offered preservative free treatments to reduce this.
Dry eyes can be roughly split into 2 categories: Aqueous dry eye deficiency and Evaporative dry eye.
Aqueous dry eye deficiency is where the gland producing the watery component of the tear film is not producing sufficient fluid to adequately cover the eye surface leading; in severe cases this may be diagnosed as Sjogren syndrome if associated with rheumatic conditions.
Evaporative dry eye is where there is enough fluid to cover the eye being produced but it is not retained on the eye surface, this may be due to the top oily layer of the tears being deficient. This can be associated with blepharitis.
Several treatment options are available in practice such as Eyebag hot compress and lid massage which can help to improve the quality of the oily layer of tears and therefore reduce symptoms. Various tear supplements are available for day and night use, gels are predominantly used at night to help stop evaporation whilst sleeping. Lipid sprays can be useful for patients with evaporative dry eye during the day also. Regardless of the method of treatment chosen these should be preservative free.
Other treatments include blocking the drainage channels in the corner of the eyes to ensure tears stay in the eyes.
In severe cases once these options have been exhausted it may be necessary to refer patients the hospital eye service for further treatment options.
It is important for patients with dry eye to understand that this would be a life-long treatment as in most cases dry eye symptoms will return if the patient stops the recommended treatment, this should become a part of a patients daily routine.