Dry eye symptoms can vary between patients. This is a list of symptoms in order of most common presentation in my dry eye practice.
1. Burning: burning is always from dryness (which is most often due to decreased meibomian gland oil in the tear film).
A. The most common cause of chronic burning is MGD: meibomian gland dysfunction which means one’s oil is not being incorporated into the tear film properly: this can occur for many reasons:
a) decrease number of oil glands
b) orifice of gland or any part of gland is scared and preventing the oil from coming out (like in patients who used Accutane or have Ocular rosacea)
c) the composition of the oil is not perfect
Most patients note actual dryness or sticking of eyelids
B. The second most common cause of burning is from Aqueous Tear Deficiency (ATD), which means the Lacrimal Gland does not produce enough Aqueous (or the watery part of the tear). This can also occur for many reasons:
a) underlying inflammation in the lacrimal gland from autoimmune disease (Sjogren’s syndrome, Rheumatoid Arthritis, Lupus, etc), previous Accutane use.
b) previous surgery/trauma
C. The 3rd most common cause of chronic burning is previous Laser refractive surgery or corneal surgery, such as LASIK, PRK, corneal transplant. This occurs usually because the corneal nerves have been cut which in some patients can lead to a cascade of inflammation that cause the nerve fibers to keep firing causing a burning pain or just pain.
D. For Acute Burning:
a. The most common cause of acute burning is not blinking enough & an acute drying out of the tear film: don’t try this but you can prove it to your self by not blinking for a couple of minutes.
b. Chemical in the eye: an abnormal ph on the eye’s surface will cause burning which usually resolves once the ph is brought back to 7.0.
2. Foreign Body Sensation: usually due to an abnormal combination of oil, and aqueous, mucin which prevents a smooth covering over the eye of the tear. Also scar tissue on the eye’s surface and/or meibomian glands can cause this sensation. Demodex mites and bacteria clumps can also cause this.
3. Grittiness: usually due to an abnormal combination of oil, and aqueous, mucin which prevents a smooth covering over the eye of the tear. Also scar tissue on the eye’s surface and/or meibomian glands can cause this sensation. Demodex mites and bacteria clumps can also cause this.
4. Dryness: “they just feel dry” or “my eye stick together”
5. Tearing: this is from a Reflex. The eye senses dryness and sends a signal to the glands to produce reflex tears which still do not have the right combination of oil, and aqueous, mucin
6. Itching: Allergies and Dry eyes go hand in hand. Allergies can destroy meibomian glands thru chronic inflammation. Dry eyes make allergic conjunctivitis worse likely because the tear cannot properly flush out allergens. A vicious cycle ensues. It is important to keep allergies under control with the options mentioned below. Remember Warm Heat is good to clean glands and lashes. Cold/ice compresses help with Allergies, redness, itching. We sometimes need to use both: 1st heat to clean and then cold after to keep inflammation/allergic reactions low.
7. Redness: never ignore eye redness. It means there is inflammation and scar tissue will form somewhere if not controlled.
8. Chronic Pain: this is less common but from reasons above.
9. Vision Loss: rare. Severe dry eye can lead to vision loss requiring a corneal transplant or even severe eye infections.
Step Ladder Approach to Chronic Eye Itching:
Dry Eye Syndrome (DES), is the essentially the same as Dry Eye Disease (DED). It is also known as Keratoconjunctivitis Sicca (KCS), and Keratitis Sicca and even sometimes as just, “Dry Eye.” Dry Eye Syndrome is a multifactorial disease of the tears and the ocular surface that results in discomfort which can range from mild irritation to eye burning and go on to terrible pain. It also causes visual disturbances which can begin as blurry vision from time to time and to progress to loss of vision in severe cases. It can cause tearing (usually due to a reflex), redness (which is a sign of inflammation that is leaving behind scar tissue in the cells of the eye), itchiness (which is often due to allergy or demodex mites and/or bacteria on the eyelash margin), and tear film instability (which causes fluctuating vision and the feeling that your glasses are the wrong prescription. All of these issues have the potential to cause significant eye surface damage.
The most unhappy medical patients I have ever seen are those with cancer with metastatic bone pain. They need iv drips with morphine. Not too far down the list on unhappy patients are my patients with severe dry eye who have terrible pain with each blink of their eye. They ignored their discomfort for years and now regret having ignored their eyes.
Initially, one or both eyes might be a little red and feel irritated.
This is what your eyeMD is looking under the microscope.
As the disease worsens, the signs of dry eye under the microscope worsen. This is called Superficial Punctate Keratitis or SPK. This means the cornea’s front layer of cells are dead and not doing their job of protecting the inner nerve layer from discomfort and pain. The front layer or epithelial layer can grow back but they often need help to do so. It is imperative that we help them grow back. Otherwise, more inflammation develops and the disease worsens. It is a vicious cycle that must be stopped.
Treatment Options: There are many options. One of the best, we have seen if initial treatments do not resolve symptoms is the Lipiflow machine.
Sandra Lora Cremers, MD, FACS
I revised the Wilkipedia page on its website a bit but was very impressed with the information provided on dry eye.
Dry eye syndrome
|Dry eye syndrome|
|dry eye, keratoconjunctivitis sicca, dry eye disease, keratitis sicca|
|Classification and external resources|
Signs and symptoms
Decreased tear or excessive evaporation
Autologous serum eye drops
Fish and Omega−3 fatty acids consumption
- Cavalier King Charles Spaniel
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