In our experience dry eyes presents in the following stages:

INTERMITTENT DRYNESS

Most of us experience this at some point in our lives. Possible causes of intermittent dryness:

  1. Lack of sleep- less than 6 hours of uninterrupted sleep
  2. Extensive near work/computer work or long drives- we tend to blink less when concentrating
  3. Wind/air flow- being in a windy environment, sleeping with a fan blowing on your face, working outdoors
  4. Contact lenses- long hours in contact lenses, sleeping in contact lenses, wearing contacts for more days or hours than they are designed to be worn

These dry eye sufferers still make enough natural tears, but environmental factors dry the eyes sometimes.

Treatment for intermittent dryness includes avoiding the trigger and using over-the-counter (OTC) artificial tears.

NEW ONSET STAGE of CHRONIC DRY EYE SYNDROME

In the early stages of dry eye syndrome, a sudden decrease in tear production causes significant discomfort. The cornea (front surface of the eyes) has more nerves per unit area than any other part of the body. When the tear film is inadequate, dry spots form on the surface of the cornea causing exposure symptoms including:

  • burning/irritation
  • itching
  • "feeling like something is in the eye"
  • light sensitivity "photophobia"
  • pain
  • tiredness/fatigue
  • difficulty keeping the eyes open
  • blurry/fluctuating vision
  • headaches
  • soreness/pressure behind the eye
  • redness
  • watery eyes
  • mild crusting in the morning

There are a lot of potential causes of dry eye syndrome. Whatever the cause, if the eyes suddenly become dry, the symptoms can be significant. Patients generally will seek medical care when these symptoms become severe enough to affect their quality of life and ability to work effectively.

     QUICK EXPLANATION OF HOW THE TEAR FILM FUNCTIONS

WELL MANAGED STAGE of CHRONIC DRY EYE SYNDROME

When the right treatment plan is found and followed on a daily basis, the symptoms become less frequent and less severe. This stage, the eyes can still get dry, but quality of life is not affected. Often patients think they only need to be on the treatment until their eyes get better.

DRY EYE SYNDROME IS A CHRONIC EYE CONDITION

Rarely does it completely go away. Some treatments such as punctal plugs improve symptoms without requiring the use of drops. Some treatments require eye drops or lid care daily. Either way, this condition needs to be managed for the rest of one's life.

LATE STAGE "ASYMPTOMATIC" DRY EYE SYNDROME

This stage is the most dangerous. The cornea may be the most innervated part of the body, but the nerves can become damaged and desensitized over the years. Patients begin to think their eyes are not dry anymore since they don't feel the symptoms of burning and irritation.

As the eyes begin to burn less, some patients will gradually decrease their treatment until they stop it altogether. If they do not keep up with regular medical eye exams to evaluate their dry eyes, they won't know that their eyes are still dry.

At this stage, patients present with the following symptoms:

  • blurry vision
  • decreased vision
  • feeling like glasses aren't strong enough
  • fluctuation in vision
  • unable to read for very long
  • tired eyes
  • poor night vision
  • glare/halos around lights
  • light sensitivity (photophobia)
  • headaches

Obviously, this stage is not truly symptom free. But patients rarely associate these symptoms with dry eyes. Once it is determined that they are in the late stage of chronic dry eye syndrome, treatment is prescribed.

Treatment for this stage is similar to the treatment for the early stage of chronic dry eye syndrome. However, often the treatment takes longer to take effect and must be treated more aggressively. Often an eye care provider that focuses on dry eye treatment is needed. Patience and persistence are key to successful improvement of this condition.

    TREATMENT OPTIONS FOR CHRONIC DRY EYE SYNDROME

BELOW ARE PICTURES TAKEN OF ACTUAL PATIENTS. (ADDITIONAL PHOTOS OF DRY EYES)

AFTER INSERTING NaFl (YELLOW) DROPS AND USING A BLUE LIGHT, WE CAN VIEW THE TEAR FILM ON THE FRONT SURFACE OF THE EYES. THE TEAR FILM SHOULD BE A SMOOTH LIGHT GREEN SHEEN OVER THE CORNEA.

THE CORNEA IS THE CLEAR WINDOW WE LOOK THROUGH... OR IT SHOULD BE...

Keratitis- the bright green spots are tiny cracks in the cornea like chapped lips

The darker areas are "tear break up" where the tears evaporate causing blurred vision like driving in the rain without windshield wipers