In the first part of our series on dry eye disease, we discussed the many causes of the condition. Now we’ll turn our focus to the symptoms that sufferers are likely to experience and how proper diagnosis is key to your treatment regimen.

Symptoms of Dry Eye

There are many symptoms associated with dry eye, which may stem from multiple, concurrent causes. Symptoms may be brought on or made worse by temporary irritants, such as exposure to wind and foreign particles, or be the result of an underlying condition, or a combination of both. As such, there is no single test that can reliably establish a diagnosis of the condition (“Preferred Practice Pattern” 2013).

Symptoms can range in severity and duration, but given the involvement of eyesight in nearly every activity and the especially bothersome nature of eye discomfort, it’s no wonder that patients with dry eye are more likely to report limitations in their daily life and a lower quality of life in general (“Preferred Practice Pattern” 2013).

The symptoms associated with dry eye include (Adler 2015, “Dry Eye Symptoms” 2014, Bustos and Patel 2014):

• Burning sensation
• Itchy eyes
• Fatigued eyes
• Soreness in eyes
• Feeling of dryness
• Redness in eyes
• Excessive tearing
• Feeling of heaviness in eyelids
• Sandy or gritty feeling
• Foreign body sensation
• Sensitivity to light (photophobia)
• Blurred or intermittently changing vision
• Stringy mucous in/around eyes
• Excessive eye irritation when exposed to smoke or wind
• Discomfort when wearing contact lenses
• Frequent blinking

Experiencing Dry Eye Symptoms

For the most part, dry eye does not result in loss of sight, though it may pose a risk in severe cases. The majority of people with dry eye experience fluctuating, blurred vision and various symptoms of irritation that usually become worse by the end of the day (“Preferred Practice Pattern” 2013). Below are explanations for a few of the more unique symptoms.

Excessive tearing

It may sound ridiculous that producing too much tear fluid could be a result of dry eye syndrome, but it is a common symptom. In a healthy, unperturbed eye, the lacrimal gland produces tears at a slow and steady rate so that the eye’s surface is constantly moist and lubricated (“What is Dry Eye?” 2014). This provides the comfort and protection that people with healthy eyes take for granted.

There is a second, heavier rate at which eyes can produce tears, and this occurs in response to a feeling of dryness, irritation, or as a reaction to emotions or pain (“What is Dry Eye?” 2014). Sufferers of dry eye frequently experience ocular discomfort, which triggers this heavier flow of tears. The extra tears are not sufficient to address the underlying deficiency in the tear film, and thus, the tears mostly exit the eye, providing another bothersome side effect (Bustos and Patel 2014).

Blurred or intermittently changing vision

The tear film is responsible for protecting the eye and providing moisture and lubrication, but a healthy tear film is also responsible for providing the eye with a significant portion of its focusing power (Bustos and Patel 2014).

An unhealthy tear film breaks down and interrupts the focusing power in different parts of the eye, which is what leads to blurry and unstable vision. This symptom is generally made worse by reading, using a computer, driving, playing video games, or watching TV (Bustos and Patel 2014).

LASIK and Dry Eye Symptoms

During LASIK vision corrective surgery, a laser is used to cut the cornea, changing its curvature and, as a result, its reflective power (Murakami and Manche 2012). The process involves cutting some nerve fibers in the cornea, which decreases corneal sensitivity, making it harder for the eyes to sense when they need lubrication and thus, hindering the production of tears (Haddrill 2016).

The procedure also affects the distribution of the tear film and the way that the upper lid interacts with the new curvature of the eye’s surface, all of which contribute to symptoms of dry eye. It’s very common for patients of LASIK to experience dry eye symptoms, particularly dryness, visual fluctuation, and foreign body sensation (Murakami and Manche 2012).

While such symptoms can last for weeks, months, or longer, in most cases the symptoms resolve within a few weeks (Adler 2015). It’s important to know, however, that many patients seeking LASIK treatment already have dry eye. In fact, the connection between dry eye and LASIK has led to an increase in detection and treatment of dry eye symptoms prior to the procedure (Haddrill 2016). The surgery is considered to be much safer if dry eye symptoms can be managed preoperatively (“Preferred Practice Pattern” 2013).

Difficulty in Diagnosing Dry Eye

Dry eye, especially in mild cases, can be difficult to diagnose for several reasons. As mentioned earlier, there is no single test that can definitively establish a diagnosis. Furthermore, dry eye can be the result of a variety of causes, the symptoms of the disorder can fluctuate over time, and there is often a poor correlation between the symptoms a patient reports and the existence of clinical signs (“Preferred Practice Pattern” 2013).

Sometimes, symptoms of dry eye are so obvious that you or your primary care physician might notice them and be prompted to seek treatment. However, most people who suffer from dry eye disease present symptoms that go unnoticed in a routine eye exam. Because of this, if you or a doctor suspect you are suffering from dry eye, it is recommended that you visit an eye doctor for an exam specifically targeting dry eye symptoms. (Bustos and Patel 2014).

There are a range of tests to target different indicators of dry eye. However, the clinical tests that do exist are not always specific or sensitive enough to deliver sufficient results (“Preferred Practice Pattern” 2013). It is generally necessary to combine the results of several tests in order to establish a diagnosis. Thoroughness is key. The treatment resulting from an incomplete understanding or identification of the underlying causes can result in frustration for patients, as their symptoms may persist or worsen (Bustos and Patel 2014).

This article is the second in a three-part series on dry eye disease. To learn about what causes or worsens the condition, take a look at part one. In the third and final installment, we discuss available treatment options.

Citations:

• American Academy of Ophthalmology Cornea/External Disease Panel. “Preferred Practice Pattern® Guidelines. Dry Eye Syndrome.” American Academy of Ophthalmology. 2013.
• Adler, Richard, MD. “Understanding Dry Eye Syndrome.” All About Vision. 2015.
• Boyd, Kierstan. “Dry Eye Symptoms.” American Academy of Ophthalmology. 2014.
• Bustos, Daniel E., MD, MS and Alpa S. Patel, MD. “Dry Eye Syndrome.” American Academy of Ophthalmology. 2014.
• Boyd, Kierstan. “What is Dry Eye?” American Academy of Ophthalmology. 2014.
• Murakami, Yohko, MD, and Edward E. Manche, MD. “Prospective, Randomized Comparison of Self-reported Postoperative Dry Eye and Visual Fluctuation in LASIK and Photorefractive Keratectomy.” Ophthalmology. 2012.
• Haddrill, Marilyn. “Dry Eyes and LASIK.” All About Vision. 2016.