Understanding and Alleviating Dry Eye

The syndrome puts comfort and eye health at risk

Illustration by Brittany Murphy

Some people long for tears to come to their eyes — not tears of laughter, joy or sorrow, but a normal coating of moisture that will soothe their burning, stinging eyes.

Dry eye syndrome or “dry eye” is a chronic condition most commonly seen in women and older individuals. In the United States, it affects an estimated 3.2 million women age 50 and over, and 1.68 million men age 50 and over, according to the American Academy of Ophthalmology.

People who are diagnosed with dry eye lack proper lubrication in their eyes because age or other factors have affected the quantity or the quality of their tears. Tears are not just salty water; they contain oils and protein that nourish the surface of the eye, says Kimberly A. Licciardi, MD, an ophthalmologist at NH Eye Associates in Manchester and Londonderry.

Genetics can raise your chances of developing dry eye — if your mother had it, there’s a better chance that you will too — and dry eye is often seen in people who have an autoimmune disease such as rheumatoid arthritis, Licciardi says. Wearing contact lenses does not aggravate the condition, she says, but contacts can become difficult to wear if your eyes are dry.

The range of symptoms brought on by dry eye varies greatly. “Some people have minimal symptoms. For others, it takes over their life,” says John J. Dagianis, MD, an ophthalmologist at Nashua Eye Associates in Nashua, Milford and Hudson. Dry eye also appears to be somewhat subjective; some patients report significant symptoms even though clinical testing of their eyes does not indicate much of a problem, and vice versa.

In rare cases, when dry eye is at its most extreme, the condition can damage the eye, but typically such harm occurs only in the very elderly or the very ill, Licciardi says. More commonly, patients with dry eye experience a burning, stinging, or scratchy feeling in their eye. Vision changes can also result from dry eye because much of the clarity of our vision comes from having an effective layer of moisture on the surface of the eye, Licciardi says.

Interestingly, some people who have dry eye experience the opposite of what you would expect; they appear to have an overabundance of tears, the result of the brain’s effort to compensate for a lack of moisture on the eyes. The majority of patients who go to the doctor complaining of wet, weepy eyes actually have dry eye, Dagianis says.

There is no cure for dry eye, but there are ways to alleviate symptoms. For example, dry eye sufferers who use a computer should take breaks to close their eyes periodically and use moisturizing drops to help replenish surface moisture, Licciardi says. Computer use can worsen dry eye because we tend to blink less when looking at a screen, which causes any tears that are present to evaporate.

Drinking water can also help. “In our society, many of us do not drink enough fluids and/or we take medications that dehydrate us,” Dagianis says. A variety of medications, including ones that are commonly prescribed for psychiatric conditions and high blood pressure, can significantly affect how the eyes feel, Dagianis says. Regardless of whether you take such medication, staying hydrated can make a real difference in eye health and comfort — and it is important to note that it is water we need, not soda or coffee, Dagianis says.

Moisturizing drops can ease dry eye symptoms, but it is important to pay attention to how many drops and what type of drops you use. Patients who use drops frequently should choose a preservative-free formula — which is easy to spot because preservative-free solutions typically come in small, single-use vials rather than bottles, Dagianis says. Generally, people can take one drop of a preservative-free solution per hour without a problem, but use of drops that contain preservatives should be limited to four times a day because the preservative can cause adverse effects in the eyes, he says. “It can actually cause the eye to pit and some of the cells to die,” he says, and can cause shrinkage in eye tendrils that are meant to grab onto some of the oil in tears and keep it in place.

Dry eye patients whose symptoms worsen during winter might also want to consider running a humidifier in their bedroom to boost the moisture in air that has been dried out by indoor heating, Licciardi says. Although some patients install a whole-house humidifier, simply putting a humidifier in the bedroom “can make a big difference,” she says.

Dry eye sufferers can also take flaxseed oil and fish oil to help improve the consistency of the oil portion of their tears. (That’s assuming that their oil glands still operate well enough to make such an effort worthwhile, which can be determined by an eye doctor, Dagianis says.) The amount of flaxseed or fish oil you need depends on your body, but generally, a person of average build needs to take between 1,000 and 2,000 mg of flaxseed or fish oil a day for the oil “to really be therapeutic in effect,” Dagianis says. Some people find that they can’t tolerate the oil gastrointestinally, though, and others need to be careful about what else they’re taking. Fish oil acts as a blood thinner and can affect medications, so people should check with their doctor before self-treating with oil or supplements.

If less-invasive measures don’t help, dry eye patients can also ask their doctor about punctal plugs, which block the tear ducts in the eye to keep tears in place by preventing them from draining out of the eye. “Punctal plugs are great,” Licciardi says. “They won’t cure anything, but they can reduce dependence on moisturizing drops in some cases.”