More than 16 million Americans have dry eye disorder, but the actual number of people living with dry eye may be much higher. This disorder, which is nearly twice as common in women than in men and in people assigned male at birth, can be difficult to diagnose and misinformation about dry eye often adds to the confusion. To clear up any doubts, we reached out to Katherine Rachon, O.D., an optometrist at Virginia Eye Consultants, for answers to some frequently asked questions related to dry eye disorder.
Dry eye disorder is a general term for a disease of your tear film, the layers of fluids that protect and moisturize your eyes. With dry eye disorder, one or more layers of the tear film do not function properly. This can cause symptoms such as redness, tearing, itching, a gritty sensation in the eyes, blurred vision, and redness of the eyelids. There are two main types of dry eye disorder, aqueous-deficient and evaporative. With aqueous-deficient dry eye, your eye does not produce enough of the watery part of your tear film to moisturize your eyes properly. Evaporative dry eye occurs when there are enough tears, but the tear film does not integrate properly. Some people have a combination of both types, which is sometimes referred to as mixed dry eye. Dry eye disorder commonly occurs in waves, meaning there may be occasional flare-ups and then no activity for a while. While most people with dry eye have symptoms, some do not know they have it until it is detected during an eye exam.
It used to be thought that dry eye disorder mainly affects older or postmenopausal individuals, and indeed, age and biological gender are risk factors that affect the incidence of dry eye disorder (individuals assigned female at birth are more likely to develop dry eye disorder, mainly due to hormonal changes that occur throughout their lives). However, we know that there are several additional factors that can affect its development. For example, some medications, including chemotherapy drugs and over-the-counter antihistamines for allergies, can trigger dry eye disorder.
There are three tear layers that make up the tear film, and each has different functions:
– The aqueous layer is the liquid part of your tears and contains all the nutrients that the tear film and the front part of the eye require.
– The lipid layer is the oily layer that prevents your tear film from evaporating too quickly.
– The mucous layer is the part of your tear film that makes everything integrate.
A healthy eye produces enough of the three tear layers to establish what is called a tear lake, which is like a small reservoir found on our lower eyelids. The reservoir stores just the right amount, not too little to cause dryness or too much to cause excess tears.
There are several medical conditions that can cause (or worsen) dry eye, such as diabetes, which causes nerve damage (including ocular nerves). If the nerves in your eye do not function well enough to notice that your eyes are dry, they will not signal your brain to produce more tears. Another condition observed with dry eye disorder is Sjögren’s syndrome, an autoimmune disease that affects the glands that serve to moisturize the eyes and other parts of the body. This syndrome, which primarily affects women and individuals assigned female at birth, can occur independently or alongside other autoimmune disorders, such as rheumatoid arthritis and lupus.
Cosmetic products can worsen dry eye because many makeup products contain chemicals called parabens, which have been shown to irritate the tissue and front surface of the eyes. Parabens can also block the glands that produce the oily part of our tear film. The good news is that there are many cosmetics available without parabens. Changing my makeup routine made a big difference in my own eye health.
In addition to irritation and discomfort, which can be very frustrating, dry eye disorder can cause blurry vision. In the long term, dryness can also cause eye infections because it breaks down the protective tissue that prevents viruses and bacteria from infecting the eyes.
Insurance companies may need some time to catch up, and you may have to try an older treatment before a new one is covered. With a little convincing (and paperwork), I can usually get coverage for most treatments.
I encourage patients to keep a log or record of their symptoms. For example, is the worst dryness in the mornings or evenings? Do you have other symptoms such as blurred vision or itching? What activities worsen dryness? Does it affect you going outside when it’s windy or using a computer? Additionally, and this is very important: What treatments have you tried before? Maybe another eye care provider recommended a treatment that didn’t work, or maybe you used various types of eye drops from a pharmacy and none worked. This is important for us to start a treatment and also to prove to the insurance company that a specific treatment has already been tried to get coverage for another option.
The treatment of dry eye disorder is very frustrating for patients and providers because there are many factors that can play a role in it. A provider may have an idea of which treatments will be best, but we are all different and what works for one person may not work for another. For more information on dry eye disorder, visit the More Real YouTube channel. More Substance. This educational resource was prepared with the sponsorship of Viatris, Inc. USA-NON-2024-00011 05/24.
