“Dry eye syndrome”, “Office eye syndrome”

The dry eye syndrome, which is incorrectly sometimes referred to as “xerophthalmia” (which is a different clinical entity because it arises due to a lack of vitamin A from malnutrition) occurs when tears evaporate very quickly or more rarely the body produces a few tears. It is particularly common; it can affect one or as usual happens to both eyes.

One study found that 17% of the 2,127 patients who visited a hospital in Japan were diagnosed with a dry eye, while 14.6% in a group of 2,520 elderly people reported dry eye symptoms.

Dry eye syndrome can occur at any age and in otherwise healthy individuals. It is more common after the age of 40 and more common in women.

Causes

The eyes produce tears throughout the day, not just when we cry or experience emotion. Healthy eyes are constantly covered with a fluid, known as a lacrimal layer which normally remains stable between each blink of the eyelids. This prevents the eyes from drying out and allows clear vision.

If the lacrimal glands produce fewer tears, the lacrimal layer may become unstable. It evaporates quickly, creating dry foci on the surface of the eyes.

Our tears consist of serum, fat, proteins, electrolytes, anti-bacterial substances and growth factors. The mixture helps to keep the eye surface smooth and clean so that we can see properly.

The dry eye can be caused by:

• a disturbance in the composition of the lacrimal layer, which causes it to evaporate very quickly
• insufficient production of tears

Other causes include eyelid problems, certain medications and environmental factors.

Disturbance in the composition of the lacrimal layer

The lacrimal layer consists of three layers: fat, serum and mucus. Problem in any of the three can lead to dry eye symptomatology.

The surface layer, the fat, comes from the edges of the eyelids, specifically from the so-called “Meibomian” glands. Fat soothes the surface of tears and slows down their rate of exhaustion. Reduced fat levels can cause tears to evaporate faster.

Inflammation along the tip of the eyelids, known as blepharitis, rosacea and some other skin conditions, can cause blockage of the pores of the “Meibomian” glands, making the dry eye more likely.

The middle layer, the thickest, consists of serum and salt. The lacrimal glands produce this layer. They clean the eyes and rinse particles and substances that cause irritation.

Problems at this level can lead to instability of the lacrimal layer. If the serum layer is too thin, the layers of fat and mucus may come into contact with each other, resulting in intense tearing, characteristic of the dry eye.

The inner layer, mucus, allows tears tThe dry eye can be caused by:

• a disturbance in the composition of the lacrimal layer, which causes it to evaporate very quickly
• insufficient production of tears

Other causes include eyelid problems, certain medications and environmental factors.

Disturbance in the composition of the lacrimal layer

The lacrimal layer consists of three layers: fat, serum and mucus. Problem in any of the three can lead to dry eye symptomatology.

The surface layer, the fat, comes from the edges of the eyelids, specifically from the so-called “Meibomian” glands. Fat soothes the surface of tears and slows down their rate of exhaustion. Reduced fat levels can cause tears to evaporate faster.

Inflammation along the tip of the eyelids, known as blepharitis, rosacea and some other skin conditions, can cause blockage of the pores of the “Meibomian” glands, making the dry eye more likely.

The middle layer, the thickest, consists of serum and salt. The lacrimal glands produce this layer. They clean the eyes and rinse particles and substances that cause irritation.

Problems at this level can lead to instability of the lacrimal layer. If the serum layer is too thin, the layers of fat and mucus may come into contact with each other, resulting in intense tearing, characteristic of the dry eye.

The inner layer, mucus, allows tears to spread evenly. A malfunction can lead to dry foci in the cornea, on the anterior surface of the eye.

Reduced tear production

After the age of 40, the production of tears tends to decrease. When it falls from a certain point down, the eyes can dry, irritate and inflame. This is more common in women, especially after menopause, possibly due to hormonal changes.

Reduced tear production is also associated with:

• autoimmune diseases such as Sjögren syndrome, lupus, scleroderma or rheumatoid arthritis
• radiotherapy
• Diabetes
• vitamin A deficiency
• corneal eye surgeries, such as laser keratomileusis, sometimes increase the likelihood of a dry eye, but symptoms are usually transient

Problems with eyelids, medicines and environmental factors

Every time we open or close our eyelids spreads a thin layer of tears on the surface of the eyes.

Most people blink about five to six times a minute. Problems of the eyelids can affect this function which is responsible for the uniform layer of tears.

These eyelid dysfunctions include the aberration where the eyelid is turned outwards or the entropy where it is turned in. Inflammation along the extremities of the eyelids, known as blepharitis, can also cause a dry eye, as can contact lenses.

Medications that can cause a dry eye include:

• some diuretics
• angiotensin conversion enzyme (ACE) inhibitors
• antihistamines
• decongestants
• some sleeping pills
• contraceptive pills
• some antidepressants
• certain anti-acne medicines, special isotretinoin-type medicines
• morphine and other opiate-based painkillers

Climatic factors include dry climate, sun, wind and other types of hot air or dry air, such as in an airplane cabin or in areas with air conditioning, air heater, etc.

High altitude, smoke and the use of contact lenses are also aggravating factors.

The use of electronic display devices, reading or driving a vehicle, in general the increased visual concentration can slow the rate of blinking so that the eyes dry out. For this reason, the term ” Office eye syndrome “has become increasingly common in recent years.

Diseases that can lead to a dry eye are also Bell-type paralysis and HIV infection.

Symptoms

A patient with dry eye syndrome may experience a number of symptoms, such as:

• a sense of foreign body
• accumulation of mucus in or around the eyes
• sensitivity of the eyes to smoke or wind
• redness of the eyes
• difficulty keeping eyes open
• eye fatigue after reading, even for a short period of time
• blurred vision, especially towards the end of the day
• sensitivity to light
• discomfort when using contact lenses
• tearing
• diplopia
• “stuck” eyelids during the morning awakening

Therapy

Clinical examination may highlight possible lack or disturbance of the quality of tears as well as possible chronic inflammation or disturbance of eyelid function.

The type of eye drops to be administered depends on the cause of the dry eye.

Treatment aims to keep the eyes adequately oiled, but the approach depends on the underlying cause.

Three ways to keep your eyes melted are:

making the most of natural tears

using artificial tears or other eye drops

reducing the drainage of tears

If the problem comes from an eye or systemic condition the underlying condition is one that must first and foremost be treated.

Medications for patients with chronic dry eye include ocular drops of cyclosporin. Cyclosporin reduces inflammation on the surface of the eyes and causes increased tear production. Patients should not use this medicine if they have an eye infection or a history of viral herpes infection.

If a patient has blepharitis, they may need to regularly clean the affected area with a dilute solution of baby shampoo. The doctor may prescribe antibiotic drops or ointment for night use; sometimes, an oral antibiotic, such as tetracycline or doxycycline, is used.

Steroid drops can help reduce inflammation if symptoms remain severe, even after frequent use of the drop.

Surgery

Problems of eyelid functionality (entropium, ectropium, hair loss) are treated surgically.

In more severe cases, the lacrimal pores through which tears flow can be deliberately incinerated, partially or completely. Silicone caps are placed in the pores of the lacrimal tubes. This helps to preserve both natural and artificial tears in the eyes for longer.

Also, hard contact lenses, such as the “Boston Scleral Lens ” that sound in the hard tunic, the white part of the eye, create a layer of liquids on the cornea, preventing it from drying out.

Salivary gland transplantation is a surgical procedure that is rarely considered in persistent and severe cases that have not responded to other treatments

Other forms of treatment

• tears made from the patient’s plasma serum (homologous serum)
• opening consciously more often when using a computer
• avoiding smoking and smoking areas
• maintaining room temperature at moderate levels
• use of a household humidifier
• humidity chamber glasses

Artificial tears and eye drops

Eye drops without preservatives can be used as often as necessary and are preferred.

Ointments and gels are mostly used before night sleep due to the transient turbidity they cause.

• Cleaning and massage of the eyelids

Nutritional advice

Some studies show that omega-3 and omega-6 fatty acids can help reduce the risk or incidence of dry eye.

Examples include oily fish, canola oil, walnuts, flaxseed, olive oil, pumpkin seeds and soya.

However, there are not enough large-scale research studies in humans to support their use as a basic treatment.