Dry eyes? That gritty feeling may be telling you something

Q & A with Ophthalmologist Nicole Bajic, M.D.

How common is dry eye?

It is very common. It is one of the most common findings I see during an eye exam, and is often found even when patients have no symptoms at all.

It is a seasonal problem?

It does seem to often get worse during the winter, especially with people turning on the heat and not using a humidifier.

What are the symptoms?

Patients may feel like they have grit or sand inside their eyes. Sometimes the only sign is blurred vision. Some people may even experience tearing, which may seem contradictory. Our tears are composed of water, oil and mucus. You need all three in order to have a proper tear. If you don’t have enough oil due to blocked oil glands in the eyelids (which is extremely common), the tears will be poor quality and can evaporate too quickly. The brain recognizes this and sends a signal to make more of these “poor quality” tears.  In some, it can become a vicious cycle.

What causes dry eye?

Dry eye can be from a deficiency of oil in the tear film or a deficiency of the watery component of tears. Tear deficiency also can be a sign of an autoimmune disease such as Sjogren’s syndrome. Prior eye surgery may also put you at risk, although this is most common with LASIK surgery. It also may be due to overexposure of the eye. Often the lower eyelid becomes lax with aging, which exposes the cornea and results in dry eye. In severe cases of this, it may be medically necessary to tighten the lower lids. 

Evaporative dry eye is more common and tends to be from meibomian gland dysfunction or blepharitis (eyelid inflammation). This is due to blockages of the oil glands along the eyelid margins. It can be due to aging, hormonal changes, some medications or rosacea.

Can people self diagnose dry eye?

Yes, and over-the-counter artificial tears can provide significant relief for dryness or irritation of the eyes.  If this does not provide relief, I would recommend an eye exam for further evaluation. I would also avoid any drops claiming to “get the red out.” Although they may temporarily whiten the eyes, they dry the eye out in the long term.

How is dry eye diagnosed?

Oftentimes, I am able to diagnose the patient just from listening to their symptoms. Most often they report feeling grit in their eyes.
On exam, I first look at their eyelids and how they function. Some people do not close their eyelids completely, which can dry out their eyes while they sleep. I also assess for laxity that may contribute to overexposure of the eye.  Next, I assess the eyelid margins for inflammation and significant blockages of the oil glands. I then look at the tear film and cornea (the clear “windshield” of the eye).  I use a special dye to assess the quality of this tear film and if exceptionally dry, the cornea will soak up this dye like a dry sponge. If dry eye is severe, people can get scarring, which can obstruct vision.

How do you treat dry eye?

• Artificial tears can be used three or four times per day. If people are using it more than that, or wear contact lenses, then I would encourage them to use preservative-free drops.
• Patients can use baby shampoo to clean their eyelids and lashes
• Warm compresses can open up the oil glands along the eyelids so patients can make better quality tears.
• Some patients may benefit from having plugs placed into the tear “drains” of the eye to help collect more of their natural tears.
• There are surgical procedures that can be done for severe cases.
• Occasionally, prescription drops may be used to help patients make more tears.

How to avoid getting dry eye?

What not to do

• Do not apply eyeliner to the waterline of the eye.
• Avoid wearing an ill-fitting sleep apnea mask.
• Don’t use eye drops claiming to remove redness. 
• Don’t sleep in contacts, which also puts patients at risk for an infection that could cause vision loss.
• Avoid smoking.

Be proactive

• Use a humidifier.
• When working at a computer, follow the 20/20 rule: for every 20 minutes on the computer, take a 20-second break looking away from it.

“We actually blink less when we’re focused on something, so staring at a computer screen all day means you’re lubricating your eye less,” says Dr. Bajic.

Nicole Bajic, M.D. performs eye and eyelid surgery at the NCH Day Surgery Center. She practices at Koziol-Thoms Eye Associates, 1211 S. Arlington Heights Road in Arlington Heights. To schedule an appointment, call 847-264-2222 or visit koziol-thomseye.com. (Depending on insurance, you may need a referral to see an ophthalmologist.)