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Dry Eyes: Need For Early Diagnosis

It is important that there be a heightened awareness of this insidious disease, especially during periods of enforced or extended usage of digital screens.

Have you ever experienced tiredness or fatigue or dryness in the eyes while working on the laptop? Or with the increase in screen times during the pandemic, a difficulty in keeping the eyes open with grittiness and increased blinking? Or had to wet the eyes in the morning to allow them to open? You may well be suffering from a chronic dry eye.

 A dry eye is defined as “A multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage & neurosensory abnormalities play etiological roles.”

The symptoms of a dry eye can be redness, pain, fatigue, a stinging or burning sensation, discomfort with contact lenses, transient blurring of vision, a sandy or gritty feeling and a decreased tolerance to sustained screen viewing.

It is important that there be a heightened awareness of this insidious disease, especially during periods of enforced or extended usage of digital screens, mobile phones, tablets, pads, laptops, computers and TV screens for educational, information or recreational purposes. Chronic untreated dry eye can lead to a roughening of the margins of the eyelids, loss of eyelashes, extra skin and mucosal folds, blurred vision, extreme sensitivity to bright lights and severe roughening of the surface of the eye (Keratinisation).

The tips and advice for preventing these advanced sequelae should not be underemphasized, because early diagnosis can prevent these occurrences largely. Computer Vision Syndrome (also known as Digital Eye Strain), is one specific syndrome, experienced by many young and otherwise healthy digital device users, students, office-goers and even housewives. Tired eye muscles & imbalance, excessive brightness, poor lighting, posture and body position, improper contrast and lack of adequate rest, all play a role. However, a dry eye is a very, very significant contributor to Digital Eye Strain.

A periodical, routine eyecheck is strongly advised. Not only do errors in focusing, a need for glasses and muscle deficiencies get picked up, one can look for impacts of diabetes and high blood pressure, thyroid disease and lipid imbalance. A dry eye and sight-threatening conditions such as Glaucoma, retinal degenerations and early cataracts can also be picked up on routine examination. In otherwise healthy individuals, with no history of wearing glasses or diabetes, etc, or other risk factors, one should broadly, schedule an eyecheck at pre-school age, every 2-4 years till the age of 20 yrs, every 5 years from age 20-40 and every 3 years thereafter. Any problem detected during these checkups will alter the frequency of further exams.

Depending on the chronicity and various environmental factors, a Dry Eye can have an up and down course. Phases of lack of sleep, travel, excess screen time especially with mobile phones and computers, exposure to dry and windy or polluted conditions, low-humidity conditions as in heated or airconditioned areas and seasonal variations can exacerbate the disease and worsen the complaints. Chronic allergies, use of some medicines such as antiallergics, some anti-hypertensives and sleeping pills, thyroid disorders and arthritis can also aggravate the symptoms. Older individuals and especially post-menopausal women are specifically more likely to develop a chronic dry eye.

A Dry Eye can have various subtypes such as an Aqueous Deficiency or an Evaporative Dry Eye, depending on the whether it is the watery component of the tears that is deficient or the oil (lipid). Though there is a considerable overlap, a thorough eye examination and special tests such as an Ocular Surface Analysis, using specific dyes to detect eye staining, answering a questionnaire and tear secretion tests assist the ophthalmologist in quantifying the level of severity & initiating appropriate therapy.

Some suggestions to counter the problem of digital eye strain are as follows:

Get a comprehensive eye exam to rule out preexisting dry eye and repeat an annual checkup thereafter. Using proper lighting, without much difference between the screen brightness and the surround, minimizing glare & reflections, modifying the position and location of the workstation, upgrading the quality of the display, adjusting computer display settings to a comfort zone with good contrast and considering using special eye wear, can all help reduce fatigue and eye strain. Its is good to take frequent breaks (remember the 20-20-20 rule?), blink more often, consciously, with ‘slow’ blinks and do eye exercises.

Other tips include ensuring the diet contains foods such as fruits and vegetables rich in Vit A, D and E and those with the essential fatty acids and omega-3, such as nuts, flaxseed and fish. Maintaining good hydration by drinking adequate amounts of water daily, minimizing the use of contact lenses, avoiding and protecting against very dry and extreme environments are also important.

Conventional treatments for dry eyes are based on the subtype and severity of the condition. Specific treatments, such as anti-inflammatory drops, low intensity steroid drops, lubricating gels and ointments, heat treatments and massages and specific thermal treatments may be advised along with strategies to retain moisture such as placing punctal plugs. 

The mainstay of treatment, however, is always the lubricating eyedrops and a wide variety is available. The ophthalmologist is the best guide as to which is the most appropriate for any given patient.



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