Dry eyes

Dry eye syndrome is a condition where the eyes do not make enough tears, or the tears evaporate too quickly. This can lead to the eyes drying out and becoming inflamed. It is a common condition and becomes more common with age, especially in women. Up to a third of people age 65 or older may have dry eye syndrome. It is more common in those with connective tissue disorders, in blepharitis and contact lens wearers.

Symptoms

  • Feelings of dryness, grittiness, soreness, tired eyes which get worse throughout the day
  • Mildly sensitive to light
  • Slight blurred vision
  • Both eyes are usually affected 

Signs

  • Redness of the eyes
  • Stringy discharge or foamy tears
  • Spotty (“punctate”) fluorescein staining lower cornea
  • May be associated blepharitis 

Eye examination

  • Observe lids, conjunctiva and cornea with white light
  • Instil 1 drop of proxymetacaine 0.5% with fluorescein 0.25%
  • Observe for corneal staining preferably using a blue light
  • Consider Schirmer tear test (wetting of tear test strip in 5 minutes, <5-7mm abnormal) 

Treatment

  • Tear substitutes: mild to moderate cases of dry eye syndrome can usually be successfully treated using over-the-counter artificial tear drops; if a patient has severe symptoms, and needs to use eye drops more than six times a day, or if they wear contact lenses, advise them to use preservative-free eye drops 
  • Eye ointment can also be used to help lubricate eyes, but it can often cause blurred vision, so it is probably best used only at night
  • More severe cases may require specialist medication or lacrimal punctal plugs