Winter is coming: Help patients combat dry eye

Warm, dry air blasting from vents in cars and homes, and bitterly cold winds whipping at our faces—these environmental conditions can contribute to and aggravate dry eye disease (DED). Doctors of optometry, however, can provide relief to the millions of Americans with the condition.

Age, gender, medical conditions and medications are linked to dry eye. Even longtime use of contact lenses, digital eyestrain and eye makeup can intensify its symptoms. But the current weather conditions matter, too, for people with DED; winter arrives on Dec. 21, but in many parts of the country a cold snap has already settled in.

DED occurs when a person doesn't have enough quality tears to lubricate and nourish the eye. Tears provide lubrication, reduce the risk of eye infection, wash away foreign matter in the eye and keep the surface of the eyes smooth and clear. Further, excess tears in the eyes flow into small drainage ducts in the inner corners of the eyelids, which drain into the back of the nose. Dry eyes can occur when tear production and drainage are not in balance.

"The air is less humid in winter," says Sue Lowe, O.D., chair of the AOA's Health Promotions Committee (HPC), who practices in Laramie, Wyoming.

Adds Daniel Bintz, O.D., HPC member who practices in Elk City, Oklahoma: "It seems most people complain more about dry eyes in the winter. The eyes can feel pretty miserable during the winters months in Oklahoma."

About dry eye

An estimated 5 million Americans over the age of 50 have dry eye; most are women. Read about the extent of dry eye in the U.S.

According to the National Eye Institute, dry eye symptoms include:

• Stinging or burning eyes.
• A sandy or gritty feeling in the eye.
• A stringy discharge from the eye.
• Pain and redness of the eye.
• Episodes of blurred vision.
• Heavy eyelids.
• Inability to cry when emotionally stressed.
• Discomfort wearing contact lenses, depending on the style and fit.
• Decreased tolerance of reading, working on the computer, or any activity that requires sustained visual attention.
• Eye fatigue.
• Episodes of excess tears following very dry eye periods.

"Dry eye disease also can make your eyes water more," Dr. Bintz says. "In response to the gritty feeling in your eyes, the brain kicks in the tear glands and the thinking that something needs to be flushed out.

"The problem then becomes making too many watery tears and not enough oily tears, which are made in the tiny meibomian glands near your eyelashes," he says. "These small glands can be coaxed into working better by applying warm compresses to increase blood supply to the glands."

Adjust to weather conditions

Doctors of optometry can provide patients with a number of treatment options that can help patients conserve tears (tiny silicone or gel-like plugs), increase tear production (eye drops and omega-3 fatty acid nutritional supplements) and decrease inflammation around the eyes' surface (eye drops or ointments, warm compresses and lid massage, and eyelid cleaners).

Often over-the-counter artificial tears—which may contain an oily mix to help replace the layer of tear film—are recommended, Dr. Bintz says. Doctors also may want to look at patients' medications (for blood pressure, pain and anti-depression) because they may exacerbate dry eye, Dr. Lowe says.

Patients also can reduce their own discomfort by:

• Blinking regularly.
• Increasing the humidity in the air.
• Wearing sunglasses.
• Taking nutritional supplements.
• Drinking plenty of fluids.

Dr. Lowe also noted the AOA's 20/20/20 rule for digital eyestrain.

"We usually advise patients with dry eye to take the drops frequently during the day," Dr. Bintz says. "At bedtime, we might recommend hot compresses along with ointments or gels. They should hydrate with water; avoid caffeine and alcohol and remember allergy meds can cause dry eye symptoms."

Learn more about dry eye disease in the landmark 2017 Report of the TFOS International Dry Eye Workshop (DEWS ll).