Managing Dry Eyes

Edited by Mirabella Chan

Working from home has become the new normal for many of us, but it has increased the number of people experiencing dry eyes.

Dry eyes occur when there is a loss of homeostasis in the natural tear film of the eye – that is, when there is an issue of tear quality or tear quantity. Tears are naturally produced and regulated by the tear glands, eye surface, eyelids, and all associated nerves. Together, these components are known as the lacrimal functional units of our eyes. If any one of these units is thrown off balance, our tear composition is no longer suitable to keep our eyes moist and comfortable. In addition, many people are not able to make enough tears to keep their eyes moist, and this reduced number of tears also leads to dry eyes.

Dry eyes can be caused by many different factors. Continuously looking at a screen, such as a computer or smartphone, has been causing more dry eyes lately than anything else. We tend to blink less when we are concentrating on a screen, and as a result, we don’t lubricate our eyes with tears as often as they need, leading to dry eyes. Environmental factors, such as the wind, low humidity, and high temperatures, can also cause dry eyes. Other factors that can cause dry eyes include certain medications (including oral birth control, allergy medications, and antidepressants), rosacea, diabetes, thyroid disease, Sjogren’s syndrome, and increasing age.

Symptoms of Dry Eyes

Since there are so many factors that can contribute to dry eyes, it makes sense that dry eyes do not present the same way in each person. Some people may feel a grittiness in their eyes – almost as if they have a grain of sand stuck in there. It is also not uncommon to feel burning, stinging, or scratchiness in the eyes. Dry eyes can also cause painful blinking, redness of the eyes, or even a sudden change in eyesight.

Perhaps the oddest symptom of dry eyes is the excessive tearing that they may cause. Some people feel as if their eyes produce more tears when they are in situations that dry their eyes. It is important to note that dry eyes can be an issue of tear quality or tear quantity. As a result, even with the excess tearing, many people do not feel that their dry eyes are relieved.

Although these symptoms may only be present in one eye, it is more common for dry eyes to affect both eyes.

Products Used to Relieve Dry Eyes

There are many different products that can be picked up at the pharmacy that are effective in reducing the symptoms of dry eyes. Products that are used to relieve dry eye symptoms are often referred to as ocular lubricants, or artificial tears. These products replace the natural tear film to provide relief. Many brands offer these products, such as Systane, Refresh, TheraTears, HydraSense, Visine, and Bausch&Lomb. Ultimately, product choice comes down to personal preference; however, it is important to know the different conditions and limitations of each product to make the best selection:

Lubricant Eye Drops

Eye drops are very commonly used. They are very user-friendly and are available in many different packaging forms, making self-selection easy. 1-2 drops are instilled into each eye when needed. Holding the eye shut and applying gentle pressure at the corner of the eye (where the eye meets the nose) after administering the drops allows for the best absorption and action of the eye drops.

Some eye drops contain preservatives such as benzalkonium chloride, EDTA, or lanolin. These preservatives allow eye drops to have a long shelf life, but they can cause eye irritation, and may even worsen the dry eye. If eye drops are being used more than 4 times per day, it is best to avoid eye drops with these preservatives and stick to preservative-free eye drops. Preservative-free eye drops are available as single use minims, or in specialty packages to protect the drops from contamination.

Lubricant Eye Gels

Eye gels serve as artificial tears, but have the added benefit of providing a protective film over the eye. Eye gels are applied to the inside of the lower eyelid. They tend to be very viscous, or thick, and provide a longer duration of action. Due to their thickness, they are best used at night since they can cause blurry vision.

Oils (Castor Oil, Mineral Oil)

Oils can be used in the eye to prevent the evaporation of tears. Some eye drops are formulated with oils to provide maximal relief of dry eyes. Only use oils in the eyes if they are advertised as being formulated for the eyes. Do not use oil that is also used in the kitchen, as this oil can be contaminated and irritate or infect the gentle surface of the eye.

Restasis (prescription only)

Restasis, also known as cyclosporine, is used as a lifelong therapy for dry eyes. Although it is unknown exactly how it works, it most likely increases mucin production in the eye. Mucin keeps the eye surface hydrated and moist; therefore, increasing mucin production relieves dry eye symptoms.

Xiidra (prescription only)

Xiidra, also known as lifitegrast 5%, is used as a lifelong therapy for dry eyes. Xiidra inhibits inflammation in the eye, causing relief of dry eye symptoms.

Other Methods of Relieving Dry Eyes

There are plenty of strategies that can be tried at home to relieve the symptoms of dry eyes.

A warm compress can provide some relief, especially if dry eyes are caused by environmental factors. Place a warm compress on the eyelids for 5-10 minutes at a time and repeat as many times as needed.

Some lifestyle modifications can relieve dry eyes and prevent dryness from recurring. Using a humidifier, maintaining proper hydration, and avoiding excessive heat and smoke can reduce the likelihood of dry eye occurrence. Remembering to blink while using a computer or smartphone will have a lot of benefit in reducing the symptoms of dry eye. Using the 20-20-20 rule (for every 20 minutes spent looking at a screen, look at something 20 feet away for 20 seconds) is a popular method used to reduce eye strain, which can ultimately reduce dry eyes.

When to See an Eye Doctor

Most causes of dry eyes can be managed at home. However, it is best to see an eye doctor if the feeling of dry eyes is accompanied with pain, severe headache, light sensitivity, or a sudden change in vision. If the symptoms do not resolve within one week of trying self-care treatments, it is best to see a doctor as the dry eyes may be caused by an underlying medical condition.

If any eye symptoms, including dry eyes, are caused by exposure to excessive heat, chemicals, trauma, or due to a foreign object being lodged into the eye, it is best to see an eye doctor as soon as possible.

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References

1. Coles-Brennan C, Sulley A, Young G. Management of digital eye strain. Clinical and Experimental Optometry. 102(1), 18-29. Published April 15, 2021.https://doi.org/10.1111/cxo.12798

2. Friesen, AM. Dry Eye. In: Compendium of Therapeutics for Minor Ailments. Canadian Pharmacists Association. Updated April 24, 2019. Accessed April 25, 2021. https://www-e-therapeutics-ca.login.ezproxy.library.ualberta.ca/search#

3. Giannaccare G, Vaccaro S, Mancini A, Scorcia V. Dry eye in the COVID-19 era: how the measures for controlling pandemic might harm ocular surface. Graefe’s Archive for Clinical and Experimental Ophthalmology. 258, 2567-2568. Published June 19, 2020. https://doi.org/10.1007/s00417-020-04808-3