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Published: October 12, 2020

Guide to Dry Eyes

The term “dry eyes” doesn’t always reflect the symptoms that people experience when their tear film is unstable. In addition to dryness, gritty/sandy sensations, or burning eyes people can often experience excessive watering of the eyes as well as redness, dull ache, stabbing pain, blurred vision, light sensitivity, mild itching, mucous strands, and crusting on the eyelids and eyelashes.

The tear film is comprised of three layers:

  1. Mucin Layer: a thin mucous coating that sticks to the eyeball and allows the upper layers to coat evenly without dry spots.
  2. Aqueous Layer: water and salty tears.
  3. Lipid Layer: a top coating of oil that prevents evaporation of the aqueous layer.

If the layers evaporate and the cornea is exposed to air, the eyes will respond by watering which can make the tear film even more unstable.

Hydration. It is extremely important to drink enough water each day, especially in the arid climate of Davis. If you struggle with this then here are some suggestions. Have a refillable water bottle at your desk, in your car, or in your bag. Add a water cooler or filtration system at home or work for good tasting water. Start drinking water early in the day before breakfast and throughout the morning and afternoon. Taper in the early evening so you can sleep well at night without having to make multiple trips to the restroom, since being well rested also helps with tear film production.

To determine baseline daily water intake take your body weight in pounds, divide by two, and convert that number to ounces. Example: 150lbs ÷ 2 = 75 ounces of water per day. This assumes that you aren’t drinking coffee, tea, diet soda, alcohol, eating salty snacks, or exercising! If you do any of the above then you need to drink even more water. On days that I exercise I drink a gallon of water or more.

Gentle Eyelid Hygiene. There are two sets of oil glands along the edge of the eyelids. The first are Sebaceous glands which lubricate the eyelashes with oil to prevent them from becoming brittle. The second are Meibomian glands which secrete oil into the tear film to produce the lipid layer. We have bacteria living on our skin that can invade these glands and cause the oil to solidify like butter, or even form crust along the eyelashes. These bacteria can occasionally cause an infection of the gland, known commonly as a stye.

A simple way to keep the oil glands healthy is to gently wash your eyelids every day. Many people neglect to wash this area because they are worried about getting soap in their eyes. When you take a shower, take the same soap you use to wash your face and gently rub a dilute amount on your fingertips over the eyelids and eyelashes, then rinse completely with warm water before opening your eyes. This is a fast and easy way of washing away excessive bacteria and debris on the surface of the eyelids. If you are consistent in gently washing your eyelids in the shower and at the sink before bed it
will gradually improve the lipid layer of tears and prevent dryness.

Warm Compress. Along with washing the eyelids, applying a warm compress can also help improve the flow of oil into the tear film. This takes a little more time but can be very effective when done consistently in the morning and/or evening. It’s important to always use a clean wash cloth or paper towel, since reusing the same towel without washing it can breed bacteria. Soak the towel in hot water which should be very warm but not so hot as to cause burns, and then place it over your closed eyes right against the eyelids and eyelashes. In order to be effective the towel needs to retain its heat for 5 minutes while remaining in place over the eyes. There are some commercial products like gel-pack masks or at-home systems like rice-filled nylons that can be briefly microwaved and placed on top of the towel to prevent it from cooling over the 5 minutes.

Diet. The source of the oil in the lipid layer is from your diet. Some people find that dietary changes and/or supplements can help improve their symptoms. Specifically recommended are Omega-3 foods such as oily fish (salmon, sardines), nuts/seeds (flax seed, walnuts), or fish oil supplements. Of course, all foods and supplements should be consumed in moderation and are most effective when combined with the other treatments listed in this guide.

Lubricating Drops. Artificial tears, gels, and ointments won’t address the root issues behind ocular irritation, but they can help to relieve symptoms. Some products are mild lubricants, such as Systane Tears, Blink Tears, or Refresh Tears, which all can be used with contact lenses. There are also slightly thicker gel formulations (not for use with contacts). Other products specifically target lipid deficiency, such as Soothe XP (contains mineral oil), Refresh Mega-3, and Systane Complete (also not for use with contacts). These products are most effective after performing warm compresses and/or eyelid hygiene in the morning and before bed.

Prevention of Exposure. Wind, vents, and fans can cause more rapid evaporation of the tear film, even when sleeping! If you sleep with an oscillating fan or ceiling fan, you may experience more symptoms in the morning. Consider using a sleep mask to act as a barrier against evaporation of the tear film, which often occurs since our eyelids leave a very small opening when we sleep. When you’re a driver or passenger in a car, aim the cabin air vent away from your eyes and toward your torso, feet, or windshield instead. When you ride a bicycle, use glasses or sunglasses that provide broad coverage over your eyes to reduce wind exposure. Adjust the vents at home or in your office to direct any air away from your face.

Prescribed Medications. In some cases prescribed medications are necessary to reduce inflammation on the surface of the eyes, to control excessive bacteria populations, and to stimulate additional tear production. In general I prefer to address ocular surface disease first through the methods above, except in the case of obvious inflammation or infection.

Ocular Allergies. The characteristic symptom of ocular allergies is moderate to severe itching. I mention this because mild itching can be common with ocular dryness even when allergy isn’t present. I only recommend using antihistamine eye drops (like Pataday) in the case of obvious allergies because they can cause more ocular dryness as a side effect. For mild ocular allergies, artificial tears can be just as effective as antihistamines when used after being outdoors.

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