Why are my eyes so dry?

“Dry eye can cause a variety of symptoms including burning, stinging, watering, redness, sandiness or grittiness and more.”

Dry eye feels like it should be a simple thing. Your eyes are dry so you need to add moisture, right?  Unfortunately, dry eye is a complex and multifactorial issue that can be a challenge to deal with. In some people it can cause stinging, in others the eyes may become red, and in another still it may cause their eyes to water. To understand dry eye you have to understand the anatomy of your tears but let’s come back to that a little later.

Ok… so what can I do? Can dry eye be cured?

“Remember, dry eye is a progressive disease that can get worse without treatment.”

Unfortunately dry eye can’t be cured but it can be managed. There are several different options for managing dry eye and the type of dry eye you have impacts the recommended treatment! At Eye Spy Optometry, we assess your tears and identify exactly the type of dry eye you have. (For the folks that love details, we assess your tear osmolarity, tear production, tear quality and even assess the meibomian glands to make sure none have given up in a test called meibography. For more details keep reading)!

A new, exciting option for dry eye treatment

If you’re suffering from evaporative dry eye, and odds are that’s the problem, there’s an amazing new treatment option known as Forma, which takes advantage of radio frequency technology. Originally used in dermatology to tighten skin, it found a new use in eye health as a treatment for dry eyes. Forma works by applying radio waves to your skin which penetrate deeply and warm the tissue, feeling much like a warm face massage! This softens the thickened oils deep in your glands and allows the doctor to express them, restoring their natural function as well as tightening skin and reducing the look of fine lines and wrinkles.

Before and after pictures of a Forma patient. Forma treats more than just dry eye!

Before and after pictures of a Forma patient. Forma treats more than just dry eye!

Are there other treatments?

Absolutely! There are two different medications just for dry eye, Restasis and Xiidra, that our doctors can prescribe. These medications work best for patients with aqueous dry eye and increases your tear production by decreasing inflammation.

We can also use something called Prokera which is a special type of contact lens made up of an amniotic membrane. When applied to the eye, it can dramatically improve the symptoms of both types of dry eye over the course of a month by improving the health of your cornea (the front clear part of the eye) and essentially turning back the clock on the health of your corneal cells.

Sometimes in severe cases of dry eye, we’ll even use special types of contact lenses called scleral contacts that vault over the whole eye and hold the moisture in.

There are other options too. We recommend and carry in our office a variety of warming eye masks, lid cleansing wipes, preservative free artificial tears and nutritional supplements that help with dry eyes.

Basic Tear Anatomy

To understand your dry eyes you also need to understand a little about how complicated your tears really are so let’s look at your tear anatomy! There are three layers to your tear film. The outer layer is oily and prevents our tears from evaporating. The middle layer is watery and the bottom layer is mucous. If there's too much or not enough of any layer our tears don't function properly and we experience dryness and irritation.


Aqueous Dry Eye

Aqueous dry eye occurs when your eye stops producing as much of the watery part of our tears as we need. The result is an increased feeling of dryness!

Evaporative Dry eye

Evaporative dry eye is much more common in Alberta. In this type of dry eye our meibomian glands, which produce the oily part of our tears, get blocked or clogged. This can happen many different ways including exposure to dust or other debris. Without enough oil, the watery part of our tears evaporates away. That's why this dry eye can improve if you go somewhere more humid. Sometimes in response our eyes over produce the watery part and our eyes water a lot!

How is dry eye diagnosed?

There are many different tests that we perform to make sure we’ve properly diagnosed the right type of dry eye and recommend the correct treatment options! We check the osmolarity of your eyes (using a fancy tool) which is really just a fancy way to say we’re looking at how much stuff is floating around in your tears that shouldn’t be there. It’s also important to check how much fluid your eyes are producing and we do that a variety of ways, incluing using special papers and threads as well as high magnification. Special dyes in the eye stain areas of the eye that are really dry and also help us check to see how stable your tear film is and how quickly it breaks up. Using a machine, we are also able to take a special picture of your meibomian glands to see how many glands you have left since sometimes they atrophy over time making evaporative dry eye worse.

How can you prevent dry eyes?

If you don’t have dry eyes yet, you might be wondering how to prevent them. One good idea is to book an appointment so your optometrist can assess your eyes and do some or all of the tests we’ve already talked about. That can help to pinpoint any areas of concern and give you an exact prevention plan. More generally, make sure you take regular breaks from devices like your phone or computer. A good idea is to take look twenty feet away every twenty minutes for twenty seconds. Big surprise, we call that the 20/20/20 rule. Another good plan is to do hot compresses every day. Heat over the eyes for ten minutes, making sure it stays hot the whole time, helps to make sure the oils in your meibomian glands stay mobile!

What if I’m not sure if I have dry eye?

It’s normal to wonder if you actually have something wrong, especially in the early stages. The easiest way to know is to book an appointment and let us assess your eyes but let’s be honest, sometimes doing a quiz at home is just more fun. Take our dry eye quiz and find out for yourself. We’ll still be here to help you when you’ve completed it.