Dry Eyes? START HERE. Understand Causes, Symptoms, and Surprising Facts You Might Not Know

Are your eyes constantly feeling tired, irritated and uncomfortably dry? You're not alone. Millions worldwide suffer from an aggravating condition known as dry eye syndrome or dry eye disease. This painful eye dryness can stem from various causes including Sjogren's disease, making simple tasks like reading or using digital devices an uphill battle. But don't worry, relief is within reach. Welcome to today's video. I'm Dr. Ayesha Budd. Thanks for tuning into our channel. In this first comprehensive video about dry eyes, we will uncover surprising facts, identify root causes and explore some preventative tips for dry eye disease. Let's get started. So what are some of the common symptoms of dry eye disease? Well, of course, your eyes may feel dry and not having enough water. But in some extreme situations, whether you believe it or not, my patients actually complain that their eyes are watery when in fact they could be very, very dry. But it's a cascade of events that your eyes feel there's something in the eye or there's just not enough moisture or the moisture that you're it's just not sticking in the eye and it keeps pouring out, leaving a very uncomfortable feeling and blurry vision, of course, whether your eyes are very dry or they're watery. If the tear composition is not very healthy, your vision is not going to be good and we will diagnose you with dry eye disease. Most of my patients will complain about symptoms such as stinging, burning or scratchy sensation in the eyes. They may feel that there is an eyelash or a piece of sand in the eye when in fact there is nothing. They may also feel that their eyes are watering and tearing excessively. Now, some of the tearing can be due to allergies, but believe it or not, even dry eye patients can complain about over or excessive tearing. So it's amazing when I tell my patients you have dry eyes and they come back and say, how can they be dry? They're in fact watery. I actually feel so much water in my eyes that I see it pouring down my cheeks. So it is very important to understand the symptoms and signs of dry eye disease. When your eyes are irritated and your brain gets a signal that there is something in the eye, it sends more and more water that is not supposed to stay in the eye. It actually is supposed to wash away that particle or foreign body. So in fact, your eyes are dry and the cycle just goes on and on and on. So what are some of the causes that will lead to dry eye disease? So eyes such as decreased tear production and increased tear evaporation. Those can be two reasons why your eyes are dry. Whether you're not producing enough tears or your tears are evaporating too quickly from the surface of your eye can lead to dry eye disease. So this image provides a comprehensive overview of the three layers of the tear film and their significance in maintaining eye health as well as how various conditions of the meibumin glands impact the quality of tear film. Let's break down each component to understand how dry eye works and the roles of different glands and cells in tear production. So what are the three layers of tear film? Number one is the oil layer or lipid layer. It is produced by meibumin glands which are lining the lid margin. This outermost layer prevents the evaporation of the underlying aqueous tear, keeping the eye surface lubricated and stable. Dysfunction of these meibumin glands or meibumin gland dysfunction, MGD, can lead to poor quality of insufficient oil tears, causing increased evaporation of tears and dry eye symptoms. Number two is the aqueous layer produced by this big lacrimal gland under your eyebrow. This middle layer provides moisture, oxygen and nutrients to the cornea. It also helps flush away debris and microorganisms. Reduced production of this layer can lead to aqueous deficiency dry eye or aqueous deficient dry eye characterized by insufficient tear volume to keep the eyes properly hydrated. The third layer is called mucous layer that is produced by these goblet cells on the white conjunctiva of the eye. The innermost layer helps spread the aqueous layer evenly over the eye surface and ensures that this tear film adheres to the cornea. A deficiency in mucous production can result in an unstable tear film, leading to dry patches and irritation on the eye surface. Understanding the role of different glands and cells is important to understand how treatment of dry eye works. So for the lacrimal gland, it's primarily responsible for producing the aqueous or water component of the tears. Aqueous production is crucial for overall tear volume and eye health. Dysfunction or reduced activity of the lacrimal gland can cause aqueous deficient dry eyes, leading to not sufficient hydration and eye discomfort. Meibomian glands. Meibomian glands located in the eyelids secrete the oily or lipid layer of the tear film. This oil prevents rapid evaporation of the aqueous layer. How the meibomian glands impact the dry eye is very important to understand. It's the most common cause of evaporative dry eye. As depicted in the image, the quality of meibom or oil can range from clear, healthy to cloudy to more like tooth paste like. Severe degeneration of these glands can cause severe dry eyes. Goblet cells. These cells are located in the white part of the conjunctiva and produce mucins, which are crucial for the formation of mucous layer of the tear film. A reduction in goblet cell density or function can lead to an unstable tear film, resulting in poor tear adhesion and distribution, contributing to dry eye disease. So now that you understand the composition of tears, you can understand that dry eyes can result from various factors that either reduce tear production or increase tear evaporation. So here are some of the common causes that actually reduce tear production. The first one is age. Tear production tends to decrease with age, both in men and women, particularly in people over 50. Second, certain medical conditions, autoimmune diseases such as Sjogren's disease, rheumatoid arthritis, or lupus. Even other conditions like diabetes, thyroid disorders, and vitamin A deficiency can cause dry eyes. There are certain medications that actually reduce the tear production, such as antihistamines, decongestants, antidepressants, blood pressure medications, birth control pills, or acne medications like Accutane. Fourth is laser eye surgery. Procedures like laser can temporarily reduce tear production until the nerves can regenerate. Fifth is the nerve damage. Damage to the nerves that stimulate tear production, often due to injury or surgery, can lead to decreased production. So what are some of the causes of increased tear evaporation? Number one, environmental factors can contribute to evaporation. Dry, windy, or smoky environment can accelerate tear production. Air conditioning, heating, fans, and all this dry environment can cause the evaporation of your tears. Number two is blinking. Prolonged screen time, reading, or other activities can reduce blink rate, and it can lead to increased evaporation. Number three, eyelid problems. Conditions such as ectropion, where the lid kind of pulls outward as we age, or entropion, where the lid is turning inwards toward the eye, basically causes incomplete closure of the eye, causing the tears to evaporate and not having the blink to be complete. Number four is the meibomian gland dysfunction. Blocked or dysfunctional meibomian glands reduce the oily layer of the tear film, leading to quicker evaporation of the tears. Number five, contact lens use. Wearing contact lenses can disturb the tear film and increase tear evaporation. Of course, you have a foreign body in your eye. Number six is allergies. Allergic reaction can cause inflammation and increase tear evaporation. There are several other factors that contribute to dry eyes. Hormonal changes during pregnancy, menopause, or while using birth control pill can affect tear production. Number two, diet and hydration. Poor diet, particularly a lack of omega-3 fatty acids and dehydration, can cause dry eyes. Number three, smoking. Cigarette smoke can irritate the eyes and increase tear evaporation. Number four, prolonged visual tasks without adequate breaks can reduce blink frequency and tear distribution. Have you seen a child watching an iPad? They hardly blink their eyes. So what are some of the treatment and management methods for dry eye disease? The top one is artificial tears. These are available over the counter that can lubricate your eyes and help relieve some dry eye symptoms. Number two, lifestyle adjustment. Taking regular breaks from screen time, using humidifiers, and staying hydrated can help manage symptoms. Number three, there are certain medications that your doctor can prescribe. Some of the medications are called Restasis, Zydra, there is also a spray called Turvaya. Anti-inflammatory medications, if inflammation is a contributing factor, can also be helpful such as Lodomax. Warm compresses are important to help smooth out the production of the lipid layer. Regularly applying warm compresses and cleaning the eyelids can help with meibomian gland dysfunction. Since we know the underlying causes of evaporated dry eyes, here in our office we use an in-office procedure called tear care to treat the meibomian gland dysfunction. This basically takes care of the root cause of loss of that oil or lipid layer. Tear care effectively heats up the glands at an FDA approved level so we can actually melt all the butter or hardened oil. Once those are melted, we can actually clean up the lids to have your meibomian glands reproduce their healthy oils. Number five is punctal plugs. Small devices are inserted into the tear ducts in the bottom of your eyelids. There are two, one at the top and one at the bottom, so you have a total of four. These small punctal plugs can be temporary, collagen-based, that can dissolve in a matter of seven to ten days, or they can be permanent or silicon-based, which my patients can leave in their eyes for up to a year. Just like everything, diet is very important so we actually end up prescribing some omega-3 supplements for our patients who suffer from dry eye disease. Addressing the underlying cause is crucial for effective management of dry eyes. Consulting an eye care professional for a comprehensive evaluation and personalized treatment plan is absolutely recommended. So understanding the roles of the lacrimal gland, meibomian glands, and goblet cells is crucial in diagnosing and treating dry eye disease. Proper function of these components ensures a stable protective tear film, while dysfunction can lead to symptoms of dry eyes such as irritation, redness, and vision disturbances. Effective management often requires addressing each layer of the tear film to restore balance and alleviate symptoms. Now that we understand that tears are very important for your eyes, what are some of the complications of dry eyes? If dry eyes are not treated in a timely manner, patients can end up with frequent infections, allergies, and foreign body sensations. Some of these patients can end up scarring their cornea with permanent scars on their eye, which can be really difficult to see through. So how can you help people who already have dry eyes and they're sick and tired of using artificial tears? It is very important to find the underlying cause of dry eyes. Is it because you're not producing enough aqueous or water part of the tears? Or your tear or oil quality is not good enough and your tears are evaporating too quickly? Are you taking medications that could be contributing to dry eyes? Or are you going through head and neck radiations, which could be the culprit? Do you have any health issues that could be making your eyes dry? Are you taking any medications that could be avoided? As part of your dry eye exam, we tend to use some yellow and green drops in the eye that literally highlights any dead or dry skin in the eye. It helps us to see the quality of your tear films as soon as you blink. We also look at the volume of your tears. So quantity as well as quality has to be good for patients who have dry eyes. So seriously, we have covered a lot of this video exploring the world of dry eyes, a condition that affects millions worldwide. If you are struggling with dry eyes, know that you're not alone and solutions are available. We'll cover the diagnosis and treatment options for dry eyes in the second part of this series, so stay tuned. Subscribe to this channel and hit the notification bell to stay updated on the latest eye health information. If you found this video helpful, give it a big thumbs up and share it with your friends and family who might also be dealing with dry eyes. Until next time, thank you for watching!