Facts From, OUR DRy eye Expert, Dr Giulia Tinari:
Impacts around 30 million Americans
DES is an inflammatory process that can flare up and worsen over time
Symptoms: redness, burning, sandy/gritty/foreign body sensation, light sensitivity, tearing, eyes can feel sticky especially upon awakening, blurry vision, eye fatigue, sudden stabbing pain
Causes: certain medications (i.e. antihistamines, Dupixent, Accutane, etc), autoimmune diseases (i.e. hypothyroidism, rheumatoid arthritis, lupus, celiac disease, etc), inflammatory diseases (i.e. diabetes, IBD, arthritis, psoriasis, etc), certain skin issues like rosacea, eczema and psoriasis), environmental triggers like allergies, excess screen time, dry environments, and contact lenses
What happens in dry eye disease?
The tear film coats the surface of the eye and is made up of aqueous, oil and mucin. If this delicate balance is interrupted, then the symptoms listed above can ensue. Dry eye is typically separated into two main types: aqueous deficient dry eye and evaporative dry eye. Recent studies show that many patients suffer from a combination of both aqueous and evaporative dry eye; therefore, it is important to determine the state and quality of the tear film to ensure the proper diagnosis and management of the disease. There are several non-invasive ways to test the quality of the tear film and lacrimal gland (which secretes aqueous). There are about 80 meibomian glands that surround our eyelids which make and secrete oils into the tear film. If these glands become congested or break down over time, then the tear film evaporates quickly and dry eye symptoms occur. Meibography is a non-invasive tool that images these oil glands and allows for better diagnosis and management. If the tear film is severely imbalanced, then cells on the eye’s surface (cornea) can slough off and die, leading to pain, blurriness and light sensitivity. If the eyes remain dry for long periods of time without treatment, the corneal nerves can break down leading to loss of sensitivity and neurotrophic keratitis. Epithelial damage can also increase the risk of infection and recurrent corneal erosions. Chronic inflammation of the eye’s surface can also lead to biofilm formation along the edge of the eyelids. This biofilm is a collection of inflammatory debris and staphylococcal bacteria that can irritate the eyes and if not removed properly, can exacerbate the cycle of inflammation.
Why do meibomian glands break down?
Several studies show that decreased blink rates can cause these glands to become stagnant, which can eventually lead to atrophy and severe dry eye symptoms. Excess screen time is a major culprit of dry eye disease since we tend to blink less when focusing on our screens. Other studies show that contact lenses over time can cause friction along the inner lids and slowly damage the meibomian glands. Inflammatory blood vessels along the lid margin as a result of systemic disease and allergies can create havoc on these delicate glands, leading to stagnation and atrophy.