How to Navigate the Challenges of Dry Eye Disease

Imagine the gritty feel of sand particles under your eyelids. Or how your eyes burn like a low-grade blaze while reading. Or how stepping out into bright sunlight can be challenging.

These scenarios are all too real for those who suffer from dry eyes.

“Many of the patients I see suffer from some degree of dry eye symptoms,” says Victoria Chang, M.D., an ophthalmologist at Bascom Palmer Eyes Institute. Common symptoms she hears from her dry eye patients include:

• burning
• fluctuating vision
• foreign body sensation
• painful or fatigued eyes
• redness
• tearing

More than 16 million Americans have dry eye disease (DED), according to the National Institutes of Health.

Women and older adults are more likely to suffer the bothersome symptoms. Dr. Chang says that some studies suggest dry eye is twice as prevalent in women as it is in men. Hormones may be to blame.

“Hormonal changes, such as those seen after menopause, likely play a big role among other factors,” she adds. “Women in menopause are more susceptible to DED due to a decrease in supportive androgen hormones, which can affect tear film stability.”

However, DED is by no means limited to women and seniors. Asian and Hispanic populations may be more prone to DED as well, according to some studies.

“Young people can be affected, especially those who heavily use digital devices, wear contact lenses, and/or live or work in low humidity environments,” Dr. Chang says.

The prevalence in the general population varies, with some studies putting it as high as 50% to 75%.  However, the Beaver Dam Eye Study considered a landmark epidemiological paper published in 2014, reported an overall prevalence of 14.4%, with a higher incidence rate among women and people who are 80 years and older.

Whatever the numbers, one fact remains: eye doctors are seeing more cases. Dr. Chang says there’s an obvious explanation for that. “One reason is that the U.S. population is aging, with a growing proportion of people aged 65 and older. The Beaver Dam Eye Study demonstrated that more than 1 in 5 individuals between the ages of 48 and 91 years developed dry eye disease over a 10-year period.” As one gets older, there is also an increase in the usage of medications and chronic health issues linked to DED.

In addition, we’ve become a screen-driven society.

“The rise in usage of digital devices has been linked to DED due to reduced blink rate causing tear film instability,” Dr. Chang says. “The COVID-10 pandemic likely contributed to this phenomenon since people were mostly indoors and used screens more often.”

Keeping your eyes lubricated might feel like a Sisyphean task, an endless chore with no clear resolution. But Dr. Chang assures her patients that several lifestyle hacks can help ease symptoms:

• Check for potential underlying medical conditions that can lead to dry eye disease. Knowing the cause can help in treatment. Some of these include autoimmune diseases (such as rheumatoid arthritis and Sjogren’s syndrome), endocrine disorders/ metabolic conditions (autoimmune thyroid disease and diabetes), psychiatric conditions (depression and post-traumatic stress disorder), cardiovascular diseases (hypertension and peripheral artery disease), dermatological conditions (rosacea and eczema), neurological conditions (Parkinson’s disease, migraines and stroke), and respiratory conditions (obstructive sleep apnea and asthma) Also, certain infections or surgeries, such as LASIK, affect the corneal nerves and can result in DED.

“A multitude of systemic medical conditions have been associated with DED due to chronic ocular surface inflammation, side-effects of medications that affect tear production, microvascular complications, blink and/or eyelid abnormalities, loss of tear film stability, and/or immune-mediated damage to the lacrimal glands,” Dr. Chang adds.

• Keep your digital screen at arm’s length and follow the 20-20-20 rule. That means taking a break every 20 minutes by looking at an object 20 feet away for 20 seconds to help your eyes relax.
• Reduce glare and adjust your lighting to decrease eye strain.
• Consider a desktop humidifier if your office is dry and cold.
• Protect your eyes in windy areas. Wear wraparound sunglasses and avoid fans blowing directly in your face.
• Practice a healthy lifestyle. “In general, healthy lifestyle habits that are good for your body are also good for your eyes,” says Dr. Chang. “Maintaining an active lifestyle with a healthy diet and sleep schedule and avoiding smoking and excessive alcohol consumption can help with dry eye symptoms.”
• Reduce or stop medications that can result in DED. These include antihistamines, decongestants, blood pressure medications, hormonal therapies, acne medications, and antidepressants and antipsychotics.
• Keep your non-preservative artificial tears handy, but steer clear of drops marketed as “red eye relief,” which often contain ingredients such as tetrahydrozoline or naphazoline. “These chemicals may temporarily provide relief but can result in rebound redness and worsening ocular symptoms,” Dr. Chang says.

 Dr. Chang recommends lubricating ointments or gels for more severe cases, though be aware that these can blur your vision. Look for lubricants that are oil or lipid-based.

• Don’t rub your eyes. It disrupts the tear film, introduces bacteria to the ocular surface, and increases ocular surface inflammation, perpetuating the dry eye cycle.
• Use prescription medication if your health care provider determines you need help producing more tears or stopping their evaporation.

These strategies usually provide relief, but you should also be aware of the telltale signs that point to a potentially more serious problem.

“You should see an eye doctor if you develop persistent or worsening symptoms of DED including ocular burning, foreign body sensation, blurred vision, discharge, redness, photophobia, eye pain, contact lens intolerance, and/or excessive tearing,” Dr. Chang says. “And if there are any signs of infection, call your eye provider right away.”

Ana Veciana-Suárez is a regular contributor to the University of Miami Health System. She is an acclaimed author and journalist who has worked for The Miami Herald, The Miami News, and The Palm Beach Post.

Tags: Bascom Palmer Eye Institute, Chronic eye discomfort, Digital eye strain, dry eye syndrome, eye care in Miami, itchy eyes, screen time