Discomfort due to dry and inflamed eyes can have a number of causes and in severe cases can lead to blindness. Fortunately early symptoms are easy to treat.
Dry eye syndrome is a common condition, estimated to affect up to a third of people at some time in their life. The condition is most frequently seen in those over 60 years of age and is more common in women than men.
Dry eye syndrome is a condition in which the eyes can’t make enough tears, the right type of tears or the tears evaporate too quickly. The tear layer normally coats the eye, aiding clear vision and protecting the surface of the eye. Disruption of the tear layer and subsequently inadequate lubrication of the eyes can cause them to become dry, inflamed and uncomfortable.
Classification of dry eye syndrome
Dry eye ranges from mild cases, which may go untreated, to more severe disorders of the tear film, which can result in chronic eye disease.
- Mild conditions will include some of symptoms mentioned above and can usually be managed satisfactorily with artificial tear supplements, lid therapy and other common treatments. Many people may suffer from dry eyes from time to time due to environmental factors and many will be unaware of the symptoms.
- Moderate dry eye may affect vision more, and will probably affect quality of life a lot more because of chronic pain, eye sensitivity, light sensitivity and restricted activities.
- Severe dry eye may lead to desiccation of the corneal epithelium, ulceration and perforation of the cornea, an increased incidence of infectious disease and, potentially, serious visual impairment and even blindness.
Patients will present with some or all of the following symptoms:
- Eyes tire easily.
- Aching and sore eyes.
- Scratchy or gritty eyes.
- Watery eyes.
- Sensitivity to light (photophobia).
- Fluctuating, blurred vision.
- Mucus build-up.
Depending on your lifestyle, various environmental conditions such as air conditioning, smoke, car heaters and prolonged use of computers can contribute to dry eye. Other causes include:
· Contact lens wear.
· The menopause.
· Laser-assisted in situ keratomileusis (LASIK).
· Eye injuries and burns, including exposure to chemotherapy and radiation.
· Eye conditions, including meibomian gland dysfunction (MGD), blepharitis and ocular rosacea.
· Absence/abnormality of lacrimal gland/ductules.
· Neurological lesions.
· Vitamin A deficiency.
· Drug side effects.
· Systemic diseases.
Initially focus on identifying and addressing lifestyle and/or environmental factors that may cause or exacerbate dry eye syndrome, for example prolonged viewing of computer screen.
The patient’s medication history should also be reviewed, as both topical and systemic drugs can produce side effects associated with dry eye symptoms. Examples of these drugs include antihistamines and diuretics.
Once the above have been reviewed, the patient should be encouraged to maintain a good level of daily water intake to aid hydration. In addition, as omega 3 fatty acids may reduce tear evaporation and inflammation, oral supplements or dietry intake via fish or flaxseed oil can be recommended.
Artificial tears and lubricants
The term ‘artificial tears’ is commonly used to describe drops, solutions and liquid gels applied directly into the eye. Artificial tears don’t have all the components of real tears - they mainly just act as a lubricant. The term ‘ocular lubricants’ generally refers to more viscous products such as ointments.
In patients with mild or moderate dry eye symptoms
- Artificial tears alone may be sufficient to provide relief.
- Hypromellose is one of the most commonly used products, and can be administered frequently.
- Products containing carbomers or polyvinyl alcohol are more viscous and longer-acting than hypromellose.
- Sodium chloride is short acting and suitable as ‘comfort drops’ or for use with contact lenses.
- Sodium Hyaluronate is now seen as the new gold standard for dry eyes. As well as providing immediate and long-lasting relief for dry or irritated eyes, its physical characteristics allow it to flow easily over the surface of the eye during blinking but also maintain its viscosity in the open eye. This allows the user a longer lasting and generally more comfortable product.
Some eye drops contain preservatives such as benzalkonium chloride and can cause irritation to the eyes. If someone is sensitive to preservatives or uses soft contact lenses, consider advising the patient to try using a preservative-free product.
In patients with severe dry eye symptoms
- Sodium Hylauronate could still be suitable for these patients.
- Eye ointments, such as those containing paraffins, physically lubricate and protect the eye surface from epithelial erosion and are particularly useful when the eye is closed during sleep.
- Acetylcysteine eye drops are beneficial to patients who have build-up of mucus in their eyes.
Moorfields Pharmaceuticals has identified Dry Eye Syndrome as a significant area of patient need. With so many different causes, symptoms and treatments out there, it’s important to keep up-to-date with all the latest information. Nurses can play a big role in educating patients about the various lifestyle factors that might be contributing to their dry eye whilst also suggesting to use preservative free treatments.
Dry eyes medical, a peer reviewed resource created especially for healthcare professionals involved in the diagnosis and treatment of dry eye conditions www.dryeyesmedical.com
British National Formulary and the 2007 Report of the International Dry Eye WorkShop (DEWS) www.tearfilm.org/dewsreport/pdfs/TOS-0502-DEWS-noAds.pdf
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