Traditionally, it has affected mostly older people as it’s to do with tear glands becoming less effective with age (the average age for the onset of dry eyes is 50). But, says Ophthalmic Plastic Reconstructive Surgeon Sabrina Shah-Desai, “large numbers of people are now experiencing it at a much earlier age, and this is linked to increased WFH screen time during and post-pandemic.”
In fact, “the increase in numbers of patients reporting dry eye symptoms has been astounding,” says Optometrist and Peep Club Founder Nicola Cross-Alexander. “I see people in their 30’s and even teenagers presenting with them.”
What is dry eye syndrome?When you suffer from ‘dry eye’, you either don’t produce enough tear fluid to properly hydrate your eyes, or the fluid you make is of poor quality. “It’s the latter type which is more impacted by lifestyle and diet, that we’re seeing the biggest increase in,” says Cross-Alexander. “It’s typically caused by dysfunction of the tiny meibomian glands in the upper and lower eyelids, which produce the lipid or oily layer of the tear film.”
Not making enough tear fluid, meanwhile, is caused by a dysfunction in the lacrimal gland that makes the watery layer of the tear film. “This is what happens mostly with age and hormone fluctuations caused by (peri) menopause, pregnancy and the Pill,” says Cross- Alexander, “but lifestyle factors are also involved, and one of them is excessive screen use.”
As a result, the nice lubricating water-and-oil film covering your eyeballs is too flimsy or evaporates too quickly, and eyes become dry and irritated. Often, they will start over-producing a too-watery fluid that doesn’t do the job properly, resulting in gritty eyes and people wondering why you’re crying when you’re not.
Why so dry?There’s a host of reasons why tear glands can start to fail:
- Digital screens
- Face masks
“The eyelid margin (or waterline) and eyelash follicles are involved in the production of the oily part of the tear film, and therefore the protection of the eye,” says Consultant Ophthalmologist and Oculoplastic Surgeon Dr Rachna Murthy. “If any part of the lid edge is inflamed or compromised, it can induce a tear film disturbance that can affect the eye surface. Left untreated, this can develop into dry eye disease.”
Makeup applied on or too near to the waterline, like kohl, ‘fine-liner’ or mascara, can spell trouble, agrees Shah-Desai, while Murthy also points to eye makeup removers: “astringent ones containing alcohol or other irritants will dry out the lash line, while anything with oil too close to the lid margins can travel into the eye, promoting bacteria and disturbing the microbiome, which can again cause dry eye.”
- Lash boosters
And to round off the bad news on the eye makeup front, Shah-Desai flags the dry-eye danger of very long false lashes or lash extensions: “odd as it may sound, they can cause a ‘breeze’ that helps evaporate tears,” she says. A dense thicket of lashes may also harbour more bacteria that your eye film can’t manage.
- Skincare… and more
She can think of further culprits as well. “A lack of hydration (aim for two litres of water a day), antioxidants and omega-3 fatty acids in your diet increases the chances of dry eye syndrome,” she says. “Smoky, polluted, centrally heated or air-conditioned (work) environments can cause tears to be wicked away faster than they are replaced. Underlying autoimmune diseases, refractive eye surgery, contact lens wearing and hormonal upheaval are factors as well.”
Is dry eye disease dangerous?Dry eye can be majorly uncomfortable and, despite in most cases not leading to permanent damage, “there are long-term risks of which there is poor awareness,” says Shah-Desai.
Cross-Alexander adds that many people mistake the early symptoms (anything from redness, itching, burning and excessive watering to a gritty feeling) for allergies – or simply accept the mild discomfort without seeking treatment. “But the tricky thing about dry eye syndrome is that it will get worse if left untreated, allowing it to potentially turn into a complicated condition to manage with sight-threatening ramifications.”
Shah-Desai mentions heavy eyelids, permanently sore dry eyes, blurred eyesight and vision fluctuation as issues that can develop over time, while infection and even eye scarring are also flagged as risks.
How to nip dry eyes in the budClearly, dry eyes shouldn’t be allowed to fester; far better to tackle the condition in its early stages. Here’s what you can do.
- Look away!
- Drop correctly
Avoid ‘whitening’ drops as well as they only serve to irritate the eye further. Cross-Alexander feels that the best products combine a humectant-like glycerin or hyaluronic acid, which adds moisture to the eye, with a lipid to lock the water in – just like the natural tear film.
Peep Club Instant Relief Eye Spray does just this. Shah-Desai, meanwhile, recommends prescription-only drops such as Lifitegrast and Eyesuvis which prevent inflammation and promote tear production for short-term treatment of more severe dry eye.
For over-the-counter eye-dration, she prefers preservative-free drops “because they are more effective than sprays.”
- Adjust your diet
- Try eye plugs
- Pulse it better
Three treatments are required for eyes, taking about 10 minutes each and spaced 2-3 weeks apart, with one annual session for maintenance. “It destroys the overgrowth of the mites that promote inflammation and resets the ocular microbiome, so reducing the inflammation typically associated with dry eye disease,” Murthy explains.
“In addition, the heat from the light allows the lipids in the oil glands to become more liquid and flow more easily, improving tear quality. Most excitingly of all, the treatment is proven to promote regeneration of the meibomian glands.” In short, it’s a procedure that could free you from a lifetime of eye drops.
… and what not to doFinally, with increasing awareness of dry eye disease comes an increasing set of made-up social media hacks as to how to treat them. To save you time and money, here are a few things Cross-Alexander urges you not to try.
- Putting food on your face
Baby shampoo is for baby’s heads
“Using diluted baby shampoo as a daily lid cleanser or makeup remover is a classic dry eye hack that has been around for years. This would be okay once in a while to clean your lids, but one of the most important dry eye studies conducted found that baby shampoo can destabilise the tear film – over time this can inflame the eye surface.”
Stick to regular glasses (if needed)
“Blue light-blocking glasses are a contentious topic amongst eye care professionals – mostly because of the exaggerated marketing claims, which include that these specs can relieve dry eye. There is little scientific evidence to support this.“