Q: My eyes are very dry and gritty and I was wondering if there is an OTC remedy that you could recommend? I have a friend who was told she had dry eye syndrome and she was told to put a heat mask on and then massage her eyelids to remove blocked oil. Could this be what is wrong with me, and if so, can you tell me a bit more about it?
Dr Grant replies: Patients with dry eye syndrome or dry eye disease (DED) are advised to try to increase natural tear production by applying a heated eye mask over the closed eye surface. The lacrimal (tear producing) glands are located on the upper outer area eye lid and produce the tear film that helps to protect, clean, nourish and lubricate the eyes.
There are multiple reasons why people develop DED. Well-known risk factors include female gender, hormonal changes, advancing age, smoking, contact lens wearers, vitamin A deficiency, and previous eye surgery. Exacerbating factors include possible medication side effects, windy cold weather conditions, low-humidity environment, and extended periods spent looking at screens. Some systemic conditions such as sarcoidosis, diabetes, Sjögren’s syndrome (SS) and Parkinson’s disease can also cause DED.
SS is a chronic autoimmune inflammatory disorder that causes reduced lacrimal and salivary gland function with resultant dry eyes and a dry mouth. SS can occur alone or with other autoimmune conditions such as rheumatoid arthritis or lupus. Age-related DED and conditions that cause conjunctival scarring lead to DED by causing obstruction of the lacrimal glands over time, and ultimately decreased lacrimal gland function. A condition called posterior blepharitis affects the meibomian glands causing increased tear evaporation and resultant dry eye. Ocular allergy syndromes can cause ocular surface irritation and increased tear film evaporation and dry eye, but ocular itching tends to be a presenting feature with allergy.
The common clinical presentations of DED include a sensation of foreign body, gritty, burning, dry eye sensation. This is often accompanied by redness (conjunctival injection), blurred vision, sensitivity to bright light and occasionally paradoxical excessive tearing. Treatment for DED is aimed at increasing or supplementing tear production, slowing tear evaporation, reducing tear resorption, or reducing ocular surface inflammation.
The mainstay of treatment involves symptomatic relief by regular (four to six times per day) artificial tear supplementation in the form of eye drops, gels and ointments. Ensure the artificial tear supplement is a preservative-free formulation. Eye gels, and especially ointments, can blur vision temporarily and are best used at night. It can take up to four weeks to notice a significant improvement in DED symptoms. Other strategies include improving environmental conditions and applying regular warm compresses to soften secretions in obstructed glands.
If your symptoms persist, you are best advised to attend an optician for initial assessment including a thorough slit lamp examination and Schirmer’s test which involves a small piece of litmus paper inserted into the lower eye lid to assess tear production. If needed, the optician will refer you to an ophthalmologist who will perform further testing to assess lacrimal gland function.
Dr Jennifer Grant is a GP with Beacon HealthCheck