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Causes of DES
a) Aging and menopause: DES should be of particular interest to women because several of its main causes are related to the natural progression of life that occurs in this population. Women in menopause have been found to have greater incidences of DES compared to men of similar age or women who have not yet reached this stage. Although it receives less attention compared to other symptoms of menopause such as hot flashes, mood swings and vaginal dryness, DES affects about 60% of menopausal women. It is currently believed to be a reaction to low estrogen hormone levels during this phase of life that might limit tear production.
b) Medications: DES, however, can also develop in younger women due to similar reductions in estrogen hormone levels artificially induced from taking oral contraceptive pills (OCPs). Other medications that might cause DES as a side effect include antihistamines (typically taken for allergies or asthma treatment), diuretics (used for the treatment of high blood pressure), antidepressants and beta-blockers (usually prescribed for heart problems).
c) Autoimmune diseases: This class of illness results from the body’s defense system mounting up attacks on its own cells and tissues. Such attacks can affect generally all cells in the body but the eye has a level of natural protection. However, events such as injuries to the surface of the eyes or surgeries (e.g. LASIK eye surgery) could expose the cells of the eyes to the body’s defense system leading to an autoimmune process which could affect tear production. Apart from direct eye injury, some autoimmune diseases such as Sjogren syndrome, lupus and rheumatoid arthritis have a natural predilection to cause very dry, irritated eyes.
d) Infections: Bacterial infection can occur in glands that secrete the three layers of tears resulting in either decreased production or blockage of the tear ducts that prevents secretion (see figure 1 above for anatomical positions of tear ducts). People who wear contact lenses are at increased risk of eye infections especially if they fail to clean their lenses according to recommended guidelines. Figure 2 shows several common eye inflammatory diseases that result from infection of the glands.
Fig 2: Inflammatory diseases of the external structures of the eyes
Source: http://i.ehow.com/images/GlobalPhoto/Articles/4674982/92957-main_Full.jpg
Treatment:
Most people who experience DES tend to have very mild, infrequent symptoms which usually do not require medical attention. Simple home remedies such as using a humidifier and filter to moisten and remove foreign debris from the air can be very helpful. Hot compresses and eyelid massages with baby shampoo can be used to treat inflammations or mild infections of the eyelids while providing a soothing feel to the eyes. Others have found artificial tears to be quite beneficial and they tend to be the first line of treatment most doctors recommend for mild to moderate dry eyes. Several brands and generic forms of artificial tears – with similar efficacy –are available over the counter. However, if you need to apply eye drops more than six times a day, consider purchasing a preservative-free solution.
People with moderate to severe DES might require prescription medications such as corticosteroids, non-steroidal anti-inflammatory drops, antibiotics or a special type of artificial tear inserts. These work by reducing the inflammatory and infectious processes, reducing incidence of corneal abrasions (from excessive rubbing/ scratching of eyes) and helping your body produce healthy tears. A few people with refractory DES resistant to other forms of treatment might benefit from a minor surgical procedure that will help improve tear flow from the ducts. As always, do discuss symptoms and treatment options with your healthcare provider who can recommend care appropriate for your specific needs.
Sources:
1) MedicineNet : Dry Eyes
http://www.medicinenet.com/dry_eyes/article.htm
2) Emedicine Health: Dry Eye Syndrome
http://www.emedicinehealth.com/dry_eye_syndrome/article_em.htm
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