Dry eye syndrome

Definition

Dry eye syndrome is when the eye is unable to maintain a healthy layer of tears to coat it.

See also:

• Conjunctivitis
• Decreased tearing
• Sjogren syndrome
• Vitamin A deficiency

Alternative Names

Keratitis sicca; Xerophthalmia; Keratoconjunctivitis sicca

Causes, incidence, and risk factors

Dry eye syndrome often occurs in people who are otherwise healthy. It is more common with older age, because you produce fewer tears with age.

In rare cases, it can be associated with rheumatoid arthritis, lupus erythematosus, and other similar diseases. It may also be caused by heat (thermal) or chemical burns.

In areas of the world where malnutrition is common, vitamin A deficiency is a cause. This is rare in the United States.

Symptoms

Signs and tests

Signs include:

• Reduced visual acuity
• Thick cornea

Tests may include:

• Slit lamp (biomicroscope) exam of the film of tears (a dye such as fluorescein may be placed in the eye to make the tear film more visible)
• Schirmer's test -- measures the rate of tear production using a calibrated paper wick placed on the edge of the eyelid

Treatment

Treatments may include:

• Hot compresses or eyelash cleaning
• Lubricating ointments (in more severe cases)
• Medications such as Restasis, topical corticosteroids, and oral tetracycline and doxyccycline
• Tiny plugs placed in the tear drainage ducts to help the tears stay on the surface of the eye
• Wetting drops called artificial tears

Surgery may be used if the eyelids are in an abnormal position.

Support Groups

Expectations (prognosis)

Most patients with dry eye have only discomfort, and no vision loss. With severe cases, the clear window on the front of the eye (cornea) may become damaged or infected.

Complications

Ulcers or infections of the cornea are serious complications.

Calling your health care provider

See your health care provider immediately if you have dry eyes and have:

• A sudden increase in discomfort or redness
• A sudden decrease in vision

Prevention

There is no way to prevent dry eye syndrome. You can prevent complications by using wetting and lubricating drops and ointments.

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References

Tu EY, Rheinstrom S. Dry eye. In: Yanoff M, Duker JS, eds. Ophthalmology. 3rd ed. St. Louis, Mo: Mosby Elsevier; 2008:chap 4.23.