Dry eye syndrome: Causes, symptoms, and breakthrough treatments

Being an Oculoplastic and facial aesthetics surgeon, I frequently come across patients who present with persistent discomfort in their eyes, which causes burning, irritation, and even blurred vision. Often these symptoms stem from a common but underestimated condition also known as Dry Eye Syndrome (DES). With the rising surge in digital screen usage and environmental challenges, dry eye is not a problem just limited to older adults- it’s affecting young professionals, students, and even children.


Understanding Dry Eye Syndrome

Dry eye syndrome is a multifactorial disease of tears and ocular surface that results in symptoms like discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It mainly occurs due to the decreasing tear production, poor quality of tears or excessive tear evaporation.

The tear film which coats the surface of the eye is usually made of three main layers: a mucous layer which helps the tears to adhere to the eye, a watery (liquid) layer that hydrates and nourishes and the lipid (oily) layer which prevents evaporation. A disruption in any of these layers has the potential of triggering dry eye syndrome.


Causes of Dry Eye Syndrome

1. Environmental Factors- prolonged exposure to air conditioning, wind, dry climates, and pollution accelerates the process of tear evaporation. In the cities, the combination of screen time and air conditioning is extremely problematic.


2. Digital Eye Strain- the increasing reliance on smartphones, laptops, and tablets is reducing the frequency of blinking significantly. Less blinking means that the eyes are being lubricated adequately and causes dryness.


3. Age and Hormonal Changes- In postmenopausal women, age-related changes lead to the reduction of tear production. The composition and stability of the tear film are also affected by hormonal imbalances.

4. Autoimmune Disorders- conditions such as Sjögren's Syndrome, rheumatoid arthritis, and lupus are usually correlated with dry eye because of immune-mediated destruction of the tear glands.

5. Medications- Antihistamines, antidepressants, decongestants, and certain acne medications have the potential to reduce tear secretion as a side effect.

6. Eyelid Disorders- several health conditions like blepharitis (inflammation of the eyelids), meibomian gland dysfunction, or incomplete eyelid closure interfere with normal tear distribution and drainage.


Recognizing the Symptoms

Dry eye syndrome usually presents in a range of severities, and its symptoms are-
● Persistent dryness or scratchy sensation
● Burning or stinging eyes
● Redness and inflammation
● Sensitivity to light (photophobia)
● Blurred or fluctuating vision
● Mucus discharge in or around the eyes
● A paradoxical symptom: watery eyes (a reflex response to dryness)
If it is left untreated, then dry eye can lead to corneal damage and an increased risk of eye infections, significantly affecting one’s quality of life.


Diagnostic Advances

Conducting a thorough eye examination acts as the cornerstone of diagnosis. Using sophisticated diagnostic tools allows us to evaluate tear quantity, quality, and evaporation rate.
Some of the most effective diagnostic methods include:
● Schirmer’s Test: It measures the rate of tear production using paper strips.
● Tear Break-Up Time (TBUT): This evaluates how long the tear film remains intact after blinking.
● Meibography: it visualizes the meibomian glands in the eyelids.
● InflammaDry: A point-of-care test that detects elevated MMP-9 levels, an inflammatory marker linked to dry eye.


Breakthrough Treatments

With the advancements in technology, the treatment of dye eye syndrome is also evolving with a shift towards a more personalized and targeted therapies. Some of the latest and most effective options are-

1. Artificial Tears and Lubricants- Over-the-counter artificial tear drops act as a mainstay in mild to moderate cases. However, patients need to choose preservative-free formulations to avoid toxicity and irritation, especially with frequent use.

2. Prescription Medications
● Cyclosporine (Restasis) and Lifitegrast (Xiidra): These drops help in reducing inflammation and increasing tear production.
● Corticosteroids: These are used for a short period of time to control acute inflammation.
● Secretagogues: Oral or topical agents help in stimulating tear production.

3. Punctal Plugs- Tiny, biocompatible plugs, when inserted into the tear ducts they prevent drainage of tears, keeping the eye surface moist longer. This is a quick, reversible and minimally invasive procedure.

4. Intense Pulsed Light (IPL) Therapy- This method was originally used in dermatology; IPL is now being used for dry eye treatment, especially in patients with meibomian gland dysfunction. The light pulses help in reducing inflammation and improves lipid secretion from the glands.

5. LipiFlow Thermal Pulsation- A groundbreaking in-office procedure that delivers soothing heat and pressure to defog and revitalizes the meibomian glands. It addresses the root cause of evaporative dry eye with long-lasting results.


A Holistic and Patient-Centered Approach

Being a committed ocular and facial aesthetic surgeon , I emphasize the importance of customizing the treatment plans, which are based on the patient’s unique anatomy, lifestyle, and underlying conditions. Dry eye syndrome is not a nuisance, but it can act as a gateway to more serious ocular complications and psychological discomfort if overlooked.
I encourage my patients to view dry eye as a chronic but treatable health condition. With the help of early intervention, proper diagnosis, and the integration of modern treatment technologies, many people can achieve significant relief and regain visual comfort.

Dry Eye Syndrome might be a modern epidemic, but it is also a field that has recently been witnessing some extraordinary advancements. Whether you’re experiencing occasional dryness or struggling with chronic symptoms, know that effective help is available.
As with all conditions, early diagnosis and proactive management are key. If you’re experiencing any of the symptoms mentioned, consult an eye care specialist for a comprehensive evaluation. Your eyes deserve it.

(By Dr. Sneha Shah , Oculoplastic and Facial Aesthetic Surgeon)