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Why dry eye disease is on the rise and what can be done about it

Consistently scratchy, irritated eyes are a modern-day phenomenon and should not be ignored – here, experts tell us how to combat dry eyes

Dry eye syndrome, or dry eye disease, is an affliction characterised by dehydrated, burning and sometimes watery eyes.

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
Excessive screen time affects tear fluid production, not so much from the heat or radiation from your screen, but because your ‘blink rate’ decreases: like moths, we are primed to stare into those bright screens, which suppresses the blink reflex that coats our cornea with moisture and protective oils. Gamers, it’s been shown, blink twice a minute compared to an average blink rate of twelve times a minute, giving you some idea of how an intense relationship with your digital screens can cause eye drought.

  • Face masks
There is another reason why the pandemic has contributed to a dry eye epidemic: “mask-associated dry eye (MADE) is a thing,” says Shah-Desai. “Due to airflow emanating from underneath face masks (that’s us talking, exhaling, huffing and puffing) our tear film will evaporate at an accelerated rate.” As if maskne wasn’t enough…

  • Makeup
In a roundabout way, our dependence on screens, social media and Zoom in particular, may have contributed to dry eye being on the rise: the eye makeup we’ve become wedded to in order to strike a perfect pose at all times carries risks when it comes to eye lubrication.

“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
She also cautions against oil-based lash conditioners – lash growth serums don’t escape her scrutiny, either. “Used excessively, those with prostaglandin analogues can inflame the eye margin while increased lash growth may lead to the plugging of the oil glands and more dry eye disease,” she says.

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
Continuing (depressingly) on the beauty theme, “recent research has found that topical retinoids used close to the eyes, for example in eye creams, can contribute to dry eye by damaging the meibomian glands,” says Cross-Alexander.

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 bud

Clearly, 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!
You must take breaks from your screen, says Shah-Desai. “Look at a distant object 20 feet away for 20 seconds every 20 minutes: it’s the 20-20-20 rule and it’s essential for giving your eyes a rest and remembering to blink.” The average screen user is nearly as bad as a gamer: “we blink six to eight times less than normal in front of our gadgets,” says Cross-Alexander.

  • Drop correctly
“If you use eye drops, you absolutely must make sure they are preservative-free – look for products that mention this specifically,” says Cross-Alexander. “The eye surface is very vulnerable to preservatives; they can make dry eye worse if used regularly. This is well-established within the eye care community, but many drops still contain them.”

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
 “I recommend an omega oil-rich diet or supplements to my patients,” says Shah-Desai. “Several studies suggest omega-3 fatty acids may help protect adult eyes from macular degeneration or dry eye syndrome. One study found that women who ate at least two weekly servings of tuna had significantly less risk of dry eye than those who ate one or fewer servings per week.” Fish-free sources of omega-3 fatty acids are eggs, flaxseed oil, walnuts, dark leafy greens and tofu.

  • Try eye plugs
‘Punctual plugs’, which are literally tiny plugs used to temporarily block the opening of the tear ducts (which drain eye fluid) to allow tears to be retained on the eye surface, are an option, says Shah-Desai. She can perform the procedure but they are also routine on the NHS.

  • Pulse it better
OptiLight by Lumenis is a new, Intense Pulsed Light (IPL) device that delivers “precise pulsed light of high intensity to the closed eyelids to improve eye, lid and lash health, blepharitis and dry eyes (it can also tackle rosacea on the face),” says Murthy. “It’s the first and only IPL system that’s FDA-approved for dry eye management.”

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 do

Finally, 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
“One popular hack making the rounds is to cut an onion to induce your eyes to produce more natural tears. Another is to use a boiled egg for a nightly heated eye compress. Both of these probably won't cause harm, but there are certainly far more hygienic and effective options. The hack I am most concerned about is applying honey directly to the eyes – that could most certainly result in a trip to A&E. Stick to manuka honey in eye drops (as an ingredient, it’s antibacterial) instead!”
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.“

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