Keratitis Sicca - What Is It, Symptoms, And How To Find Relief
What is Keratitis Sicca?
Keratoconjunctivitis sicca (KCS), or keratitis sicca, is also known as dry eye disease. This condition is a multifactorial condition, meaning that it has many causes and contributors that are not the same for everyone. Keratitis sicca is a disease of the ocular surface and tear film, and inflammation plays a large role.
There are two main forms of dry eye syndrome; aqueous deficient dry eye disease and evaporative dry eye disease. Aqueous deficiency can be characterized as either Sjogren’s syndrome or non-Sjogren’s syndrome, and this form of dry eye disease occurs when the lacrimal gland is affected. This important gland produces the watery portion of the tears. Those with evaporative dry eye disease most often have issues with their meibomian glands. These tiny glands in your eyelids produce the oily portion of your tears, and the oil is responsible for preventing tear evaporation.
Keratitis Sicca Symptoms
Patients with keratitis sicca may notice many different symptoms, outlined below:
Discomfort or irritation of the eyes
Redness of the eyes and eyelids
Intermittent blurred vision
Sensitivity to light
Watering of the eyes
The feeling of something in the eyes
The symptoms are often similar for those with aqueous deficient and evaporative dry eye, although those with an evaporative component may notice more issues with their eyelids. The eyelids are incredibly important for keeping the eyes lubricated and for maintaining comfort and vision. Without the oily portion of the tears, and the ability of the eyelids to effectively spread those tears, keratitis sicca symptoms come about.
What Causes Keratitis Sicca?
As already discussed, there are many things that can contribute to this condition. Aqueous deficiency is often caused by Sjogren’s syndrome, which is a condition affecting the immune system whereby the body attacks the lacrimal and salivary glands. Aging, systemic medications, hormones, radiation injury, and other causes can affect the lacrimal glands as well.
For evaporative dry eye, the meibomian glands are often affected by age, blepharitis, disorders of blinking or the inability to blink fully, allergies, contact lens wear, and medications such as Accutane. However, most people have a combination of factors, and meibomian gland dysfunction is incredibly common, affecting the majority of dry eye sufferers.
In addition to the above, other potential contributors to meibomian gland dysfunction include demodex eyelash mites, which live within the eyelash follicles. These mites are found on nearly all humans naturally, but can become problematic if they overpopulate (common in immunocompromised individuals and the elderly). The skin condition rosacea has also been implicated as a contributor to MGD, as people with this condition often suffer from eye issues such as ocular rosacea. Learn more about ocular rosacea here.
How to Relieve Keratitis Sicca
Although there is no cure for keratitis sicca, there are many ways to effectively manage this condition and prevent symptoms from worsening. A great eyelid hygiene routine, as well as a proper anti-inflammatory diet, can go a long way in treating this condition and helping you feel normal again.
The number one recommendation we make is to ensure you’re keeping your eyelids clean. We already discussed how important the eyelids are, and if they’re not being kept clean you’re just going to be dealing with what are basically dirty windshield wipers.
First and foremost, make sure you’re removing your makeup every single night. Without doing this, you’re allowing bacteria and chemicals to sit on your eyelids, worsening the issue. Use an oil-based eye makeup remover, since these contain less chemicals and are great for dissolving all makeup.
Next, wash your face with a tea tree oil soap. We recommend tea tree oil because it has antibacterial and anti-inflammatory properties that make it wonderful for skin conditions such as rosacea, which can contribute to keratitis sicca. In addition, tea tree essential oil has been shown to be an effective killer of demodex eyelash mites.
Lastly, cleanse your eyelids and lashes. A hypochlorous acid formulais great for this because it contains minimal ingredients that could potentially be bothersome for the delicate eyelids. Hypochlorous acid is also incredibly effective at eliminating microorganisms on the skin and mucous membranes, making it a great choice for eyelid cleansing. Simply spray your closed eyelids with the solution, rub it in with your clean fingertips, and let it dry.
When bacteria accumulate on the eyelids, they begin to form biofilm. As an example, dental plaque is a form of biofilm and the same thing occurs on your eyelids. Biofilm is difficult to remove with cleansing alone because it acts like a fortress to protect bacteria, and it must be removed mechanically.
There are a few great ways to remove biofilm on the eyelids. First of all, you can have BlephEx performed at your eye doctor’s office. Many offices have this device now, and it’s a simple way to have your doctor remove the biofilm for you. Alternatively, the NuLids device is an at-home device designed to remove biofilm in a similar fashion. This device is to be used at home once per day to remove biofilm and prevent further build-up.
Hydration and a Plant-Rich Diet
You’ve likely heard us discuss the importance of hydration and a healthy diet ad nauseam, but we do this because it’s so important and not talked about enough. Rarely is your eye doctor going to mention the importance of these two factors when you see them for your eye appointment. However, we’ve seen lives changed because of these very recommendations.
Hydration is important for all of the cells in your body. Without water, they cannot function properly. As a general rule, you should be drinking half your bodyweight in ounces of filtered water per day. For someone who weighs 150 pounds, that’s 75 ounces of water you should be drinking. We recommend purchasing a reusable stainless steel or glass water bottle and refilling it throughout the day with filtered water.
As for your diet, we could write an entire book on this topic (and we did... you can find that here). The main point that makes the largest difference for patients is replacing your breakfast with a green smoothie. We’re not taking away any of your favorite foods here, but we are telling you to replace the cereal, pancakes, bacon, dairy, or whatever else you’re having with a healthy, antioxidant-rich green smoothie.
After you’ve successfully done this for a few weeks every single day, we then get into the foods you should be avoiding. To decrease overall inflammation in your body, and eye inflammation as well, avoid added sugar, processed food (most food items in boxes, cans, and from fast food joints), and unhealthy fats such as trans fats. Replacing these foods with fruits, vegetables, and healthy fats such as organic olive oil can mean the difference between suffering and comfort.
Omega-3 Fatty Acids
We touched on healthy fats a bit already, but our bodies crave a ratio of omega-6 to omega-3 fatty acids in a ratio of about 4:1. For the average American, that ratio can sometimes be greater than 30:1 because fast food and processed items are full of unhealthy omega-6 fatty acids.
To enhance this ratio in your favor, you can begin to eat more wild caught, fatty fish such as salmon, mackerel, and anchovies, up your intake of avocados and walnuts, or take an omega-3 supplement. We recommend taking a triglyceride-based omega-3 supplement
if you decide to supplement, because these are more easily absorbed by your body.
In-Office Procedures: IPL and LipiFlow
There are a few incredibly beneficial procedures that can be performed in your doctor’s office. The first one, Intense Pulsed Light (IPL) is beneficial because it uses light to destroy inflammation and unwanted blood vessels on the face and eyelids. This procedure often works well for those who have rosacea, ocular rosacea, and MGD.
LipiFlow is another great option for those who have MGD, and especially those who have stagnant oil blocking their glands. LipiFlow uses thermal pulsation (the combination of heat and pressure) to heat the oil within the glands and remove that oil out into the tear film where it belongs. This can help to clear the stagnant meibomian glands, potentially prevent atrophy of the glands, and get them working again.
What Are The Best Eye Drops for Keratitis Sicca?
While we don’t recommend eye drops often, they can be helpful for those with mild keratitis sicca. They can also be great for symptom relief throughout the day.Oasis Tears Plus Preservative Free is a great option. It contains no preservatives that could be bothersome to already sensitive eyes, and it is a true solution that keeps tears on the eye surface to relieve the dryness and irritation. Oasis distributes its product through eye doctors only, and it’s a great company we trust.