If you have eye drops in your purse, your car, your nightstand, and your desk, constantly reapplying throughout the day, you might be one of millions of Americans who live with dry eye disease. You probably know the feeling all too well: the scratchiness, the sensitivity to strong lights, the uncomfortable contact lenses that you (unsuccessfully) try to insert. Maybe your eye is twitching — or watering, or burning — just reading this paragraph.
But many of us might not even realize it’s a disease, dealing with pesky and painful symptoms daily without thinking much of it. The American Optometric Association (AOA) reports that 16 million Americans have been officially diagnosed with Dry Eye Disease (DED), but another 6 million experience all of those symptoms, undiagnosed. Here’s how to better understand risk factors and signs, seek treatment, and heal, with the help of modern medicine and technology.
Dry eye disease, defined
While it seems like DED is a straightforward condition characterized by just that — dry eyes — it’s actually a bit more complicated. The lesser-known, less intuitive symptoms can cause confusion. For example, one of the symptoms of DED is watery eyes (you read that right) because your body sometimes responds to irritated dry eyes by trying to overcompensate with some extra water works.
Other symptoms they say to watch for include:
- Sensitivity to light, contact lenses, and night driving
- Eye redness, burning, scratchiness, stinging, or watering
- Stringy mucus in or around the eyes
- Feeling like there’s something in your eyes
- Blurry vision or eye fatigue
Often these painful and agitating sensations can be traced back to a common root cause of DED, called Meibomian Gland Dysfunction (MGD). One 2012 publication points to MGD as the cause in 86 percent of cases of DED. The meibomian gland is said to be an “important contributor” to maintaining a healthy surface of the eye, called the ocular surface. The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) explains that these essential oil glands line the edges of our eyelids, keeping our tears from evaporating. The water and oil together make up the “tear film” on the ocular surface, and even keep our vision sharp — unless they aren’t working. Many congenital and environmental causes can disrupt that significant gland’s processes, leading to DED, among other diseases.
Optometrist Dr. Kambiz Silani, OD, in Beverly Hills, Calif. says MGD and DED are genetic and hereditary, so it’s important to share if family members also experience the same symptoms. “We’ve had many [patients] share comments such as, ‘Oh, my mom used to put in drops all the time and she used to complain about dry eyes and light sensitivity,’” he explains. Proper diagnosis and treatment is especially important for those who wear contacts, or those who have cataracts, prior to surgery. This is because the conditions can impact how successful contacts are for patients, and can also delay surgery if the tear film isn’t stable.
Our pandemic environment only encouraged DED, among other risk factors
The pandemic moved everyone indoors, and onto screens, adapting by replacing in-person interactions with virtual ones. Those longer Netflix binges when the world shut down, the increase in doomscrolling — all of that staring at a screen meant less blinking, leading to fewer chances to replenish moisture.
A March 2022 study in Plos One suggested increased and alarming rates of DED due to both increased screen time and stress, especially in younger groups who don’t typically report high numbers of DED. For example, the study found that 64 percent of engineering students in South India had DED, and 70.8 percent of medical students in another group in the same study. They used perceived stress scales to measure how much stress the students were under in addition to their increases in screen time. Higher rates of DED were associated with longer screen time use, with 68 percent of those using devices more than 13 hours per day reporting dry eye, as opposed to just 28 percent of students who limited screen time to three hours per day.
It’s not just that the pandemic made DED more prevalent. When asked by his patients how they got MGD or DED, Silani has a short, humored answer: just living in the 21st century. “We’re on screens all day long so we’re not blinking as much,…up to 70 percent less.” He adds that blinking is necessary for optimal oil gland health and tear film function. “We’re staring at these devices, we don’t blink as often, and we perform these pseudo (or half) blinks. Therefore, the lids are not making contact, the oils stay within the glands, and they become stagnant.” Normal lids make contact, releasing healthy oils that are clear liquids that are almost like an olive oil consistency, he says — but when they’re not moving, they become rancid, almost toothpaste-like, and unhealthy. Add that to a list of other risk factors: stress, diet, cosmetics, and wearing (or overwearing) contact lenses, and masks (which can cause upward airflow that contributes to dry eyes). Environmental factors, like the weather, also play a role in disrupting that meibomian gland as well, leading to issues with the ocular surface.
Age and gender also factor into the risk of dry eye disease. It’s widely accepted that aging makes our eyesight less exact as the years tick by, and the same goes for DED — almost one in five adults age 75 and older have DED as opposed to just 2.7 percent of 18-34-year-olds, the AOA reports. The same report also notes that twice as many women (8.8 percent) have DED compared to just 4.5 percent of men; experts connect this significant difference to women’s hormone fluctuations, which impact the meibomian glands. Certain periods of life, like menopause, can also raise the probability of developing DED.
Treating dry eye disease, improving vision and quality of life
So many Americans are walking around with compromised ocular surface health for a variety of reasons. Some simply haven’t asked their eye care professional about it. Others don’t realize it’s impacting their life so significantly.
Because DED and MGD conditions are chronic and progressive, it’s extremely important to intervene early and begin proactive and preventive treatment, Silani says. He compares DED and MGD to a cavity: even if you don’t feel like something is wrong, something is not right. “If you don’t take care of [a cavity], it can get worse — it’s the same idea with DED and MGD.” But there are highly effective diagnostic tools and treatments available.
Regular eye exams for prevention and early detection
Getting screened for DED is essential, but there are challenges to a simple diagnosis. First, the diagnosis criteria are unclear as there are “inconsistent definitions and diagnostic criteria,” the Plos One study reports, that constitute a dry eye diagnosis. It also is a sneaky disease: MGD starts out at first asymptomatic, progressing into more agitating symptoms if it isn’t diagnosed early. The AAPOS explains that the oil-secreting Meibomian glands then become clogged and unable to secrete oil, resulting in permanent changes in the tear film and then eventual DED in many cases. So, regular eye exams are essential for prevention before MGD progresses into DED. It’s also not uncommon to be diagnosed with other comorbidities, such as myopia, presbyopia, glaucoma, and cataracts, hence why regular exams and comprehensive screening are so important.
Eye doctors might not be able to identify MGD and DED with their naked eye, or even with their typical instruments, potentially contributing to a lack of diagnosis for the millions of Americans reporting symptoms. That’s why many eye care practices have added an additional screening tool, Johnson & Johnson Vision’s TearScience® LipiScan® Dynamic Meibomian Imager, which helps screen for MGD. The imaging tool gives doctors a high-definition image of the meibomian gland structure. Additionally, the TearScience® LipiView® II Ocular Surface Interferometer also images the tear film lipid layer thickness, and checks for abnormal blinking habits.
Improved eye hygiene and diet
At your eye exam, your doctor will discuss eye hygiene with you to remove dead skin, oil, and bacteria, the AAPOS says, and might recommend warm compresses, massage, or lid scrubs to remove build-up. Many treatments require diligence and patience and need to be done every day to keep up with clogged glands and subsequent DED symptoms to eventually overcome and maintain ocular surface disease. But sometimes, these at-home remedies aren’t enough. They also might recommend diet changes, including Omega-3 fatty acids, flax seed, and fish oil, which improve the quality and consistency of the oil the Meibomian glands produce, improving the tear film on the ocular surface. And of course, there’s the obvious that anyone glued to their phones can guess: They may also suggest limiting screen time and getting fresh air regularly to preserve your eyesight and eye comfort. To help prevent eye strain, take time to encompass the 20-20-20 routine into your lifestyle: Every 20 minutes, look up for 20 seconds and focus on an object 20 feet away.
Treatments to help
Patients with MGD and DED don’t have to suffer with daily symptoms, when effective in-office treatments are available. The TearScience® LipiFlow® Thermal Pulsation System, which has been performed more than 400,000 times worldwide, gently massages and heats up the affected areas, removing blockages in just 12 minutes. This gentle procedure has been said to help gland function and therefore dry eye symptoms, and contact lens wearers are able to keep their contacts in for four hours longer, research in Clinical Ophthalmology showed. Six to eight weeks later, most patients have seen dramatic improvements. Post-treatment for MGD, patients have reported reduced symptoms like blurred or poor vision. With just one treatment of TearScience® LipiFlow®, they also show increased abilities to perform certain tasks like using digital devices for longer. ¹ ²
Patients can ask providers if they have these additional screening and treatment tools available to ensure they are getting all the diagnostic and treatment tools technology has to offer. Dr. Silani mentions that, on average, dry eye patients visit four to five doctors before finding a specialist to properly address their concerns and condition(s). “Thankfully, we’re the last stop for most patients,” he adds.
Dr. Silani recently had 43-year-old male patient, who suffered with dry eye for more than five years. Prior to visiting his practice, the patient previously tried various over-the-counter remedies and was currently using eye drops between 10 to 12 times per day. His symptoms were not only worsening, but becoming more frequent and interfering with his day-to-day activities. “After a thorough evaluation, we diagnosed the patient with obstructive MGD (or evaporative dry eye). During his consult, the patient agreed to same day treatment with LipiFlow®. When the patient returned for his 6-week follow-up, he reported that his symptoms improved significantly, his tear film stability was normal, and he was no longer dependent on daily use of eye drops. He was thrilled with the results and grateful that we spent the time to listen and help find him relief.”
- Blackie CA, et al. A single vectored thermal pulsation treatment for meibomian gland dysfunction increases mean comfortable contact lens wearing time by approximately 4 hours per day. Clin Ophthalmol. 2018;12:169-183.Lane SS et al. A New System, the LipiFlow®, for the Treatment of Meibomian Gland Dysfunction (MGD). Cornea. 2012;31(4):396-404.
- Lane SS et al. A New System, the LipiFlow®, for the Treatment of Meibomian Gland Dysfunction (MGD). Cornea. 2012;31(4):396-404.
INDICATIONS AND IMPORTANT SAFETY INFORMATION for TearScience® LipiFlow® Thermal Pulsation System
Federal law restricts this device to sale by or on the order of a licensed physician.
The TearScience® LipiFlow® Thermal Pulsation System is intended for the application of localized heat and pressure therapy in adult patients with chronic cystic conditions of the eyelids, including meibomian gland dysfunction (MGD), also known as evaporative dry eye or lipid deficiency dry eye.
Do not use the TearScience® LipiFlow® System in patients with the following conditions. Use of the device in patients with these conditions may cause injury. Safety and effectiveness of the device have not been studied in patients with these conditions. Ocular surgery within prior 3 months, including intraocular, oculo-plastic, corneal or refractive surgery procedure. Ocular injury within prior 3 months. Ocular herpes of eye or eyelid within prior 3 months. Active ocular infection (e.g., viral, bacterial, mycobacterial, protozoan, or fungal infection of the cornea, conjunctiva, lacrimal gland, lacrimal sac, or eyelids including a hordeolum or stye). Active ocular inflammation or history of chronic, recurrent ocular inflammation within prior 3 months (e.g., retinitis, macular inflammation, choroiditis, uveitis, iritis, scleritis, episcleritis, keratitis). Eyelid abnormalities that affect lid function (e.g., entropion, ectropion, tumor, edema, blepharospasm, lagophthalmos, severe trichiasis, severe ptosis). Ocular surface abnormality that may compromise corneal integrity (e.g., prior chemical burn, recurrent corneal erosion, corneal epithelial defect, Grade 3 corneal fluorescein staining, or map dot fingerprint dystrophy).
The Activator or Activator II (Disposable) may not fit all eyes, such as eyes with small palpebral fornices. Use of the TearScience® LipiFlow® System in patients with the following conditions may result in reduced treatment effectiveness because these conditions may cause ocular symptoms unrelated to cystic meibomian glands and require other medical management. Safety and effectiveness of the device have not been studied in patients with these conditions. Moderate to severe (Grade 2-4) allergic, vernal or giant papillary conjunctivitis. Severe (Grade 3 or 4) eyelid inflammation (e.g., blepharochalasis, staphylococcal blepharitis or seborrheic blepharitis). Patients with severe eyelid inflammation should be treated medically prior to device use. Systemic disease conditions that cause dry eye (e.g., Stevens-Johnson syndrome, vitamin A deficiency, rheumatoid arthritis, Wegener’s granulomatosis, sarcoidosis, leukemia, Riley-Day syndrome, systemic lupus erythematosus, Sjögren’s syndrome). Taking medications known to cause dryness (e.g., isotretinoin (Accutane®) and systemic antihistamines). Esthetic eyelid and eyelash procedures (e.g., blepharoplasty, lash extensions, eyelid tattooing). In addition, the treatment procedure may loosen previously inserted punctal plugs, which may worsen the patient’s dry eye symptoms.
Potential adverse effects that may occur as a result of the procedure include, but are not limited to, the onset or increase in: Eyelid/eye pain requiring discontinuation of the treatment procedure; Eyelid irritation or inflammation (e.g., edema, bruising, blood blister, dermatitis, hordeolum or chalazion); Ocular surface irritation or inflammation (e.g., corneal abrasion, conjunctival edema or conjunctival injection (hyperemia)); and Ocular symptoms (e.g., burning, stinging, tearing, itching, discharge, redness, foreign body sensation, visual disturbance, sensitivity to light). Potential serious adverse events (defined as permanent impairment or damage to a body structure or function or necessitates medical or surgical intervention to preclude permanent impairment or damage to a body structure or function) that are not anticipated because of the device mitigations to prevent occurrence include: Thermal injury to the eyelid or eye, including conjunctiva, cornea or lens; Physical pressure-induced injury to the eyelid; and Ocular surface (corneal) infection.
Reference the TearScience® LipiFlow® Thermal Pulsation System Instructions for Use for a complete listing of indications, warnings, and precautions.