Dry Eye Types and Symptoms

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Dry Eye Types and Symptoms

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There are two main forms of dry eye: Evaporative and Aqueous Deficient.

Aqueous deficient dry eye occurs when the Lacrimal Gland, which produces the watery portion of the tears, does not produce enough AQUEOUS to keep the eye comfortable and moist. Decreased tear production associated with dry eye may be caused by any condition that decreases sensation of the cornea (the transparent membrane covering the iris and pupil) or damages the tear glands, called lacrimal glands. As corneal sensation is part of the tear-making response, eyes with decreased sensation will tear less. Some of the causes of decreased corneal sensation include long-term contact lens wear and certain viral infections. The most common cause of lacrimal gland damage is Sjögren’s syndrome, a chronic inflammatory disease in which mucous membranes, especially those in the eyes and the mouth, become extremely dry. Primary Sjögren’s occurs alone with no other associated disorders, while secondary Sjögren’s is often accompanied by other autoimmune disorders such as lupus or rheumatoid arthritis.

Treatment for this type of dry eye consists of using:

  • preservative free artificial tears to replace the moisture

  • punctal plugs to stop the tears from draining quite so fast and keep more tears on the eye for a longer period of time

  • Restasis / Xiidra

  • Drinking more water

  • Using a humidifier

Evaporative dry eye occurs when the LIPID LAYER of the tears is deficient. Approximately 86% of all dry eye patients have evaporative dry eye, which is caused by Meibomian Gland Dysfunction (blockages in the meibomian glands located in upper and lower eyelids). There are ~ 75 of these glands in the lids of each eye and they create the oil layer that prevents the tears from evaporating too quickly. Tears can evaporate up to 16x faster with a deficient lipid layer! The lipid produced by a normal functioning meibomian gland has the consistency of olive oil and flows freely. With Meibomian Gland Dysfunction, this oil can have the consistency of toothpaste and can be trapped in the glands. With chronic disease, the structure can change by shortening or by completely shutting down. This damage is irreversible and can cause worsening of symptoms.

Treatment for this type of dry eye consists of using:

  • Omega 3
  • Heat therapy
  • Blinking exercises
  • Usage of cosmetics and skincare that are not harming the meibomian glands
  • BlephEx - in office treatment to remove plaque that could be coating the opening to your meibomian glands preventing them from functioning properly
  • TearCare - 14 minute in office heated “SPA-LIKE” treatment that unclogs the glands and removes the thickened oil from the glands to restore healthy function
  • Lipiflow

  • IPL

  • RF


Dry eye can impair your ability to read, drive, work on the computer and wear contact lenses. It is the most common condition that an Optometrist will encounter in practice.

Most common symptoms of Dry Eye include:

  • Blurry vision

  • Fluctuating vision (gets better when you blink)

  • Redness

  • Stinging / Burning

  • Itching

  • Excessive tearing / watery eyes

  • Sensitivity to light

  • Gritty / sandy / scratchy feeling

  • Foreign body sensation (feeling like something is always in eye)

  • Eye pain or discomfort

  • Tired eyes / eye fatigue

  • Stringy mucus in or around the eyes

  • Eyes tough to open in the morning

  • Contact lenses discomfort

  • It’s tough to remove contact lenses at the end of the day

  • Excessive eye irritation in windy, smoky, or low humidity conditions