We get this question all the time in our clinic, out on the street, and basically from anyone we meet. Our еуеѕ wіll ѕеrvе uѕ for a lifetime, so it іѕ important that we get to the root cause of our eye issues so that we can сhооѕе the right ѕоlutіоn to our еуе problems. We want the kind of treatments that not only treat the ѕуmрtоmѕ, but dіrесtlу аddrеѕѕ thе root саuѕе оf those problems. Thе same рrіnсірlе аррlіеѕ tо drу еуе, a major vision concern аffесtіng аn еѕtіmаtеd 30 mіllіоn Americans, whether they know it or not.
Thе саuѕеѕ of dry eye range from іmmunе dіѕоrdеrѕ to the more common causes, like a lасk of tear production and a lack of eyelid hygiene. Aѕ a result, thіѕ рrоduсеѕ іnflаmmаtіоn аnd the surface of the eye аnd the inner еуеlіds bесоmе drу.
Below, we’ll discuss the major contributors to dry eye disease, whether you have a mild form or severe. For each of these causes, there are natural treatments that can help alleviate the most common symptoms and hopefully lead you on the path to feeling more normal again.
Aqueous deficient dry eye disease can be broken down into Sjogren's Syndrome and Non-Sjogren's Syndrome. Sjogren's Syndrome is an autoimmune condition where your immune system is attacking the salivary glands in the mouth and the lacrimal glands of the eyes. The secretions from these glands (saliva and watery tears) will be lessened or non-existent, which will create an extremely dry mouth and chronic dry eyes (because the glands don’t produce enough tears).
As with any autoimmune condition, diet usually plays a crucial role, but may not explain the whole story. Non-Sjogren's Aqueous Definifiect Dry Eye occurs when the lacrimal gland is affected, but not due to an autoimmune response, but rather due to something else. Systemic drugs (such as many of those discussed below), a reflex block, lacrimal gland duct obstruction and lacrimal deficiency are examples of this.
Treatment for aqueous deficiency is all about finding the underlying cause of the problem in the first place. If it’s an autoimmune condition, such as rheumatoid arthritis, your best option is to treat the condition. If something else has caused the aqueous deficiency, such as a medication, you might want to discuss other medication options with your doctor. Often, there are ways in which medications can be switched around so that your dry eye symptoms are lessened.
In addition to this, Restasis has been shown to increase tear production so it can be helpful for symptom relief in those suffering from all forms of aqueous deficiency. Punctal plugs may also be of great use for those with this form of dry eye. By plugging up the drainage holes in your eyelids, you can keep more tears in your eyes.
Blepharitis is, by definition, an inflammation of the eyelids. There are two different types of blepharitis: anterior (front) and posterior (back) blepharitis, which are location dependant. Anterior blepharitis is sometimes called Staph Blepharitis as it is an overgrowth of the normal Staphylococcus Aureus that lives on our eyelids. Posterior blepharitis is also called meibomian gland dysfunction (MGD), which will be discussed in the next section.
Anterior blepharitis, like stated above, tends to be more bacterial-related. We have normal bacteria that live on our eyelids that can become overpopulated, whether from a lack of hygiene or normal changes in the body.
Blepharitis Symptoms and Signs:
If you have these signs and symptoms, treatment is simply keeping your eyelids clean with a hypochlorous acid eyelid cleanser. This spray is a natural antiseptic and mimics your body’s natural ability to heal. It is free of any harsh chemicals, alcohol, parabens, sulfates, or other preservatives.
An example of a hypochlorous acid eyelid cleanser that works well for our patients is Heyedrate Lid and Lash Cleanser, which can be found online. Eyelid hygiene should be performed twice daily, both morning and evening, and more often as needed.
Meibomian glands are located on the posterior or back surface of your eyelid. Their primary responsibility is to secrete an oil called meibum into the eye, which prevents your tears from evaporating. This leads to more comfortable and less dry eyes. If meibomian glands are disrupted in any way, it can lead to meibomian gland dysfunction (MGD), which results in symptoms of dry eyes, grittiness, irritation, inflammation, redness, and that feeling like you have sand in your eye because your tears are evaporating too quickly.
Meibomian glands have little oil producing factories, called acini, which produce oil. The acini release the oil into the meibomian gland and, with the help of the eyelid muscle (the orbicularis oculi), oil is milked down the gland and out the opening, called the terminal duct. This occurs every time you blink. The oil is then released onto the eye’s surface to help prevent evaporation of your tears.
Meibomian gland dysfunction (MGD), or posterior blepharitis, occurs when any part of the process discussed above is dysfunctional. The muscle can lose its function, the oil factories can stop working, and the opening can become clogged. This disease is a progressive, obstructive disease that advances from the production of normal, healthy oils of the tear film into thicker secretions that cause stagnation and blurry vision. If left untreated, the glands can become completely obstructed and eventually atrophy. Unfortunately, this disease currently has no cure, but there are ways to effectively treat it and reverse some of the issues.
MGD Symptoms and Signs:
MGD Treatment: At Home
Step 1: Warm Compresses
Warm compresses are best performed with a mask that is specifically formulated for dry eye. Check out the Heyedrate Dry Eye Warm Compress here.
We recommend applying warm compresses at least every night, but you cannot overdose, so feel free to do it as often as you want for symptom relief.
Step 2: Meibomian Gland Expression After Warm Compresses
Meibomian gland expression is the process of expressing the meibomian glands after heating. Heating up your meibomian glands helps turn the oil into more of a liquid (think of placing a stick of butter on the stove... it melts). After doing this you can milk the glands by rolling a q-tip starting away from your eyelid margin and rolling towards it (or you can use your finger). Check out this video on meibomian gland expression.
Step 3: Use a Hypochlorous Acid Cleanser
After you perform your warm compresses and meibomian gland expression, it is essential to clean your eyelids with a great eyelid scrub to eliminate all the exfoliated oil and debris from the surface. We recommend a hypochlorous acid eyelid cleanser in our clinic, like our Heyedrate Lid and Lash Cleanser.
Step 4: Increase Intake of Omega-3 Fatty Acids
Omega-3 fatty acids are so important for those with MGD. Because the meibomian gland oils of those with MGD are of poor quality, it is imperative to ensure you're ingesting a good ratio of Omega-3 to Omega-6 either through food or supplementation. A healthy Omega-6 to Omega-3 ratio is 4:1 but, sadly, our Western diet almost guarantees that yours may be closer to 20:1 or even 50:1. To make sure your ratio is healthy, eliminate all processed and fried foods and sugars and replace them with healthy omegas like wild caught salmon, mackerel, walnuts, chia seeds, flaxseed, and avocados.
For those who wish to supplement, find a triglyceride-based omega-3 supplement that is fished sustainably. We love Heyedrate Omega-3 for Eye Health.
In your doctor’s office, LipiFlow is also a great option for MGD treatment. This procedure takes less than 15 minutes of your time and can give long-lasting relief.
Demodex are tiny mites found in or near hair follicles. They are most commonly found on the face and around the eyelashes. They are usually about 0.3 mm long, have eight legs, and their body is covered in scales for anchoring into a hair follicle. They eat skin cells and oils which accumulate in hair follicles. Demodex is mostly nocturnal and can be transferred via contact. Gross!
Infestation is very common, especially in the elderly, and usually does not cause symptoms, but skin disease can develop from demodex. They are considered parasitic, however most of the time no adverse symptoms are observed.
Demodex Symptoms and Signs:
Demodex treatment is centered around using a tea tree based product on your hair, face, and eyelashes every day to prevent and eliminate demodex. Do not use straight tea tree essential oil, as it is very powerful and toxic. Use a product that contains tea tree oil and has been specially formulated for use on the face and around the eyes.
Tea tree essential oil has known antibacterial properties that work well to kill off microorganisms on the skin around the eyelids. Tea tree oil is a known killer of demodex and it's imperative to keep your facial and eyelid skin clean while treating demodex, because more bacteria will only exacerbate the issue. We recommend our Heyedrate Tea Tree Oil Soap bar for use in the shower and on the face.
Everyone has probably heard the term ‘rosacea' at least once or twice in his or her lifetime. Rosacea, in this case, is one that deals with the face; however, most people don't know the term can also apply to a condition which targets the eyes. Burning, itching, and redness could sometimes be symptoms of ocular rosacea.
This condition is a type of inflammation which typically corresponds with chronic skin rosacea. In certain instances itchy, red eyes are the initial sign that an individual has ocular rosacea. Whilst there isn’t a cure available for rosacea, great eye care and eyelid hygiene practices could help manage it and reduce the symptoms.
Ocular rosacea is typically caused by environmental and genetic factors. The majority of the causes below could also exacerbate ocular rosacea.
Ocular Rosacea Triggers:
Ocular Rosacea Symptoms and Signs:
Ocular Rosacea Treatment
Ocular rosacea can be managed by keeping to a strict eye care routine. This routine should be kept up even when the condition seems to clear up. This aids in the prevention of flare-ups.
First, you’ll want to wash your face and eyelid area with an all natural, tea tree oil based soap such as Heyedrate Tea Tree Soap. Ensure that your eyelids are cleaned twice per day: a cotton round/ball should be sprayed with a hypochlorous acid eyelid cleanser, such as Heyedrate Lid and Lash Cleanser, and then moved across the eyelid to eradicate oil and debris from the area. Also, spray this hypochlorous acid eyelid cleanser on areas of rosacea on the skin to help alleviate symptoms.
As discussed for MGD above, a warm compress can be applied in the same manner. However, if you find that a warm compress exacerbates your condition, do not use one!
Keep in mind the following things during rosacea treatment:
There are many environmental factors that may play a role in your dry eye, so we’ll discuss a few very common ones below:
Smoking affects dry eye in two different ways. The most devastating way is through the inhalation of numerous toxins and chemicals that flood your bloodstream with free radicals, which, as discussed above, increases your risk for dry eye, heart disease, and cancer. Secondly, the actual smoke is an eye irritant as well.
I don’t need to go into more detail, as smoking has been proven over and over again to cause problems and you have probably heard it ad nauseum. If you smoke, there’s never been a better time to quit!
Fans and Air Vents
Direct wind can cause a lot of irritation, whether it be from air conditioning or heat in your car, overhead or direct fans at home, and natural wind from mother nature. Turn your vents and fans away from your face if you need to have them on.
To block natural wind, wear a great pair of polarized sunglasses that wrap well and provide a barrier of protection.
As stated above, find a pair of polarized, UV protected sunglasses that wrap well and block the wind, but any sunglasses are better than none. Make sure you’re wearing sunglasses whenever you’re outdoors. Sunglasses are not just for sunny days! UV radiation can enter the eye even on cloudy days, and getting into the habit of wearing them means your eyes will always be more comfortable.
Excessive Phone, Tablet, and Computer Use
So, why do your eyes feel tired after a long day? There are many causes of eye fatigue, but a huge culprit is the technology we're surrounded with daily. Working on a computer or even on your smartphone throughout the day can make your eyes much more tired. This occurs because, when you go to look at something small and close to you, the ciliary muscle inside your eye contracts and changes the focusing system of your eye to allow you to view up close. This small muscle is so important because it controls your ability to focus far away, up close, and at all distances in between!
The longer this muscle has to work, the more eye strain you may feel (the ciliary muscle gets tired just like your other muscles do after a weightlifting session!) Also, working on a computer that emits blue light means that the contrast of what you're viewing is decreased, making it tougher to see clearly.
If all that weren’t enough, it’s also proven that we blink much less often while on a computer, looking at a phone, or while reading a book. This means your eyes dry out much more quickly.
We love to employ the 20-20-20 Rule. This is how it works: Every 20 minutes, look up from your computer (or cell phone, needlepoint project, etc) and look 20 feet away for 20 seconds. Set a timer! This is the best way to ensure that you're giving that ciliary muscle a rest every once in awhile, and ensures that you’re getting in plenty of precious blinks!
Lastly, grab yourself a pair of blue light blocking glasses (or have blue light technology put into your prescription lenses). This technology helps prevent too much blue light from entering your eyes and can help relieve symptoms of eye fatigue and dryness while you work throughout the day. They can also help you sleep better, so that's a welcome bonus! We love the Eye Love Blue Light Blocking Glasses.
If you’re taking medications, there’s a large possibility that they could be contributing to your dry eyes. Here are a few of the worst offenders:
Any drug that operates to change chemicals in your brain, including ones used for the treatment of mental health issues, can have a negative impact on vision, disrupting the messages received by the cornea (the front of the eye) and optic nerve (the back of the eye). Examples may include Prozac, Paxil, and many others.
Decongestants and Allergy Medications
Decongestants especially target the eyes and nasal areas because the symptoms they treat are itchiness and runniness of the eyes and nose. If you suffer from allergies and dry eye problems, consider checking with your doctor for something other than over-the-counter drugs. Medications such as Claritin, Zyrtec, and Benedryl will often dry out the eyes very easily.
Beta Blockers and Other High Blood Pressure Medications
Generally prescribed for those with chronic high blood pressure, one of their primary side effects is dry, itchy, and painful eyes. Watch out for any medication that ends in -ol, such as metoprolol and propranolol.
OTC and Prescription Pain Relievers
If you are on a regular regime of ibuprofen or acetaminophen, or you’ve been prescribed narcotics by your doctor for pain, you may experience dry eye symptoms. If so, try lowering the dosage slightly and drink more water to help solve your pain issue.
Birth Control and Hormone Replacement Therapy
Anything that messes with the hormones in the body is going to cause dryness issues, including birth control of all kinds, HRT, menopause in general, and even pregnancy! This is often the reason why many women in menopause experience dryness.
We hope this has been helpful for you in pinpointing the causes of your dry eyes, so that you can take action.Do you know what caused your dry eye? Let us know in the comments below!
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