Blurred, Burning, & Over It: Understanding Dry Eye

Blurred, Burning, and Over It

Understanding dry eye and how to treat it

Written by Mimi Greenwood Knight

“I’ve gotta live with my dry eye. There’s nothing I can do about it.”

“Dry eye is just a sign I’m getting older.”

“The only thing that can help is eyedrops.”

Optometrist Laura Agnew hears statements like this all the time. “We used to see dry eye mostly in white women over fifty. Now we’re seeing it at younger and younger ages,” she said. “Screen time is one culprit. We tend to blink less often when we’re online, and blue light can add to dryness. We also see it in longtime contact wearers and in men who’ve worked for years outdoors in the sun.”

It frustrates Dr. Agnew and others in her profession to know their patients can get new teeth or even new organs, but you can’t get new tear glands to alleviate dry eye. “Your tears are made in the stem cells of your corneas, but they’re expressed through glands in your eyelids,” she said. “Dry eye can occur when these glands malfunction or don't produce enough oil.” Our tears consist of three layers: oil, water, and mucus. While our main tear glands, located above our eyes, produce the watery layer, Meibomian glands, located along the eyelid margins, produce an oily substance that forms the outer layer of the tear film. The watery layer lubricates and nourishes our eyes while the oily layer helps prevent the watery layer from evaporating, and a mucin layer helps the tears spread evenly over the surface of the eye. It’s a great system, when it’s working.

Dry eye occurs when either the Meibomian gland is not producing enough oil or the oil it does produce is of poor quality. This is called Meibomian gland dysfunction (MGD).

Dr. Agnew points to other potential culprits. “In South Louisiana, we love sleeping under ceiling fans, but ceiling fans can dry out our eyes, especially as we age and our eyelids become lax,” she said. “Our lids are basically like Ziploc bags that seal our eyes and keep them moist. As we get older, they don’t do this as well.” There are also some seasonal allergies that can exacerbate dry eye leading to a gritty or scratchy sensation, burning, or excessive tearing. But if you suffer with dry eye, we don’t have to tell you that.

What Can Be Done

So, what can bring relief? One easy fix, Dr. Agnew says, is to cut back on caffeine. “Caffeine is a diuretic. Diuretics can lead to dehydration, reduce tear production, and contribute to dry eyes. Before we resort to a prescription, let’s look at lifestyle changes. If you’re drinking caffeinated drinks all day, let’s try cutting back. And maybe switch to a box fan instead of a ceiling fan.”

There are also lubricating eye gels, such as Genteal and Systane, that when applied to the eyes at night allow you to start the day with well-lubricated eyes. “Gels also prevent the lid from sticking to the cornea and ripping off the top layer when you wake up,” Dr. Agnew said.

Once these simple strategies have been exhausted, if you’re not finding relief, your optometrist can talk to you about prescription options, steroid drops, even drops that are formulated from your own platelets. Intense Pulsed Light (IPL) therapy, which is offered locally at the Dry Eye Spa at Eye Wares in New Orleans, Metairie, and Mandeville, is a dry eye treatment that utilizes pulses of light to improve the function of the all-important meibomian glands. This is especially helpful if your problem is determined to be related to ocular rosacea.

Dr. Agnew also encourages patients who wear contact lenses to opt for the daily over the monthly because the monthly can damage your glands. “Keep a good, preservative-free eye drop next to your toothbrush and use it every time you brush your teeth,” she said. “Keep another at your desk and another where you sit to watch TV. Think of it like ChapStick for your eyes.”

“Now that people are living longer, it means they might live with dry eye for decades,” Dr. Agnew said. “Fortunately, we’re learning more about the condition every day. There are more options for treating it and more knowledge about how to ward it off or reduce symptoms.”