Symptoms and Risk Factors for
Dry Eye Syndrome

Dry Eye Syndrome (DES) is the most common condition we see in our clinic, to the extent we feel compelled to develop a dedicated Dry Eye Clinic. Though DES sounds like a minor condition, the problems it causes are not.

Lasik Dry Eye is not actually an eye disease, but has become such a common cause of dry eye I felt compelled to include it.

Symptoms of Dry Eye Syndrome

DES causes fluctuating vision, especially when reading or working on the computer.

The symptoms are:

• Burning eyes.
• Scratchy eyes.
• Fluctuating vision.
• Excessive tearing or watery eyes.

If the condition has existed for a long time the corneal nerves will "go to sleep" and there will be no discomfort. Unfortunately, at this stage the patient is at increased risk for eye infections and corneal scarring.

This stage tends to grow progressively worse, since normally-functioning corneal nerves are necessary to keep the eye moist. Treating this stage of DES often produces a mild discomfort for the first couple of weeks as the corneal nerves "wake up".

1. Corneal Dry Spots (Punctate Epithelial Erosions)
2. Non-functioning Tears Glands (Meibomian Gland Dysfunction)

Dry Eye. The green stain (lissamine green) stains dried-out cells but not normal ones.	Notching of the lid caused by loss of meibomian glands.

Risk Factors

Dry Eye Syndrome is caused or aggravated by:

• Being female, even a young female. There is a strong hormonal effect in DES. Many of the new, promising drugs for dry eye are androgen-based (testosterone). Women normally have about 10% of the amount of testosterone men do, and if the level is reduced dry eyes is one of the common symptoms.
• Going through menopause.
• Living in a dry climate or in air-conditioning. This increases the rate that your normal tears evaporate.



• A diet with insufficient omega-3 fatty acids. (See omega-3 in Nutritional Principles). Omega-3 oils are very important in production of good quality tears.
• Computer use. Concentration as in reading or computer use reduces the normal blink rate to about one third of normal. If you have a dry eye to start with, this really pushes you over the edge and allows the eye to dry out.
• Prolonged reading (See Computer use above).
• Sleeping with your eyes open. Yes, it's true. It's a condition called lagophthalmus and it's more common than you might think. These patients wake up with very irritated, scratchy eyes.
• Medications:
• Estrogens.
• Most anxiety or depression medications.
• Diuretics, often used for blood pressure control.
• Sleep medications and many others.
• Eye drops, including some glaucoma medications and many of the over-the-counter artificial tears. The reason is that many companies, including some of the biggies, use a cheap preservative called benzalkonium chloride (BAK) which is toxic to the eye. I know, you're thinking, "That doesn't make sense." You're right, it doesn't, but that's what these companies do. Our office only recommends artificial tears that do NOT use BAK.

Related Information

For more information about DES also check out the following pages:

• Dry Eye Treatment
• Severe Dry Eyes
• Lasik Dry Eye


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