Can dry eyes cause serious problems in the long term?Eye & LASIK
I experience dry eyes every morning. It often leads to a feeling of itch in my eyes and an uncontrollable urge to rub them. How serious a problem is it to have dry eyes, especially in the long term? (eg. can it lead to problems such as glaucoma?) Can my dry eyes be cured using eyedrops, or do you have any other recommendations?
I'm sorry to learn that your dry eye condition is causing you discomfort. Please resist the temptation to rub!
In my years of practice, I have seen some very bad consequences from vigourous eye-rubbing, including cataract and retinal detachment, which can be sight threatening!
Dry eyes is actually a relatively common condition, and majority of cases are (thankfully) mild. However I can empathize that the symptoms of grittiness, like having sand in the eye, tearing, and the fear of bright lights etc can be quite bothersome.
The good news is that most cases of dry eyes can be treated with lubricants. If you find that you need to use your lubricants more than 4 times a day I would generally recommend using a preservative-free type (that comes in disposable single-day use vials), so that the preservatives that are found in the bottled form (that can be used up to a month after opening) does not further irritate the surface of your eye.
Preservative-free lubricating eye drops are generally very safe for long term prolonged use.
Lubricating gels can also be used at night (and in the day) to provide more relief, although your vision may be temporarily clouded for a few minutes after applying the gel.
In addition to lubricants, I often advise my patients to perform regular lid cleansing. There is a row of oil glands behind our eye lashes, which function to secrete oil to lubricate the eyes and also prevent tears from evaporting too rapidly.
By cleaning your lids properly (twice a day), the opening of these glands can be unclogged so that oil can be secreted to keep the eyes moist.
The good news is that dry eyes does not cause glaucoma directly. However, more serious cases of dry eyes in which the transparent surface of the eye (cornea) is very rough or scarred up may require steroid eye drops, which can sometimes lead to pressure spikes in the eye.
These pressure spikes need to be detected and treated, to prevent progressive, irreversible damage to the nerve and loss of vision (=glaucoma).
Unfortunately there is seldom a complete "cure" for dry eyes. However, with a combination of lubricating drops and eye lid cleansing, most patients are able to keep their symptoms under control.
I hope you have sought treatment for your dry eyes, and are feeling better! Remember - do not rub your eyes! Feel better soon!
Dry eyes, like many other conditions, span a spectrum from mild to severe.
Mild cases of dry eyes, such as those which are considered 'situational' (associated with factors such as prolonged near visual work, dry environments) are relatively innocuous and do not affect the health of the eye in any way.
Severe cases, which are uncommon, can cause problems such as inflammation, corneal 'epithelial defects', and possibly corneal scarring.
But dryness per se does not directly cause other eye conditions such as glaucoma.
Treatment of dry eyes in general involve:
1. Addressing contributing factors, such as prolonged near visual work, avoiding/stopping medications such as isotretinoin, minimising or avoiding contact lens wear, especially soft contact lenses
2. Tear supplementation with eye drops or gels/ointments
3. Other helpful measures such as punctal plugging where necessary
There is often no simple or single cure for eye dryness ie there is no tablet or eyedrop that you can take for a few days and then never have the problem again.
To address dry eyes on waking in the morning, many people find using a gel such as Vidisic gel or Genteal gel at night before sleep to be helpful, as the gels last longer in the eye compared with eyedrops.
If the eyes are not fully closed at night while sleeping, some people use oil based ointments (such as Duratears) that do not evaporate, or rarely, special goggles that cover the eyes while the person sleeps.
*Vidisic, Genteal, Duratears are all available over the counter at pharmacies such as Guardian or Watson's.
Thankfully dry eyes rarely causes serious problems for most patients. The majority of patients experience discomfort such as tearing, intermittent blurring of vision and some mucoid discharge which are worse during certain activities of the day like reading, prolonged use of screen devices or fast-moving dry air being directed into the eyes.
These symptoms are mostly adequately managed by manipulating their environment, modifying their activities and the regular use of lubricating and secretagogue eye drops.
Rare patients may have a condition called Primary Sjogrens disease. These patients require more intensive treatment including punctal occlusion, and combination secretagogue treatment which they would receive from their ophthalmologist. Most of the complications are related to ocular surface conditions including scarring and severe forms of dry eyes / keratopathy and rarely cornea infections. Thankfully glaucoma is not a known complication of dry eyes.
Unfortunately as you can gather from my reply above, dry eyes cannot be cured, but rather managed with a combination of environment manipulation, activity modification and the regular use of lubricating eye drops and other adjunctive treatments.
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