Severe dry eye: Advanced solutions to a common, chronic condition
July 15, 2020
Many of us experience dry eyes at one time or another due to allergies, low humidity, or windy weather. But for patients with certain health conditions, including autoimmune diseases, dry eyes transcend annoyance and become a health risk.
Some patients are surprised to learn that their dry eyes might be caused by an underlying health condition such as diabetes, rheumatoid arthritis, or rosacea.
Dry eye disease develops when these changes cause too little tear production or cause tears to evaporate too quickly. In both cases, there is not enough fluid in the tears. This insufficiency in the amount of tears can make the surface of the eye dry out. This also makes the tears saltier. The increased saltiness of the tears drives inflammation and symptoms. Common symptoms of dry eye disease include:
- Feeling like something is in your eye
- Excessive watering
- Light sensitivity
- Blurry vision
Chronic dry eye disease can damage ocular tissues and in very serious cases, lead to scarring of the cornea, the clear dome of tissue that covers the front part of the eye. This damage can cause blurry vision and in severe instances, vision loss. Dry eye disease can have a significant impact on a person’s quality of life. In fact, one study in the United Kingdom found that having chronic, mild to moderate dry eye disease can decrease quality of life as much as breaking one's hip due to pain and physical limitations.
UT Southwestern has formed a new Advanced Dry Eye Specialty Clinic to care for patients with dry eye due to underlying health conditions. Our ophthalmologists and optometrists partner with experts from non-eye fields across the medical center to personalize treatment plans that start with their underlying condition.
Progressive Eye Conditions: Why They Can't Wait
Delaying eye care during the COVID-19 pandemic, particularly for progressive conditions, could result in vision loss. Our specialists take every precaution to keep patients safe as they return for expert ophthalmology care.
6 health conditions that can cause severe dry eye
- Diabetes: Nearly half of people with diabetes have dry eyes. The development of dry eye is often linked to a loss of nerves in the cornea (neuropathy). Without functional nerves in the cornea, tear production from the tear-producing lacrimal glands is decreased.
- Rosacea: While rosacea is primarily known as a skin condition that causes facial redness and visible blood vessels, more than half of these patients also develop eye problems known as ocular rosacea. Approximately 80% of patients with ocular rosacea have meibomian gland dysfunction, which causes the eyelids to secrete fewer oils that blend with a patient's natural tears. Without the oils, the patient's tears evaporate too quickly, resulting in dry eyes.
- Sjögren's syndrome: The immune system targets the glands that make tears and saliva, leading to dry eyes and dry mouth. Sjögren's syndrome can stand alone, though it often accompanies rheumatoid arthritis and lupus.
- Rheumatoid arthritis: Dry eye disease in patients with rheumatoid arthritis can progress from annoying to painful quickly. Rheumatoid arthritis can also cause other eye conditions, which like dry eye disease, if not treated can lead to vision disturbances or loss.
- Lupus: With lupus, dry eye disease can make eyes have a gritty feel and burning sensation, as if something is in the eye. Approximately 20% of patients with lupus also have Sjögren's syndrome. Lupus can also cause changes in the skin, nerves, and blood vessels in and around the eye, which can lead to long-term vision complications.
- Scleroderma: Because scleroderma causes a hardening or tightening of the body's connective tissues, including the eyelids, the eyes are at risk. The condition can also decrease functionality in the tear producing glands of the eyes, reducing overall eye moisture.
If you have any of these conditions, the Advanced Dry Eye Specialty Clinic at UT Southwestern can recommend self-care tips to manage dry eyes at home, as well as medical management if you need additional help.
Tips to care for dry eyes at home
Your dry eye specialist likely will start your care with steps to reduce environmental dryness and shake up your daily routine. The first line of care recommendations might include these tips:
- Avoid air blowing in or across your eyes: Air conditioners and heaters are major contributors to dry eye disease. When indoors or driving, point fans away from your eyes. Outdoors, wear protective eyewear such as sunglasses when it’s windy outside. If you run a heater or fan at night while you sleep, consider using an eye mask or use a humidifier. Ceiling fans are major culprits in drying out the eyes!
- Blink more often or take an eye break: We tend to blink less often while reading or looking at a computer or smartphone. If you’re doing tasks that require more visual concentration, make a conscious effort to blink more frequently or stop periodically to close your eyes for a few minutes.
- Use artificial tears: Artificial tears are a mainstay to dealing with dry eye disease. I recommend using preservative-free artificial tears. This is because the preservatives that are used to keep bacteria from growing can damage the surface of the eye over time, causing even more irritation and redness. Preservative-free artificial tears can be purchased over the counter at many pharmacies or grocery stores. They come in single use vials. Most importantly, they cannot be re-used once open and must be discarded. This helps prevent against developing eye infections. The key to artificial tear use is that they must be used in a pattern that prevents the eyes from feeling dry in the first place, and not after the eyes start to feel dry.
- Try an eye gel or ointment: These thicker versions of tears might provide longer lasting lubrication. Consider putting them in right before bed because the thickness can blur your vision for 15 minutes or more. Overnight use also helps protect your eyes if you don't close them all the way during sleep.
- Use a warm compress: Putting a warm washcloth or mask over your eyes can help clear blocked oil glands. Do this for five to 10 minutes twice a day. I do this regularly to maintain my eye health – and it can be quite relaxing!
- Lid scrubs: To help keep the glands in the eyelid healthy, it is important to keep the eyelid area clean. Lid scrubs, which can be purchased at many pharmacies or grocery stores, can help to scrub away debris. Lid scrubs should be used daily and can be done in conjunction with warm compresses to increase oil production and keep your glands healthy. Tear-free baby shampoo is an effective and less costly alternative to lids scrubs.
Advanced dry eye therapies
If self-care therapies don’t effectively treat your symptoms, your doctor might suggest more advanced, nonsurgical treatments, such as:
- Medication adjustment: Certain drugs, such as antihistamines, antidepressants, birth control pills, and blood pressure medications can worsen dry eye symptoms. We can work with your primary care doctor or specialist to find an alternative. Make sure to talk with your doctor about all medications you are taking and continue taking them as prescribed until your doctor recommends a change.
- Prescription eye drops: If over-the-counter artificial tears are not enough, prescription eye drops can help increase tear production and decrease inflammation.
- Nonsteroidal anti-inflammatory drugs (NSAIDS): Oral NSAIDs purchased over the counter may be used to help ease discomfort associated with dry eye disease.
- Steroid eye drops: Dry eye disease triggers inflammation, which may require short-term use of steroid eye drops. These eye drops can help get the inflammation under control but should only be used for a short period of time due to potential side effects.
At UT Southwestern's Advanced Dry Eye Specialty Clinic, our ophthalmologists and optometrists partner with experts from non-eye fields across the medical center to personalize treatment plans for dry eye that start with the patient's underlying condition.'
- Autologous serum eye drops: These are eye drops made from your own blood. To do this, we take a sample of your blood and remove all of the cells, and then place the serum into small eye drop bottles. Serum contains a mix of growth factors, proteins, antioxidants, and lipids, and for some patients, is an effective replacement for artificial tears. Serum eye drops can also help fight inflammation, and some patients get a lot of relief from them when over the counter tears do not work sufficiently.
- Specialty contact lenses: Certain types of contact lenses can help protect the surface of the eye and trap moisture. This helps to keep the cornea hydrated and promotes healing. For patients with severe dry eye disease, contact lenses called scleral lenses can offer significant benefits.
- Eyelid thermal pulsation technology: If you have meibomian gland dysfunction, we may try this in-office procedure. We use a device that fits over the eyelids and applies heat to soften the hardened oil-like substance trapped in the glands. It also uses pulsed pressure to open and express the clogged glands. By removing the hardened oil-like substance from the glands, the glands can begin producing healthy oils to prevent evaporation of tears. This procedure takes about 12 minutes.
- Intense pulsed light (IPL) therapy: This is another procedure that can be done in office for patients with meibomian gland dysfunction due to rosacea. We use a special light to close the small blood vessels that supply the glands in the eyelids. This decreases inflammation in the eyelids and ocular surface and promotes the production of healthy lipids that block tear evaporation.
Dry eye disease can make it difficult to perform everyday activities, such as reading or driving. And the longer dry eye goes untreated, the worse it gets and the more difficult it can be to get under control.
If you have an autoimmune or other health condition mentioned above, our specialists will work with you and your doctor to treat your dry eye disease so you can be pain free with clear vision and one less health concern to manage.