How long does it take for dry eye to get better or improve? The doctor explains the causes of dry eye syndrome and the treatment plan in detail
Have you ever tried to work for a while, but you feel that your eyes are dry and itchy, and you can't help blinking, even if you close your eyes and rest? This may be a symptom of dry eyes! Want to improve dry eyes, think that just eye drops, artificial tears, or reduce the TV and computer screens, can improve dry eye symptoms from the root cause of the disease? If you think it won't take long for dry eyes to heal on their own, you're very wrong! It may be that these methods will only make the symptoms of dry eye more and more serious.
What is dry eye?
Dry eye is a common eye disease, with 3 out of 10 Hong Kong people having dry eye. It occurs when the eye can't produce enough tears, or when the tears aren't working properly, which can make the eyes feel dry and itchy. The cause of dry eye syndrome is mainly because with age, tear secretion decreases, clinical data show that by the age of 65, the secretion of the lipid layer in tears is reduced by 60% compared with 18 years old, tears evaporate faster, so dry eye patients themselves are mostly older groups.
How does the composition of tears affect eye health?
Before we know how to improve dry eye symptoms, we should know how tears can do in eye protection. In addition to keeping the cornea moist and providing optical properties, tears can also provide oxygen to the cornea, and also have the effect of washing away impurities and foreign bodies entering the eye, while the antibodies and enzymes can resist foreign bacteria and protect the health of the cornea.
The tears on the surface of the eye are made up of three layers, each of which plays a specific role, and if there is a problem with one of the layers, the tear cannot moisturize the eye completely, causing dry eye syndrome.
First, the grease layer
The outermost layer is the oil layer, which is lubricated by the secretory glands under the eyelashes, which not only prevents the aqueous components from evaporating too quickly, but also increases the surface tension to maintain the stability of the tear layer while providing lubrication of the eyelids.
Second, the water layer
The aqueous layer is the intermediate layer, the main component of tears, produced by the lacrimal glands. It is an important component that provides nutrients to corneal epithelial cells and contains anti-infective substances that protect the eye from bacterial infection.
Third, the mucin layer
The innermost layer is the mucin layer, secreted by conjunctival cells, and its main function is to contact the cornea and conjunctival epithelium, providing lubrication and ensuring that the water layer adequately wets the cornea.
The composition and function of these three layers of tear fluid must be kept adequate, and it needs to be evenly distributed over the eyes by blinking to keep the eyes comfortable. If one of the layers is undersecreted or unevenly distributed, the eyes will experience a feeling of dryness, sometimes even foreign body eye pain, tingling or temporary hazyness, and may even cause dry eyes.
What are the subjective symptoms of dry eye?
Have you ever felt dry eyes, itchy, foreign body sensation, photophobia, and blurred vision? Or do you feel that the tears in your eyes are less secreted than ordinary people? However, do these symptoms mean dry eyes?
In fact, the symptoms of dry eyes are not a disease, but eye discomfort caused by external factors. As for xerophthalmia, most patients will have the following subjective symptoms, including:
- Dry eyes
- Foreign body sensation
- Burning sensation
- Pins and needles
- Itchy eyes
- photophobia
- jealous
- Fatigue easily
- Blurred vision
- Vision fluctuations
The reason for the above symptoms is that patients with dry eye have poor tear layer stability and are prone to many of the symptoms mentioned above. The reason is that the discomfort of dry eye stimulates the lacrimal glands, causing them to secrete a large amount of reflex tears, while making the patient very sensitive to wind and light, and often temporary blurred vision.
How to objectively tell if you have dry eye?
TO ACCURATELY DIAGNOSE WHETHER YOU HAVE DRY EYE, THE MAIN THING IS, OF COURSE, BASED ON A SERIES OF SYMPTOMS AND TEST RESULTS. HOWEVER, IF YOU ARE SIMPLY SUSPICIOUS AND WANT TO KNOW IF YOU HAVE DRY EYE, YOU MAY WISH TO SELF-TEST FOR DRY EYE THROUGH AN INTERNATIONALLY RECOGNIZED OCULAR SURFACE DISEASE INDEX (OSDI).
First, the eye sensation in the past week
| anytime | Most of the time | About half the time | Occasionally | not | |
|---|---|---|---|---|---|
| Dry | 4 | 3 | 2 | 1 | 0 |
| photophobia | 4 | 3 | 2 | 1 | 0 |
| Redness with bloodshots | 4 | 3 | 2 | 1 | 0 |
| ache | 4 | 3 | 2 | 1 | 0 |
| Foreign body sensation | 4 | 3 | 2 | 1 | 0 |
| Thick discharge | 4 | 3 | 2 | 1 | 0 |
| Blurred vision | 4 | 3 | 2 | 1 | 0 |
| Poor vision | 4 | 3 | 2 | 1 | 0 |
2. The following activities have been affected by eye discomfort in the past week
| anytime | Most of the time | About half the time | Occasionally | not | not applicable | |
|---|---|---|---|---|---|---|
| Read | 4 | 3 | 2 | 1 | 0 | NA |
| Use a mobile phone/computer | 4 | 3 | 2 | 1 | 0 | NA |
| Night driving | 4 | 3 | 2 | 1 | 0 | NA |
| Watch TV | 4 | 3 | 2 | 1 | 0 | NA |
3. In the past week, the eyes have not felt comfortable in the following conditions
| anytime | Most of the time | About half the time | Occasionally | not | not applicable | |
|---|---|---|---|---|---|---|
| When the wind blows (eyes are afraid of the 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 syndrome scoring method
OSDI = (sum of scores x 25) / sum of answers
| OSDI SCORE | Symptoms. |
|---|---|
| 0~12 | No, normal |
| 13~22 | Mild dry eyes |
| 23~32 | Moderate dry eye |
| 33~100 | Severe dry eye |
If you do this self-test and find that your score is about 13 points or higher, you may need to seek a more accurate test. To confirm the diagnosis of dry eye, ophthalmologists usually evaluate it with an ocular tear film analyzer (OSA) or a tear secretion test (Schirmer's test).
1. EYE SURFACE TEAR FILM ANALYZER (OSA)
THE SURFACE TEAR FILM ANALYZER (OSA) IS AN ADVANCED EXAMINATION METHOD THAT ACCURATELY DETECTS ALL ASPECTS OF THE EYE, INCLUDING THE STRUCTURAL FUNCTION OF THE TARSAL LINE, THE THICKNESS AND ANALYSIS OF THE TEAR FILM OIL LAYER, TEAR RUPTURE TIME, TEAR RIVER HEIGHT, AUTOMATIC BLINK RECORDING, AND QUANTIFICATION OF GLAND DISRUPTION.
Tear secretion test (Schirmer's test)
Schirmer's test is a common method to measure tear secretion, a special filter paper is placed on the lower eyelid for about 5 minutes, according to the wetness of the filter paper can know the basic secretion of tears, the normal value should be more than 10 mm. The tear film rupture time refers to the time when the tear film completely ruptures after the patient blinks, and the normal value should be more than 10 seconds.
According to the above criteria, if the patient has only eye symptoms, but there are no changes in tear secretion during eye examination, it is dry eye. If it is only a simple dry eye, it can be relieved after ordering eye drops, and it is not a dry eye syndrome, it may just be a condition of visual fatigue, such as temporary eye discomfort after reading books for a long time, reading the computer, dry eyes, photophobia and tears, blurred vision and other phenomena.
What causes dry eyes?
There are many causes of dry eye, mainly related to the state of the tear film and the function of the lacrimal glands, including insufficient secretion of tears, or poor quality of tears, so dry eye syndrome can be divided into two categories:
- Dehydrated dry eye
- Evaporative type of dry eye syndrome with oil deficiency
Many people mistakenly think that dry eyes are dehydration, avoiding dry eyes can improve dry eyes, but in fact, the lipid layer of the outer layer of the eye can prevent the evaporation of the tear film, and the lipid layer secretes clear oil by the meibomian glands, locking the tear film formed on the surface of the protective eyeball, so that the tear fluid is not easy to evaporate and keep the eyes moist. When the oil secreted by the patient is thick or even solidified, it is easy to cause tears to evaporate quickly, which in turn makes the eyes feel dry, which is also the cause of dry eyes. Therefore, the cause of dry eye syndrome is not necessarily water shortage, but also oil deficiency, that is, the cause of dry eye syndrome can be subdivided into four types: insufficient secretion of water layer, imperfect secretion of oil layer, uneven distribution of tear film, and improper secretion of mucin layer.
First, the secretion of the water layer is insufficient
Insufficient secretion of the water layer is the most common cause of dry eyes. This may be due to the reduced function of the tear glands due to aging, and women are also prone to dry eyes after menopause, which may be related to changes in hormone secretion in the body. In addition, some autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus), blood diseases (lymphoma, leukemia), trauma, infection, autonomic nervous disorders, long-term use of certain eye drops or drugs, etc. can also cause insufficient tear secretion. Long-term wearing of contact lenses can also affect the secretion of tears, because contact lenses reduce the sensitivity of the cornea, reduce tear secretion, and dry eyes will also occur.
Second, the secretion of oil layer is not perfect
Inadequate oil secretion is also a common cause of dry eyes. This is usually due to eyelid disease causing poor function of the eyelid sebaceous glands, which in turn affects the oil layer of the outer layer of the tear film, so that the tear cannot be effectively maintained on the surface of the eyeball, resulting in dry eye syndrome.
Third, the tear film is unevenly distributed
Excessive evaporation of tears and uneven distribution of tear film are also causes of dry eyes. Eyelid disease can lead to poor eyelid closure, excessive evaporation of tears. In addition, prolonged concentration on driving, staring at the TV, using the computer and other activities will reduce the number of blinks, which in turn will affect the distribution of tears. Prolonged work in an air-conditioned room or in a hot and dry environment may also affect the stability of the tear film, resulting in dry eyes.
Fourth, the mucin layer is secreted improperly
THE MUCIN LAYER IS THE INNERMOST LAYER OF THE TEAR FILM, WHICH IS SECRETED BY CONJUNCTIVAL CELLS AND HAS A LUBRICATING EFFECT TO MAINTAIN AN EVEN DISTRIBUTION OF TEARS ON THE SURFACE OF THE EYE. VITAMIN A DEFICIENCY, CHRONIC CONJUNCTIVITIS OR PEMPHIGOID DISEASES CAN LEAD TO INSUFFICIENT MUCIN SECRETION, WHICH IN TURN AFFECTS THE STABILITY OF TEARS. IN ADDITION, WHEN THE EYES ARE EXPOSED TO CHEMICALS OR HARMFUL SUBSTANCES, IT CAN LEAD TO DAMAGE TO CONJUNCTIVAL CELLS, WHICH IN TURN AFFECTS THE NORMAL SECRETORY FUNCTION OF THE MUCIN LAYER.
Who is at high risk of dry eye?
Dry eye syndrome has many causes, from age, living environment, autoimmune diseases and daily habits.
1. People over 50 years old
Aging is one of the main causes of dry eye, as aging lacrimal gland function and hormonal imbalance can lead to insufficient tear production, and between the ages of 50 and 55 is at high risk for dry eye.
Second, long-term wear of contact lenses
When using contact lenses for a long time, it may interfere with the normal secretion and distribution of tears, and it is easy to produce dry eye syndrome, especially soft contact lenses, wearing watery soft contact lenses such as eyes is like putting a sponge that is very absorbent in a place with water, it will suck away all the nearby water.
Third, long-term use of electronic products
Long-term use of electronic devices such as smartphones and tablets reduces the frequency of blinking, which is easy to cause insufficient tear secretion and prone to dry eyes.
4. Driving for a long time
Air conditioning and ventilation systems in vehicles dry out the air, which in turn accelerates the evaporation of tears, leading to dry and uncomfortable eyes. At the same time, staring ahead for a long time and paying attention to traffic conditions will also keep the eyes focused for a long time, reduce the number of blinks, and further increase the risk of dry eyes.
5. Unhealthy eating habits
Omega-3 fatty acids are important for maintaining healthy tear production and reducing eye inflammation. When a diet deficient in omega-3 fatty acids, such as a low intake of fish (salmon, mackerel, sardines), flaxseeds, chia seeds, and walnuts, increases the risk of dry eye.
6. Patients with chronic diseases or eye injuries
Studies have found that people with conditions such as diabetes, glaucoma, thyroid disease and high blood pressure are more likely than others to develop dry eye syndrome because these chronic diseases may affect the production or composition of tears, which can lead to dry and uncomfortable eyes. In addition, if the eye has been injured in the past, such as trauma or surgery, it may lead to decreased or damaged tear gland function, because the repair process after an eye injury affects the secretion of tears and the protective layer on the surface of the eye, thereby increasing the risk of dry eye.
What are some ways to improve dry eyes?
Many patients want to know how long it will take for dry eye symptoms to get better and what can be done to improve dry eye symptoms immediately. However, to improve dry eye, it depends on the symptoms and the extent of the condition of the individual patient. At present, most of the medical profession will adopt artificial tears, autologous serum, thermal pulse therapy, pulsed light therapy and other methods to help patients improve dry eye syndrome.
1. Artificial tears
Patients with mild symptoms can improve dry eye syndrome by supplementing traditional artificial tears as a treatment method, including liquid type, gel type and ointment type, so as to improve dry eye syndrome. The use of artificial tears can reduce dry eye symptoms, avoid corneal damage, and maintain the smooth surface of the eyeball. However, sometimes the effect of artificial tears may not improve immediately and significantly, and most people with dry eye syndrome take longer to improve. However, depending on the individual, some patients may only take a few days, but more dry eye patients will take longer to improve, which may take weeks or even longer.
Second, autologous serum
In recent years, autologous serum has been found to contain components closer to tear fluid, so it has begun to be used in different ocular surface diseases, including the improvement of more severe dry eye patients. When artificial tears do not relieve symptoms, your ophthalmologist may recommend using autologous serum eye drops. However, the production of autologous serum eye drops is complicated, which requires the patient's blood to be drawn, then centrifuged, isolated serum, and finally made into eye drops of appropriate concentration and frozen in aliquots. These serums contain growth factors that have anti-inflammatory and healing effects. A single blood draw can usually make 6 to 10 eye drops, and because they do not contain preservatives, care must be taken to avoid contamination of eye drops, and it will take longer than most treatments, but it can also improve the symptoms of dry eye syndrome and allow patients to live a comfortable life again.
3. Thermal pulsation therapy
Some eye conditions are more severe and can be treated with Lipidflow. By using the instrument, warm at 40°C for 12 minutes, and massage the meibomian glands with regular pulsation, soften and unblock the blocked meibomian glands, improve dry eye symptoms, and avoid further atrophy caused by meibomian gland blockage, thereby improving eye health.
4. Pulsed light therapy
Intense Pulsed Light (IPL) is suitable for all levels of dry eye and can open up blocked tarsal plates, help normalize oil production, and reduce tear evaporation. The number of treatments usually takes 3 to 4 times, and the dry eye will gradually improve.
Are dry eye care methods effective?
To improve eye fatigue and dry eye syndrome, many people will choose supplemental health foods, such as lutein. However, although lutein can help filter blue light and prevent retinopathy, it does not help much to improve dry eye syndrome.
In addition, many people think that dry eyes can be cured with eye drops. However, eye drops can only temporarily relieve symptoms, and excessive use of eye drops can hinder the natural production of tears in the eyes, leading to dry eyes.
How can dry eyes be prevented or improved?
Instead of trying the above methods casually, it is better to protect your eye health and stay away from dry eyes through correct eye habits and avoiding bad habits.
First, the correct eye habits
When using electronic devices regularly, working or reading, you should take regular breaks from your eyes. One of the widely recommended methods is the 20/20/20 Eye Protection Rule, which rests your eyes for 20 seconds every 20 minutes while shifting your gaze to a distance of about 20 feet (about 6 meters) away from you. This helps reduce the stress associated with prolonged close use of the eyes and helps keep the eyes healthy.
Second, 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 too dry an environment on the eyes. In addition, we should also avoid direct exposure to the direct blowing airflow of the fan or air conditioner and adjust the angle of the fan or air conditioner to avoid blowing directly into the eye area or, where possible, away from direct contact with the airflow.
3. Supplement antioxidant nutrients
Antioxidant nutrients are essential nutrients that protect the eyes, which need light to become imaging. Consuming foods rich in omega-3 fatty acids, such as salmon, walnuts, and flaxseed, can reduce inflammation and stabilize the tear film. At the same time, consuming foods rich in vitamins A and C, such as carrots, oranges and kiwifruits, can help fight free radical damage and protect eye tissue.
4. Supplement anti-inflammatory phytochemicals
Dry eye is often associated with inflammation in the eye, and anti-inflammatory substances can help reduce inflammation in the eye, reduce discomfort, and promote the repair of eye tissue, thereby improving dry eye syndrome. Many phytochemicals have anti-inflammatory effects, such as quercetin, turmeric, anthocyanins, eugenol, etc., which can help improve dry eyes.
