你有試過每當稍微工作一會，就覺得眼睛乾澀、痛楚，忍不住眨眼，即使閉眼休息也無法緩解嗎？這或許是乾眼症的症狀！想改善乾眼症，以為只要滴眼藥水、滴人工淚液，或者減少電視、電腦螢幕，便能從病情的根本原因改善乾眼症嗎？如果你以為乾眼症不用多久就會自己好了，那就大錯特錯了！可能這些方法，只會令乾眼症症狀越來越嚴重。
什麼是乾眼症？
乾眼症是一種常見的眼疾，每10個香港人3個有乾眼症。當眼睛無法產生足夠的淚液，或當淚液無法正常工作時就會出現，這種情況會讓眼睛感到乾澀、痛楚。出現乾眼症的原因，主要是因為隨著年齡的增長，淚水分泌量減少所致，臨床數據顯示，到65歲時，淚水內油脂層的分泌量比18歲時減少超過60%，淚水因而加快蒸發，所以乾眼症患者本身多半是年齡較大的族群中。
How does the composition of tears affect eye health?
在了解如何改善乾眼症症狀之前，我們該知道淚液本來在眼睛保護上的功用。除了保持角膜的滑潤和提供光學性能，淚液同時可以為角膜提供氧份，更具有將進入眼內的雜質和異物沖走的作用，而當中的抗體和酵素可以抵抗外來細菌，保護角膜的健康。
The tear film on the surface of the eye consists of three layers, each playing a specific role. If any one layer malfunctions, the tear film cannot adequately lubricate the eye, leading to dry eye syndrome.
I. Oil Layer
最外層是油脂層，由眼瞼毛下的分泌腺產生滑潤劑，它不僅可以防止水液成份過快蒸發，還增加表面張力維持淚液層的穩定性，同時提供眼瞬的滑潤度。
II. Aquifer
水液層是中間層，是淚液的主要成份，由淚腺產生。它是提供養份給角膜上皮細胞的重要成份，同時含有抗感染物質，能保護眼睛免受細菌感染。
III. Mucin Layer
最內層是黏液素層，由結膜細胞分泌，它的主要功能是與角膜和結膜上皮接觸，提供滑潤作用並確保水液層充分滋潤角膜。
這三層淚液的組成和功能必須保持充足，並且需要通過眨眼的動作來均勻分佈在眼睛上，才能使雙眼保持舒適。如果其中一層分泌不足或分佈不均，眼睛就會出現乾澀的感覺，有時甚至有異物感眼痛，刺熱或短暫昏矓的情況，甚至可能造成乾眼症。
What are the subjective symptoms of dry eye syndrome?
你是否也曾感到眼晴乾澀、疼痛、具異物感、怕光、視力模糊？或是覺得雙眼的淚水分泌比常人少？可是，有這些症狀就代表有乾眼症嗎？
In fact, experiencing symptoms of dry eyes is not a disease, but rather eye discomfort caused by external factors. As for dry eye syndrome, most patients will experience the following subjective symptoms, including:
- Dry eyes
- Foreign body sensation
- burning sensation
- Pins and needles sensation
- 眼痛
- photophobia
- envy
- 容易疲倦
- Blurred vision
- Fluctuations in vision
The reason for these symptoms lies in the poor stability of the tear film in individuals with dry eye syndrome, making them prone to the various symptoms mentioned above. This occurs because the discomfort from dry eye stimulates the lacrimal glands, causing them to secrete excessive reflex tears. Simultaneously, patients become highly sensitive to wind and light, frequently experiencing temporary blurred vision.
How can you objectively determine if you have dry eye syndrome?
To accurately diagnose whether you have dry eye syndrome, the most important factor is, of course, a combination of symptoms and examination results. However, if you simply suspect you might have it and want to understand your risk, you can use the internationally recognized Ocular Surface Disease Index (OSDI) to perform a self-assessment for dry eye syndrome.
I. Eye Sensations Over the Past Week
| at any time | Most of the time | About half the time | Occasionally | None | |
|---|---|---|---|---|---|
| Dry | 4 | 3 | 2 | 1 | 0 |
| photophobia | 4 | 3 | 2 | 1 | 0 |
| Redness with blood vessels | 4 | 3 | 2 | 1 | 0 |
| 疼痛 | 4 | 3 | 2 | 1 | 0 |
| Foreign body sensation | 4 | 3 | 2 | 1 | 0 |
| Thick secretions | 4 | 3 | 2 | 1 | 0 |
| Blurred vision | 4 | 3 | 2 | 1 | 0 |
| Poor eyesight | 4 | 3 | 2 | 1 | 0 |
II. Over the past week, eye discomfort has impacted the following activities:
| at any time | Most of the time | About half the time | Occasionally | None | Not applicable | |
|---|---|---|---|---|---|---|
| Reading | 4 | 3 | 2 | 1 | 0 | NA |
| Using a mobile phone/computer | 4 | 3 | 2 | 1 | 0 | NA |
| Night driving | 4 | 3 | 2 | 1 | 0 | NA |
| Watching TV | 4 | 3 | 2 | 1 | 0 | NA |
III. Over the past week, my eyes have felt uncomfortable under the following circumstances:
| at any time | Most of the time | About half the time | Occasionally | None | Not applicable | |
|---|---|---|---|---|---|---|
| When the wind blows (eyes are sensitive to wind) | 4 | 3 | 2 | 1 | 0 | NA |
| Dry environment | 4 | 3 | 2 | 1 | 0 | NA |
| air-conditioned room | 4 | 3 | 2 | 1 | 0 | NA |
Dry Eye Disease Scoring Method
OSDI = (Total score × 25) / Total number of questions
| OSDI Score | Symptoms |
|---|---|
| 0–12 | No, it's normal. |
| 13–22 | Mild dry eye syndrome |
| 23–32 | Moderate dry eye syndrome |
| 33–100 | Severe Dry Eye Syndrome |
If you complete this self-assessment and find your score is around 13 or higher, you may need to seek a more accurate examination. To confirm a diagnosis of dry eye syndrome, an ophthalmologist will typically evaluate you using an ocular surface analysis (OSA) device or perform a tear production test (Schirmer's test).
I. Ocular Surface Analysis (OSA)
The Ocular Surface Analysis (OSA) instrument is an advanced diagnostic method capable of precisely evaluating various aspects of ocular health, including the structural function of the tarsal plate, analysis of the tear film lipid layer thickness, tear break-up time, tear meniscus height, automated blink recording, and quantification of glandular disruption.
II. Tear Secretion Test (Schirmer's Test)
淚液分泌檢查(Schirmer’s test)是一種測量淚液分泌量的常見方法，將特殊濾紙放在下眼瞼約5分鐘，根據濾紙的濡濕程度可以得知淚液的基礎分泌量，正常值應該在10毫米以上。淚膜破裂時間是指患者眨眼後淚水膜完全破裂的時間，正常值應在10秒以上。
According to the above criteria, if a patient only experiences ocular symptoms but no changes in tear secretion are observed during an eye examination, it is diagnosed as dry eye syndrome.If it is merely simple dryness that resolves after applying eye drops, it does not constitute dry eye syndrome. This may simply be a case of eye strain, such as temporary discomfort, dryness, gritty sensation, light sensitivity, tearing, or blurred vision occurring after prolonged reading or computer use.
造成乾眼症的原因是什麼？
Dry eye syndrome has multiple causes, primarily related to the state of the tear film and the function of the lacrimal glands. These include insufficient tear secretion or poor tear quality. Therefore, dry eye syndrome can be classified into two categories:
- Aqueous Deficiency Dry Eye Syndrome
- Evaporative Dry Eye Syndrome
很多人誤以為乾眼就是缺水，避免眼乾就能改善乾眼症，但其實眼睛外層的脂質層可預防淚膜蒸發，脂質層由瞼板腺分泌清澈的油脂，鎖住保護眼球表面形成的淚膜，使淚液不容易蒸發，保持眼睛的滑澤。當患者分泌的油脂是濃稠甚至凝固狀，易導致淚液蒸發快，進而使眼睛感到乾澀，也是乾眼症的原因。故此，乾眼症的原因不一定是缺水，也可能是缺油，也就是說，乾眼症的原因可細分成水層分泌不足、油脂層分泌不健全、淚液膜分佈不均勻，以及黏液素層分泌不當四大類型。
I. Insufficient Secretion of the Aqueous Layer
水層分泌不足是最常見的乾眼症的原因。這可能是由於年紀老化導致淚腺功能降低，女性更年期後也容易出現乾眼現象，這可能與體內荷爾蒙分泌變化有關。此外，一些自體免疫疾病(類風濕性關節炎、全身性紅斑狼瘡)，血液疾病(淋巴腫、白血病)、外傷、感染、自律神經失調、長期使用某些眼藥水或藥物等也會造成淚液分泌不足。長期配戴隱形眼鏡也會影響淚液的分泌，因為隱形眼鏡減少了角膜的敏感度，使淚液分泌減少，也會出現乾眼症。
II. Inadequate Sebum Secretion
Inadequate oil layer secretion is another common cause of dry eye syndrome. This typically results from eyelid disorders that impair the function of the meibomian glands in the eyelids, thereby affecting the outer lipid layer of the tear film. Consequently, tears cannot effectively remain on the surface of the eye, leading to dry eye syndrome.
III. Uneven Distribution of the Tear Film
淚液過度蒸發和淚液膜分佈不均勻也是乾眼症的原因之一。眼瞼疾病可能導致眼瞼閉合不良，使淚液過度蒸發。此外，長時間專心開車、盯著電視、使用電腦等活動會使用眼次數減少，進而影響淚液的分佈。長時間在冷氣房工作或處於強風燥熱的環境也可能影響淚液膜的穩定性，因而造成乾眼症。
IV. Improper Mucin Layer Secretion
黏液素層是淚液膜的最內層，它由結膜細胞分泌，具有滑潤作用，保持淚水在眼表面的均勻分佈。如果缺乏維他命A、患有慢性結膜炎或類天皰瘡等疾病，都可能導致黏液素層分泌不足，進而影響淚液的穩定性。此外，當眼睛暴露於化學藥品或有害物質時，可能導致結膜細胞受損，進而影響黏液素層的正常分泌功能。
Who are the "high-risk groups for dry eye syndrome"?
Dry eye syndrome has numerous contributing factors, including age, living environment, autoimmune diseases, and daily habits.
I. Individuals aged 50 and above
年紀增長是其中一個主要出現乾眼症的原因，因為淚腺功能老化及荷爾蒙分泌失調會導致淚液分泌不足，50至55歲之間更是患上乾眼症的高危時期中。
II. Long-term wear of contact lenses
當長時間使用隱形眼鏡，可能會干擾淚液的正常分泌和分佈，就容易產生乾眼症的現象，尤其是軟式隱形眼鏡，配戴眼這類含水的軟式隱形眼鏡就像將一塊很會吸水的海綿放在有水的地方，它會把附近的水全吸走。
III. Long-Term Use of Electronic Devices
Prolonged use of electronic devices such as smartphones and tablets reduces blink frequency, potentially leading to insufficient tear production and an increased risk of developing dry eye syndrome.
4. Extended Driving
The air conditioning and ventilation systems inside vehicles can dry out the air, accelerating tear evaporation and leading to dry, uncomfortable eyes. Simultaneously, prolonged focus on the road ahead to monitor traffic conditions causes the eyes to remain concentrated for extended periods, reducing blink frequency and further increasing the risk of dry eye syndrome.
V. Unhealthy Eating Habits
Omega-3脂肪酸對於維持健康的淚液分泌和減少眼睛發炎非常重要。當飲食中缺乏Omega-3脂肪酸，如少攝取魚類（三文魚、鱒魚、沙丁魚）、亞麻籽、奇亞籽和核桃，都會增加患上乾眼症的風險。
VI. Individuals with chronic conditions or a history of eye injury
研究發現糖尿病、青光眼、甲狀腺疾病和高血壓等疾病的患者，比起其他人更容易引發乾眼症，因為這類慢性疾病可能會影響淚液的分泌或淚液的成份，進而導致眼睛乾燥和不適。此外，如果眼睛曾經受到傷害，如外傷或手術，可能會導致淚腺功能減退或損傷，因為眼睛受傷後的修復過程會影響淚液的分泌和眼睛表面的保護層，從而增加患上乾眼症的風險。
What methods can improve dry eye syndrome?
Many patients want to know how long it takes for dry eye syndrome to improve and what methods can provide immediate relief from symptoms. However, the improvement of dry eye syndrome depends on the individual patient's symptoms and the severity of their condition. Currently, the medical community primarily employs methods such as artificial tears, autologous serum, thermal pulsed therapy, and pulsed light therapy to help patients alleviate dry eye symptoms.
I. Artificial Tears
症狀較輕的患者，可以透過補充傳統人工淚液作治療手段改善乾眼症，包括藥水型、凝膠型和藥膏型三種，藉此改善乾眼症。使用人工淚液可以減輕乾眼症狀，避免角膜傷害，並維持眼球表面的光滑。然而，有時候人工淚液的效果可能不會立即顯著有改善，乾眼症患者多數要更久時間才會好轉。但用這個方法改善乾眼症要多久才會有好轉的療效，則視乎個人情況，有些患者可能只需要數天，但也有更多乾眼症患者要更久才會好轉，可能需時數週，甚至更長的時間。
II. Autologous Serum
近年來發現自體血清含有更近於淚液的成份，因此開始用在不同的眼表疾病上，包括改善較嚴重的乾眼症病患。當使用人工淚液無法緩解症狀時，眼科醫生會建議搭配使用自體血清眼藥水。但自體血清眼藥水的製作複雜，需要抽取患者的血液，然後進行離心處理，分離出血清，最後製成合適濃度的眼藥水並分裝冷凍。這些血清中含有生長因子，具有抗發炎和促進癒合的效果。一次抽取的血液通常可以製作6至10支眼藥水，因為不含防腐劑，所以使用時必須小心，避免眼藥水受到污染，而且也比多數治療時間久才會好轉，但也能令乾眼症的症狀有改善，讓患者重新獲得舒適的生活。
III. Thermal Pulsation Therapy
For more severe cases of dry eye syndrome, Lipidflow therapy may be administered. This procedure involves using a device to apply continuous heat at 40°C for 12 minutes while delivering rhythmic pulsations to massage the meibomian glands. This softens and unblocks obstructed glands, alleviating dry eye symptoms and preventing further atrophy caused by gland blockage, thereby improving overall eye health.
IV. Pulsed Light Therapy
脈衝光治療（Intense Pulsed Light，簡稱IPL）適合所有程度的乾眼症患者，能打通塞的瞼板，幫助油脂分泌回復正常，減少淚水蒸發。治療的次數通常需要3至4次，乾眼症就會逐漸改善。
Are over-the-counter dry eye care methods effective?
To alleviate eye strain and dry eye syndrome, many people turn to supplements like lutein. However, while lutein can help filter blue light and prevent retinal degeneration, it does little to improve dry eye symptoms.
Additionally, many people mistakenly believe that dry eyes can be "cured" simply by using eye drops. However, eye drops only provide temporary relief from symptoms. Overuse of eye drops can actually interfere with the eye's natural tear production process, potentially leading to the development of dry eye syndrome.
How can dry eye syndrome be prevented or improved?
Instead of randomly trying the methods mentioned above, it's better to protect your eye health and avoid dry eye issues by adopting proper eye care habits and steering clear of bad ones.
I. Proper Eye Care Habits
經常使用電子產品、工作或讀書時，應該定期休息眼睛。其中一個被廣泛推薦的方法是20/20/20護眼法則，即每隔20分鐘，讓眼睛休息20秒，同時將視線轉移到距離你約20英吋（約6公尺）的遠處。這有助於減少長時間近距離使用眼睛所帶來的壓力，有助於保持眼睛健康。
II. Maintain a Good Environment
When working or resting indoors, special attention should be paid to the humidity in the air to avoid the adverse effects of an overly dry environment on the eyes. Additionally, we should avoid direct exposure to the airflow from fans or air conditioners. Adjust the angle of fans or air conditioners to prevent direct airflow toward the eye area, or move away from the direct contact with the airflow whenever possible.
III. Supplementing Antioxidant Nutrients
Antioxidant nutrients are essential for eye health, as the eyes rely on light to form images. Consuming foods rich in omega-3 fatty acids—such as salmon, walnuts, and flaxseeds—can reduce inflammation and stabilize the tear film. Meanwhile, incorporating foods high in vitamins A and C—like carrots, oranges, and kiwis—helps combat free radical damage and protect ocular tissues.
IV. Supplement with Anti-Inflammatory Phytochemicals
乾眼症往往與眼部的炎症相關，抗發炎物質能夠幫助降低眼部的炎症反應，減輕不適感，同時促進眼睛組織的修復，從而改善乾眼症的情況。很多植化素都具有抗發炎作用，如槲黃素、薑黃、花青素、丁香酚等，都有助改善乾眼症。
#乾眼症多久會好 #乾眼症會好嗎 #乾眼症治療 #乾眼症如何改善
