What is Dry Eye disease and how is it diagnosed?

What is dry eye disease?

Dry eye is a medical condition in which the eyes do not produce enough tears. You may wonder why that is a problem. The human eye needs to produce a certain amount of tears to remain healthy and comfortable so if the eye does not produce enough tears, it is a problem. A common type of dry eye disease is when the eye does not produce the right type of tears and tear film.

Understanding the importance of tears

Dry and cracked eye

Each time you blink, a film of tears spreads over your eyes to keep their surface clear and smooth. In other words, your tear film promotes clear vision. There are three layers of tear film and they are the mucus layer, watery layer, and oily layer.

The oily layer is outside the tear film and its purpose is to make the eyes’ surface smooth. It also prevents the tears from drying up too quickly. The oily layer is produced in the Meibomian glands. The watery layer is the middle of the tear film and it makes up most part of the visible tears. Its major function is to clean the eyes by washing away dirt or particles from the eyes. This layer comes from the Lacrimal glands right in the eyelids.

The mucus layer is the inner layer of the film and it ensures that the surface of the eyes is always moist by spreading the water layer over the eyes’ surface. This layer comes from Conjunctiva. Sometimes the eyes do not produce enough tears or one or more of the three layers become dysfunctional. Either case will lead to what is known as dry eyes. Dry eye can be diagnosed through three major tests that have been outlined below.

Common tests used during a dry eye assessment

Osmolarity Test

This test can be carried out using various osmolarity instruments. The osmolarity test assesses the quality of tears with results displayed in most/l. An elevated reading, >300 mOsm/L, indicates loss of tear film homeostasis. When the inter-eye difference is >8 mOsm/L, it indicates instability of the tear film. The iPen and Tearlab are two common examples.

Schirmer’s Test

To perform this test, a patient is first given numbing drops to reduce the discomfort that the test may cause. The optometrist will then pull down the lower eyelid and place a strip of paper beneath it. After that, the patient will close their eyes and leave it closed for 5 minutes. The strip is removed thereafter and the amount of moisture in it is measured. Dry eye disease is diagnosed if the amount of moisture is insufficient.

Red Thread Test

This is a very similar version of the Schirmer’s test. The main difference is that the strip is replaced with a red thread in this test.

Oculus Keratograph 5M

This is an advanced form of corneal topography coupled with specific dry eye tools. It consists of a keratometer, topographer and a color camera that has been optimized for external imaging. Apart from topography and external imaging, the equipment helps to evaluate the lipid layer, measure the tear meniscus height and performs a non-invasive tear film break-up time. Optometrists use this tool to diagnose the specific type(s) of dry eye disease involved. It also helps provide comparative pre and post treatment analysis.


This is an imaging study of the morphology of meibomian glands in vivo. The test is for the purpose of examine the upper and lower meibomian glands and to assist in diagnosing Meibomian gland dysfunction (MGD).

Patients with dry eye syndrome are advised to see an optometrist with the right equipment to run a comprehensive diagnostic battery of tests. Specific tests tailored for the diagnosis of dry eyes will help narrow the diagnosis and the root cause of the condition and ultimately helps in providing a guide for a targeted treatment.

360 Eyecare is proud to offer a specialized dry eye clinic located at our Queen St office. If you're experiencing dry eye please contact our dry eye clinic or fill in this dry eye assessment request form.

What is Chronic Dry Eye

chronic dry eye

Chronic Dry Eye

A healthy eye produces an adequate amount of tears to keep the eyeball moisturized. Tears are made up of oil, water and mucus. Each of these is an important component in protecting the front of our eyes and keeping them comfortable. An oil layer helps prevent evaporation of water, while the mucin layer spreads the tears evenly over the eye. If the tears evaporate too quickly or do not spread evenly over the cornea due to issues with any of the tear layers, you will begin experiencing dry eye symptoms. Most people at some point will experience these symptoms, but people with chronic dry eyes experience symptoms almost daily.

What Causes Chronic Dry Eyes?

Causes of chronic dry eye depend on a variety of factors such as living in a dry climate, exposure to smoke and wind which increase the rate in which tears are evaporated. Women are also more likely to experience chornic dry eyes due to hormonal fluctuations during pregnancy and menopause. Medications such as antidepressants and high blood pressure medications are known to aggravate dry eyes. Age is another cause of dry eyes, most people over the age of 65 experience symptoms.

What are the Symptoms of Chronic Dry eyes?

If you’re experience chronic dry eyes you most likely feel your eyes heavy and out of focus most of the time. Additional symptoms are as follows:

  • Difficulty driving at night
  • Sore Eyes
  • Sensitivity to light
  • Itching, burning
  • Gritty feeling, like there is sand in your eyes
  • Eye redness and eyelid soreness

How is Chronic Dry Eye diagnosed?
The only way to obtain a proper diagnosis is to be evaluated by a reputable eye doctor. It is important to find an eye care provider with the proper technology to make the most accurate diagnosis and match you with the best treatment for your specific condition.

What treatments are available?
Once your eye doctor has examined you, the best course of treatment will be determined. Fortunately, you have plenty of options on how to treat Chronic Dry Eye depending on the severity of the discomfort:

  • Steroid Eye Drops
  • Restasis
  • Xiidra
  • Meibomian Gland Expression
  • Punctal Plugs

Contact Us here at 360 Eyecare - Metro for more information.

Dry Eye Disease

dry eye diseaseYou may have seen the commercial on TV. An attractive doctor diagnoses her patient with chronic dry eyes, prescribes a drug to alleviate the symptoms, and announces that the drug helped her too. It was one of the most memorable American TV ads of 2013—making it to the Neilson top ten in advertising. One reason for its top-ten status was that it skillfully announced to the public how dry eye disease or dry eye syndrome (DES) is actually a disease, and not just an annoying temporary symptom.

It’s not often that eye disorders get such public attention, but dry eye disease confirms how important regular comprehensive exams are in treating conditions that patients sometimes brush off. Your optometrist can diagnose dry eye disease and set you on a path to better, more comfortable vision.

Dry eye disease is a chronic, or long-lasting condition. It happens when your eyes do not produce, or maintain enough tears to adequately lubricate the surface of the eye. Sometimes this is because of reduced tear production. In other cases, it arises as a result of the lack of lipid in tears. As medical professionals, we learn from current research—and dry eye is one condition where research and corresponding treatment is ongoing.

Dry eye symptoms run the gamut from dry and itchy, to burning and watering. They can also be painful, stinging, and irritated. It can even feel like you have a grain of sand in your eye. Dry eye effects different people in different ways, and treatment depends on the severity of the symptoms.

As for the contributing factors and causes? Dry eye can happen as a result of normal aging or hormonal change, environmental factors such as living or working in dry or dusty conditions. Air conditioning in summer and heating in winter can exacerbate the condition, as can staring at a computer or television screen for long periods of time. Researchers know that age and gender are factors in who gets dry eye. Women over 50 have a greater risk than men of the same age. Certain medications for blood pressure, allergies, and depression, can contribute, as well as having medical conditions such as diabetes, arthritis, and thyroid disease.

Optometrists have a number of weapons in their arsenal for treating dry eyes. Treatment depends on isolating the cause and determining the severity. Often, we examine the effects of lifestyle with an eye on alleviating major contributors to discomfort. If the cause is environmental, you may be able to eliminate or avoid it—such as wearing wrap-around glasses or goggles in dusty environments, or making sure you blink often while staring at a computer, video, or television screen.

Dry eye treatment could also include using over the counter eye drops, prescription drops, or even prescription drugs (such as the one promoted in the television commercial). Many people find the limiting their use of contact lenses, and warm compresses on the eyes, can help, as well as eye scrubs. Long term treatment plans include eating a diet rich in omega-3 fatty acids, keeping hydrated with water and blinking fully and consistently.

If you believe you have been suffering from dry eyes, give us a call, we have a number of treatment options that can help replenish moisture on the surface of your eyes and help you feel better.