Dry Eye Disease and Treatment
Dry eye · Meibomian gland dysfunction · Punctal plugs · Prof. Dr. Fırat Helvacıoğlu, FEBOS-CR · Veni Vidi Eye Clinic, Caddebostan – Kadıköy, Istanbul
Dry eye is a chronic disease in which disruption of the tear film causes burning, stinging, grittiness, blurred vision and, paradoxically, watering. Its most common cause is blockage of the meibomian glands in the eyelids. Our dry eye treatment combines preservative-free artificial tears, lid care, anti-inflammatory drops and, when necessary, punctal plugs, and we tailor it to each patient.
What is dry eye?
Dry eye (dry eye disease) is a chronic, multifactorial disease in which disruption of the tear film leads to irritation, inflammation and fluctuating vision at the ocular surface. The international TFOS DEWS II report links the disease to tear film instability, increased tear saltiness (hyperosmolarity), surface inflammation and nerve changes.
Its prevalence ranges from 5% to 50% depending on the population studied; it increases with age and is more common in women. Prolonged screen use, air-conditioned environments and contact lens wear worsen symptoms.
What causes dry eye? Tear film illustration
Shows the layers of the tear film and the balance that is disrupted in dry eye.
- Healthy tear filmThe tear film has three layers: lipid on top, an aqueous layer in the middle and mucin, which helps it adhere to the surface.
- Dry eyeThe aqueous layer decreases or the lipid layer is disrupted; tears evaporate quickly and the surface dries out and becomes irritated.
- Meibomian gland obstructionWhen the oil glands in the eyelids become blocked, the lipid layer of the tear film is depleted; this is one of the most common causes of dry eye.
- TreatmentArtificial tears, lid hygiene and warm compresses, anti-inflammatory drops and, when necessary, tear duct plugs (punctal plugs) are planned together.
Symptoms
- Burning, stinging, grittiness and a foreign-body sensation
- Blurred vision that fluctuates during the day or improves with blinking
- Redness, light sensitivity, eye strain
- Paradoxical watering: The drying ocular surface reflexively produces excessive tears
- Contact lens intolerance; tiring quickly at the screen
Causes and types
- Evaporative dry eye (most common): Blockage of the meibomian glands in the eyelids (blepharitis and meibomian gland dysfunction) reduces the protective lipid layer of the tear film.
- Aqueous tear deficiency: Age, menopause, Sjögren’s syndrome and rheumatic diseases, and certain medications (antihistamines, antidepressants, blood pressure medications, isotretinoin).
- Environmental and lifestyle factors: Screen use (blinking decreases), air conditioning, wind, cigarette smoke, prolonged contact lens wear.
- After eye surgery: Temporary dryness may occur after laser eye surgery, cataract or eyelid surgery, which is why we assess the ocular surface before surgery.
Diagnosis before dry eye treatment
The examination assesses tear break-up time (TBUT), surface staining (fluorescein and lissamine green), tear volume (Schirmer test), the lid margin and the meibomian glands; when necessary, tests such as meibography and tear osmolarity determine the type and severity of the disease.
Dry eye treatment
In addition, we plan treatment in steps according to the individual and the type of disease:
- Basic measures: Preservative-free artificial tear drops and gels, screen breaks (the 20-20-20 rule), humidifying the environment, avoiding smoke.
- Lid care: Warm compresses, lid massage and lid hygiene to open the meibomian glands.
- Anti-inflammatory treatments: Immunomodulatory drops such as ciclosporin, short courses of mild corticosteroid drops and, when necessary, oral antibiotics (doxycycline/azithromycin).
- Preserving tears: We insert small plugs (punctal plugs) into the tear ducts so that tears stay on the eye longer.
- Advanced treatments: Autologous serum drops, device-based meibomian gland treatments and treatment of any underlying systemic disease.
Despite the widespread use of omega-3 supplements, the DREAM study of 535 patients found that 3 g of omega-3 daily for 12 months provided no significant benefit over placebo; we therefore consider supplements on an individual basis.
Everyday tips that support dry eye treatment
- Position your screen slightly below eye level; every 20 minutes, look 6 metres (20 feet) away for 20 seconds and blink deliberately.
- Do not direct air-conditioning or heating vents towards your face; use a humidifier if needed.
- Wear wraparound sunglasses in windy and sunny weather.
- Drink enough water and pay attention to your sleep routine.
- If you use drops frequently, choose preservative-free (single-dose) products.
Frequently asked questions
Dry eye is often a chronic condition; however, the right treatment and daily measures can largely control the symptoms.
You can also use preservative-free artificial tears as often as needed during the day. Using drops containing preservatives more than 4–6 times a day can irritate the ocular surface.
Yes. A drying ocular surface can reflexively produce excessive tears. Also, we distinguish the cause of watering at examination; tear duct obstruction can cause similar symptoms.
Significant dry eye needs treatment first. Once the ocular surface has improved, we can plan laser surgery with a suitable method; some methods are more favourable in terms of dry eye.
We insert it in a few minutes in the clinic with anaesthetic drops; most patients feel no pain, and it can be removed if necessary.
If artificial tears do not relieve your burning, stinging, redness, blurred vision or light sensitivity within a few days, you need an examination. However, if you have pain, marked redness or a sudden decrease in vision, you should see an eye doctor without waiting.
Mild to moderate dry eye mostly does not permanently impair vision. If dry eye goes untreated, it carries a risk of ocular surface irritation and damage to the corneal surface. Therefore, doctors recommend an examination and regular follow-up if symptoms persist.
You blink less when you look at a screen. Prolonged contact lens wear also carries a risk of drying the ocular surface. However, taking regular breaks and increasing the humidity in your environment help relieve symptoms. If you wear contact lenses, you should review the lens type with your doctor.
References
- Craig JP et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15(3):276–283. doi:10.1016/j.jtos.2017.05.008
- Stapleton F et al. TFOS DEWS II epidemiology report. Ocul Surf. 2017;15(3):334–365. doi:10.1016/j.jtos.2017.05.003
- Jones L et al. TFOS DEWS II management and therapy report. Ocul Surf. 2017;15(3):575–628. doi:10.1016/j.jtos.2017.05.006
- Dry Eye Assessment and Management Study Research Group; Asbell PA et al. n-3 fatty acid supplementation for the treatment of dry eye disease. N Engl J Med. 2018;378(18):1681–1690. doi:10.1056/NEJMoa1709691
- Nichols KK et al. The international workshop on meibomian gland dysfunction: executive summary. Invest Ophthalmol Vis Sci. 2011;52(4):1922–1929. doi:10.1167/iovs.10-6997a
- Helvacıoğlu F. Cornea and ocular surface diseases. In: Oruçoğlu F, ed. Güncel ve Özet Oftalmoloji. 2018:55–125 (in Turkish). ISBN 978-605-7993-19-9.
This page offers patient information and does not replace an examination or medical assessment. For this reason, we determine the treatment that is right for you after an eye examination and measurements.
Dry eye assessment
Prof. Dr. Fırat Helvacıoğlu · Veni Vidi Eye Clinic, Bağdat Caddesi No: 257, Caddebostan – Kadıköy, Istanbul, Türkiye
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