Dr. Jiří Spíšek from the Ophthalmology Clinic in Pardubice answers your questions on our web side.
The so-called Dry Eye Syndrome is discussed more and more often nowadays. How does it manifest?
The most frequent subjective symptoms are burning sensations, feelings of eye pressure, foreign body or sand in the eye, tired eyes, feeling of eyelids sticking to eyes, photophobia (sensitivity to light), or pain when applying eye drops. Other factors related to Dry Eye Syndrome are strong winds, smoke and air conditioning tolerance, evening vision deterioration, vision quality variations in the day light and paradoxically increased tearing due to the poor quality of the tear film, which can lead to early leakage from the eye slit. Consequently, the irritation of the drying eye surface repeatedly provokes overproduction of the same poor quality tear film, which in turn causes further leakage. Thus, the whole process is steadily repeated.
What can cause the appearance of dry eye syndrome?
Not only the eye surface but also some systemic disease is very often present. Psychosomatic aspects play an important role, such as emotional instability, environmental factors (cigarette smoke), wearing contact lenses etc. Dry eye difficulties may develop in predisposed patients due to increased tear vaporing in air-conditioned rooms, working on the PC all day or watching TV for several hours. Many patients suffer from mouth and nose dryness as a result of central heating systems or air-conditioning.
Some drugs may also contribute to a decrease in tear secretion and to the development of dry eye syndrome, drugs such as antidepressives, antiarythmics, or antihistamines. Development of the disease may also be strengthened by local eye medication, due to the toxicity of the preservatives that are contained in the drugs, or by long-term usage of vasoconstrictive eye drops. Patients predisposed to dry eye syndrome are those suffering from certain internal diseases, such as diabetes, decreased function of the thyroid gland, or suffering from some rheumatic and skin diseases.
Can dry eye syndrome develop in young or generally healthy people?
The causes of tear film instability can vary. Most frequently, we find decreased tear secretion from the corresponding glands, pathological changes on the surface of the cornea, such as scars, dystrophic changes, or deposits, disorders in the position of the eyes and the configuration relating to the eye surface. Any conditions and situations encouraging increased tear vaporing also play a negative role. Besides professional causes, dry eye syndrome development may be influenced by an increase in age (e.g. by hormonal disorders due to climacteric or long-term beta-blocker administration in patients with glaucoma). However, younger patients are not excluded, most commonly due to the above-mentioned conditions such as spending all day at the computer or after laser refraction operations.
How can patients better stay, for example, in offices or air conditioned shopping centers if they suffer from dry eye syndrome?
Among symptoms of the so-called dry building syndrome are headaches, eye or mucosal irritation, a feeling of having a foreign body in the eye, burning sensations, and hypersensitivity to light. They are all caused by dry air, air conditioning or by harmful vapors from office furniture, wall surfaces, or carpets. In winter, the air humidity decreases below 40% in the overheated rooms although according to European Union standards healthy air should have 45 – 55% humidity.
In air with insufficient humidity, dust particles spontaneously move and attract polluted molecules, therefore irritating the eyes and mucosa. This counts mainly for people who work almost 8 hours at a computer because there is an electrostatic field around the monitor that whirls harmful dust directly into the eyes. A healthy eye is able to protect itself against such dust particle attacks but a diseased eye is almost defenceless due to disturbances in the natural eye sheath (tear film).
How do dry eye symptoms relate to pollen, mites or mold allergies?
Allergies appear mainly at the beginning of the year. However, not every itching eye is a symptom of hay fever. The symptoms often show dry eye problems. They are caused by irritating substances, e.g. grass pollen. During allergic reactions appearing at the beginning of the year (mainly hay fever), the conjunctiva gets bigger, tear overproduction occurs and the even nose and respiratory apparatus can be affected.
Diagnosis is more complicated in case of allergies known as ‘polyvalent allergies,’ such as allergies to house dust and mites. Symptoms of allergies such as these, e.g. inflamed eyelids, can be symptoms of dry eyes as well.
While anti-allergy substances do not help in cases of dry eye, the condition may be reduced. However, medication supporting tear production may help even in hay fever: the liquid washes away the substances that cause allergies and lead to allergy improvement.
Some symptoms of eye irritation from mold spores are blurred vision, burning and itching, circles and sacks under the eyes, tearing, light hypersensitivity, red eyes, or pain in the eyes. If inflammation with pus discharge occurs, a doctor prescribes suitable antibiotics or antimycotics.
Some effective means of protecting oneself against indoor molds are, for example, sufficient and regular room ventilation, regular cleaning using suitable cleaning agents, avoiding increased humidity, using preventive anti-mold preservatives on the various materials. Preventive protective agents should not be confused with antiseptic agents that are active only against already existing molds!
And what about traveling?
Air density in areas with travelers is very often low and the eyes are strained. Eyes itch, burn, they are bloodshot and very quickly become tired.
Those who complain the most are airline passengers. The average air humidity in an airplane is only around 10%, which is only around one fifth of the normal value. The air that is pumped into the passenger sections is, at a height of 10, 000 m, far drier than air at lower altitudes. As a result, tear film, which is composed 90% of hydration components, is insufficiently hydrated and ultimately prematurely damaged. The eye is then not protected against dust and harmful substances. The longer the flight takes the higher risk that the eyes will dry out.
There may also be dry air in cars or trains. Ventilators and draft in the cabins cause fast vaporing that leads to air dryness. Moreover, only a very small number of means of transport have filters for pollen or dust, thus the eyes are strained due to the various tiny substances entering the eyes.
What is the treatment of dry eye syndrome?
Treatment must be very complex. At the beginning, it is always necessary to stabilize all the local or general diseases that may influence the development of dry eye syndrome. It is also important to find out which part of the tear film is damaged and to what extent, and base the treatment on these findings. By substituting natural tears with artificial ones, a steady layer of tear film on the eye surface, thus providing protection against drying and irritation. We determine the form of treatment, eye drops or gel, according to the level of damage. Surgical therapy includes application of various types of caps in order to close drain passages temporarily or permanently.
A number of supporting treatment procedures are an integral part of medicamentous therapy: eyelid hygiene, psychosomatic treatment, adjustment of outer conditions.
Early diagnosis and suitable dry eye syndrome treatment may ease the patient’s long-term unpleasant subjective complaints and contribute to an increase in the patient’s quality of life.
Is there any self-treatment for people suffering tiredness and tearing?
Patients should never treat themselves if they are not 100% sure of the cause of their trouble. Many drugs only diminish symptoms but they do not treat the cause of the disease. Symptoms will usually reappear in cases of self-treatment and could even lead to chronic eye inflammation.
Alternatives to improve indoor spaces are plants. Some kinds of plants help to moisturize the air and significantly contribute to keeping air clean and improving the overall indoor atmosphere. Here we are speaking of plants with large water circulation, such as cypress or banana trees. They release from their surface up to one liter of water a day, thus increasing the air humidity, something which is recommended for people with dry eye syndrome.
Some additional advice: try to expose your eyes to fresh air several times a day, take walks outside and drink a lot.