Dry eye syndrome, a condition affecting more than 3 million Americans yearly, occurs when the eye cannot produce enough liquid tears (sometimes referred to as aqueous fluid). The importance of tear film cannot be overstated—this liquid covers the eye surface and is responsible for protecting the eye from environmental hazards, maintaining the ocular surface, and helping with light refraction. The three major layers of tear film include the inner mucin, middle aqueous, and outer lipid layer; a disruption or tear in any layer contributes to dry eye symptoms. Recognizing these symptoms is key to timely and adequate intervention.
Oddly enough, watery eyes may be a symptom of dry eye syndrome. This strange phenomenon occurs when the meibomian glands don't produce enough oils to protect the outer layer of the tear film. When this happens, the middle aqueous layer tries to overcompensate by producing excess tears, leading to watery eye symptoms. Researchers found this symptom appears most commonly in people with diabetes or meibomian gland disorders
A gritty sensation in the eyes is another common complaint associated with dry eye syndrome. Decreased tear production and poor tear quality lead to inadequate lubrication; this causes ocular irritation and poor eyelid movement. Some people with the condition liken the feeling to having sand or dirt particles trapped in their eyes, and research suggests excessive screen use exacerbates this symptom.
Dry eyes can also cause a painful burning sensation. Researchers posit that this burning sensation likely occurs due to the absence of oils typically present in human tears. These oils, present in the outer lipid layer, help prevent evaporation of tears; when absent, tears evaporate quickly and cause inflammation. If this symptom becomes a chronic complaint, doctors refer to it as "burning eye syndrome" and may prescribe anti-inflammatories or autologous serum eye drops to alleviate the discomfort.
Eye discoloration is often associated with dry eye syndrome. Eyes may turn either red or take on a yellowish hue due to irritation and inflammation. However, not all redness points to dry eye syndrome. Other causes, such as conjunctivitis, environmental irritants, and allergic reactions can also lead to concerning discoloration. It is always best to seek the opinion of a trained optometrist or ophthalmologist if discoloration appears.
Sometimes, symptoms associated with dry eye syndrome indicate other problems. Blepharitis, a condition that makes eyelids red, swollen, and irritated, contributes to the occurrence of dry eye syndrome. Most people with blepharitis complain of itchy and watery eyes in addition to swollen eyelids. Meibomian gland dysfunction, a genetic eye condition characterized by red, swollen eyelids, leads to altered tear film composition; this causes the quick evaporation of tears and enhances dry eye symptoms.
No one likes waking up to crusty eyes, but people with dry eye syndrome may find this to be a common occurrence. Because dry eye syndrome causes excessive irritation, the body responds with an increase in mucus production. This excess mucus cannot be stored in the eye and often seeps out through the tear ducts. As the mucus dries on the eyelashes, tear ducts, and eyelids, it forms crusty deposits that cause discomfort and additional inflammation.
Itchy eyes occur when the eye lacks adequate lubrication and tear production, and itchiness is one of the most prevalent complaints of people with diagnosed dry eye syndrome. However, itchy eyes may be a symptom of something more serious, such as an allergic reaction. Allergic reactions cause itchy eyes but are also accompanied by throat tightening, hives, or even difficulty breathing. Whatever the cause, it's important to avoid rubbing itchy eyes; this will only lead to increased inflammation and irritation. Medicated eye drops are one of the best ways to combat itchy eye symptoms.
A poor night of sleep has long been blamed for under-eye puffiness, but this swollenness around the eye may also be an indication of dry eye syndrome. Lack of quality tear production causes inflammation and irritation, leading to enlarged tissue and tear ducts that cause excess swelling. Underlying causes, such as blepharitis, may also increase irritation and puffiness.
Many people with dry eye syndrome complain of a variety of morning discomforts, including puffiness, eyelid sticking, and excessive scratchiness upon waking. Although counterintuitive, sleeping can actually increase dry eye symptoms. Doctors found that many people with prominent morning discomfort may have a condition caused nocturnal lagophthalmos, which means they sleep with their eyes partially open. This condition leads to increased evaporation of tears and may be a leading cause of severe dry eye symptoms.
Recurrent corneal erosion occurs when corneal layers begin to separate due to severe dryness or trauma. People with dry eye disease that has progressed to this stage will experience recurrent morning pain and blurred vision. Unfortunately, this condition requires serious medical intervention through surgery or laser treatments. Luckily, after medical intervention, this condition can heal in as little as 24 hours but often takes up to a week.
Migraines are well-known for inducing sensitivity to light, but dry eye syndrome may also be a cause of sensitivity. Medical researchers do not have an exact understanding as to why this phenomenon occurs. Some suggest that inflammation of nerves around the cornea may be to blame, while others suggest that the lack of tears does not allow for proper light refraction to occur. Other causes of photophobia may include bacterial infections or neurla abnormalities.
Dry eye syndrome dramatically affects visual clarity. Tears and tear film both play an important role in visual acuity, as they provide a smooth surface for light refraction into the cornea. When the eyes are dry, this refraction occurs unevenly, thus creating blurry images and poor distance vision. Blinking lubricates the eyes, so many find that their vision clears after rapid blinking, and eye drops offer another effective tool to combat this symptom.
Extremely sensitive, the cornea is responsible for refracting 80% of the light that enters the eye. In the later and more serious stages of dry eye disease, the nerves around the cornea become extremely inflamed and easily irritated. When this happens, these nerves send frequent messages of pain to the brain, increasing sensitivity around the cornea. Wearing contact lenses or using eye drops with artificial preservatives may increase this burning pain and cornea discomfort.
Twitchy eyes, medically referred to as eyelid myokymia, occurs when nerves in and around the eye react improperly to stimuli. Doctors are unsure why this temporary condition occurs in conjunction with dry eye syndrome, but some posit that inflammation is to blame. Research suggests that women with dry eye syndrome may experience more eyelid twitching than men with the condition. Other common causes of eyelid myokymia include poor sleep habits, caffeine intake, stress, or even digital eye strain.
Although most people with dry eye syndrome experience painful or bothersome symptoms, some people with the disease may not experience any symptoms at all. Untreated, dry eye syndrome is correlated with an increased risk of eye infection, abrasion of the corneal surface, and even vision loss. Regular visits to a licensed optometrist allow for early detection and may help prevent long-term health consequences.
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