Dry eye syndrome or keratoconjunctivitis sicca

Medical content revised by - Last revision 12/05/2022
Dry eye syndrome or keratoconjunctivitis sicca

What is it?

Dry eye syndrome is a common eye disease that occurs when there is a lack of lubrication and moisture on the surface of the eye, either because the tear is insufficient or of poor quality. The patient suffers discomfort such as itching, a feeling of sand in the eyes, eyestrain, blurred vision or photosensitivity. In the most severe cases, it can cause severe visual problems and even lesions on the ocular surface.

This condition, also known as keratoconjunctivitis sicca, is suffered by about 5 million people in Spain and about 100 million people worldwide. It usually appears in both eyes and is more frequent among women, especially beyond the age of menopause.

The origin of this discomfort is a malfunction of the meibomian glands located in the upper and lower eyelid. These sebaceous glands are the ones that secrete lipids that serve to moisturize and lubricate the eyes and, at the same time, prevent tears from evaporating the tear film that covers and protects the eye.

The ICR Cornea Department has the most innovative, safe and reliable technology for the proper diagnosis of dry eye and for the determination, in a personalized way, of the treatment required by each patient.


Symptoms

The symptoms of dry eye syndrome are, in addition to dry eyes:

  • Watery eyes, as the body’s response to dry eyes.
  • Burning, stinging or pins and needles sensation in the eyes.
  • Eye redness.
  • Heaviness in the eyelids.
  • Presence of a viscous mucus in or around the eyes.
  • Sensitivity to light (photophobia).
  • Sensation of having sand in the eye.
  • Blurred vision.
  • Visual fatigue that makes daily tasks such as reading or driving difficult.
  • Inflammation and irritation of the eyes.

These symptoms may worsen due to environmental factors and, in case of presenting any or several of them, it is necessary to see an ophthalmologist as soon as possible.


Causes and associated factors

Nowadays, dry eye affects a large number of people and is one of the most frequent disorders in ophthalmological consultations.

Although it can affect anyone, dry eyes are more common among women, especially beyond the age of menopause, or in people living in large cities where air pollution levels are higher. Some studies also show that in higher altitude areas, this condition is more common.

There are several factors associated with this syndrome:

    • Advanced age: as the years go by, the tear loses quality and does not hydrate the eye as it should.
    • Indoor environmental factors, such as the use of air conditioners, heaters, fans or hair dryers, which can dry the eye even more and should therefore be avoided as much as possible if you suffer from dry eye.
    • External environmental factors such as wind or pollution. As they are external agents and therefore cannot be avoided, for those who suffer from the disease, the use of sunglasses that protect the eyes is recommended.
    • Hormonal changes that mostly affect women (e.g. menopause).
    • Dermatological disorders, such as rosacea.
    • Frequent use of contact lenses.
    • Consumption of drugs such as antidepressants, anxiolytics, contraceptives or antihistamines.
    • Use of electronic devices for long periods of time.
    • Having undergone eye surgery, such as laser refractive surgery.
    • Frequent air travel.
    • Chemotherapy or radiotherapy treatment.
    • Poor eating habits.
    • Suffering from certain systemic or autoimmune diseases such as diabetes, fibromyalgia, lupus, rheumatoid arthritis, etc.
    • Eyelid problems, such as blepharitis.

Types

There are mainly three types of dry eye: 

  • Acuodeficient: Deficiency of one of the layers of the tear film (the aqueous layer) causes the eye to not produce an adequate amount of tears. 
  • Evaporative: The problem is not tear production but rather the excessively rapid evaporation of tears. In other words, the amount of tears is normal but, due to the lack of the lipid layer of the tear film, the tears evaporate too quickly, resulting in dry eye. 
  • Mixed: The patient has both a deficiency of the aqueous layer and the lipid layer. This is the most common type.

Diagnosis

The main problem for the diagnosis of this syndrome is that it presents a very generic picture of symptoms, which could be associated with other common conditions such as an allergy or simply the aging of the person. For this reason, the diagnosis of the disease may be delayed until a thorough study of the symptoms, the composition of the tears and the functioning of the meibomian glands is completed.

Some of the diagnostic tests to be performed are:

  • Analysis of blink frequency and tear production and quality.
  • Meibography or imaging of the Meibomi’s glands of the upper and lower eyelid to check their condition.
  • Anterior segment photograph of the palpebral margin
  • Contrast study to verify the status and sensitivity of the cornea.
  • Biopsy of the eye surface.
  • Blood test to rule out an associated immune disease.

Treatment

As it is a chronic disease, the treatment for dry eye is personalized and long term, and requires an individualized assessment of each case and the study of the patient’s history.

It is relatively common for patients to feel that none of the treatments applied brings relief of symptoms, despite following all the guidelines indicated by the specialist. This is due to the fact that in many cases finding the best treatment may require a combination of different therapies and a continuous follow-up, as well as a change of habits, either in the diet or in the environment in which the patient moves.

The main and most innovative treatment for dry eye today is Intense Pulsed Light (IPL), which involves the application of thermal pulses around the eye to stimulate the Meibomian glands, restore their normal function and reduce inflammation.

IPL treatment is a specific solution that leaves behind generic treatments by acting on the focus of the problem with the following effects:

  • Reduction of inflammation of the eye surface.
  • Recovery of the usual flow of the eye to avoid tear evaporation.
  • Elimination of the abnormal veins surrounding the Meibom’s glands, thus reducing much more the possibility of recurrence of the attachment.
  • Improved blood circulation
  • Stabilization of the conjunctival flora.

IPL thermal stimulation improves tear composition and therefore also the patient’s quality of life by reducing redness and gritty sensation, increasing comfort when using screens and computers and reducing the need for artificial tears.


Intense Pulsed Light (IPL) treatment session at the Insitut Català de Retina. Patient and assistant have to use protective glasses during the treatment. Photo: J. Casanova / ICR.


It can also be combined with other generic treatments, which usually include:

  • Proper eyelid hygiene. In this way, excess secretions that can cause other associated eye conditions (blepharitis) are eliminated.
  • Use of artificial tears. This type of treatment will help keep the eyes moist and lubricated.
  • Use of anti-inflammatory or antibiotic eye drops and/or corticosteroids.
  • Exfoliation of the eyelids to remove debris caused by flaking and bacteria that have accumulated due to lack of tears.
  • Probing of the Meibomi glands to open the tear duct and remove accumulated secretions.
  • Blocking of the tear ducts with the insertion of silicone/ice plugs in the tear duct to allow natural tears to remain in the eye longer.

Tips to prevent dry eye

To avoid and/or alleviate the risk factors that cause dry eye syndrome, we can take a series of precautionary measures:

  • Use of artificial tears, which can be purchased without a prescription. Normally they can be administered as many times as necessary, although it is necessary to check the administration guidelines for each type of drops before administration. If they are expected to be used more frequently than every two hours, the use of preservative-free artificial tears is preferable.
  • Application of lubricating gels, somewhat thicker than artificial tears. However, as they are thicker, they may impair vision, so it is recommended to apply them at bedtime.
  • Avoid air movements, whether natural from the external environment, such as the wind, or those caused by appliances such as fans or hair dryers, as they can dry the eyes even more. If the agent that causes it is external and cannot be avoided (wind), it is recommended to wear wraparound sunglasses that protect the eyes.
  • Use of humidifiers. Air conditioners and heating can cause increased dryness, so the use of humidifiers can reduce the dryness of the environment and alleviate some of the symptoms.
  • Let your eyes rest. If reading or watching TV aggravates dryness symptoms, you need to take breaks to rest your eyes and blink more frequently to regain lost moisture.
  • Avoid tobacco smoke. The reasons to stay away from tobacco are countless, and one of them is that it can irritate dry eyes and, in fact, is one of the factors that increases the risk of suffering from this condition.
  • Applying warm compresses to the eyes and gently cleansing the eyelids with specific soaps can help release the oil that accumulates in the glands of the eyelids, which can improve the quality of tears. It is necessary to rinse off the soap completely after cleansing is complete.
  • Including omega-3 fatty acid supplements in the diet can alleviate, in some cases, the symptoms of dry eyes. This component can be found naturally in oily fish (salmon, sardines, anchovies) and flaxseed. Consult your ophthalmologist to find out if it would be advisable to take omega-3 fatty acid supplements and in what form and dosage.

In any case, it will always be necessary to see an ophthalmologist to establish a personalized treatment if you notice any symptoms or discomfort in your eyes.

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