Dry eye is a common condition caused by a lack of tear production or a problem with secretion and draining tears. If left untreated, dry eyes can damage the corneas and result in vision loss.
Uncontrolled severe dry eyes can lead to significant consequences such as scarring and infectious keratitis. Other non-eye problems can result from living with dry eyes, such as poor sleep quality.
This article explains what happens if dry eyes are left untreated and which conditions can ultimately develop. It will also detail treatment for dry eyes, as well as prevention.
Dry eyes are a common symptom that occurs when the eyes produce too few tears, or they evaporate too quickly. Doctors identify many different causes of dry eyes, which can include certain medications and conditions. However, untreated, dry eyes can have consequences.
Left untreated, dry eyes can have negative effects on quality of life, including:
- Physical health: Dry eyes can harm physical health, with increased pain and poor sleep quality due to discomfort.
- Psychological health: Dry eyes can have a negative effect on body image, appearance, and self-esteem. It can also impact thinking, learning, memory, and concentration. This is due to fluctuating vision and disruption to visual tasks.
- Level of independence: Dry eyes can result in dependence on medications and medical aids, including artificial tears or punctal plugs. It can also result in decreased productivity at work and a reduction in workplace performance overall.
- Environmental impact: Dry eyes can negatively impact participation in activities for enjoyment, such as sports. It can also be a financial burden for the person experiencing dry eye, with the cost of eye appointments, medications, supplements, or even surgery.
Eye-related issues
Uncontrolled severe dry eyes can also lead to the development of eye-related issues. Eye-related issues can be mild to severe and include:
- infectious keratitis
- corneal ulcer
- scarring
- depression
- migraine
- sleep and mood disorders
Infectious keratitis
Infectious keratitis is an eye infection of the cornea, with a risk factor being dry eye disease. With inadequate tears in people with dry eyes, people are at risk of infections. Different germs can cause infectious keratitis, such as bacteria, fungi, and viruses.
Infectious keratitis can cause pain and vision loss and is the fifth leading cause of blindness. The psychological impact includes the possibility of losing an eye and the stigma attached. Infectious keratitis may also have an economic burden if people cannot work.
A person should use lubricants to treat dry eyes and prevent the development of infectious keratitis and eye infections overall.
Corneal ulcer
The cornea is the outer layer of the front of the eye. The cornea’s function is to help focus light to see clearly and protect the eye from infections.
With dry eyes, the tears cannot keep the eyes wet, which can cause ulcers. A corneal ulcer is an open wound on the front surface of the eye. Without treatment, a corneal ulcer can cause vision loss and blindness.
Other treatments can include laser treatments for corneal ulcers.
Scarring
Scarring on the cornea is a complication of having uncontrolled severe dry eyes. Stress from dry eyes can form a scar on the cornea, known as corneal fibrosis.
A scar on the cornea affects vision because the passage of light to the retina is affected. The only treatment for vision loss from corneal scarring is corneal transplantation.
Migraine
Previous studies on the association between migraine and dry eye disease have given conflicting results. A 2019 study published in the Journal of the American Medical Association of Ophthalmology explored the strength of the association between these two conditions.
The researchers found that the odds of having dry eye disease in people with migraine is higher than that of people who do not experience migraine. They identified a 20% greater risk of having both dry eye disease and migraine. This association is most pronounced in people 55 to 64 years old.
The relationship between dry eyes and migraine requires further study to identify the exact mechanism explaining the association. Understanding the mechanism can help determine whether migraine is an effect of dry eyes or a possible cause.
Sleep and mood disorders
A 2019 study published in the journal Cornea evaluated sleep and mood disorders in people living with dry eye disease. Researchers suggest that poor sleep quality may have a role in the development of dry eyes.
Poor sleep quality lowers the secretion of tears and destabilizes the tear film. The tear film spreads across the eye every blink, keeping them moist. A destabilized tear film contributes to dry eyes.
However, pain and discomfort from living with dry eyes can affect sleep. People with dry eye disease had lower sleep scores in the study than people without dry eyes. Furthermore, among people with dry eyes, depression and anxiety rates were higher.
Dry eyes can result from poor sleep, and poor sleep, in turn, can cause dry eyes.
How to treat dry eyes
Depending on the cause of dry eyes, doctors recommend different treatments. Over-the-counter and prescription eye drops can help soothe and treat dry eyes. People with loose eyelids may require surgical repair to keep tears in their eyes.
People whose tears drain too quickly may require tear duct plugs, known as punctal plugs. These are special plugs that doctors insert in the tear duct and help keep the eyes moist. They work by keeping tears in the eyes and draining them slowly.
The National Eye Institute recommends lifestyle changes that can help some people living with dry eyes, such as:
- avoiding smoke, wind, and air conditioning
- using a humidifier to avoid dry air in the home
- limiting screen time
- taking frequent breaks from screens
- wearing protective wraparound glasses outside
- drinking 8–10 glasses of water each day
- getting at least 7–8 hours of sleep each night
Medications for dry eyes
Doctors may recommend the following medications for dry eyes:
- artificial tears
- anti-inflammatory eye drops, including prednisolone (Pred Forte), cyclosporin (Restasis), lifitegrast (Xiidra)
- serum eye drops
Prevention
To prevent complications from dry eyes, speak with a doctor to determine the best treatment. With a diagnosis and a cause for dry eyes, doctors can recommend the best treatment to resolve dry eyes.
Strategies to prevent dry eyes include:
- limiting screen time
- blinking often
- using artificial tears
- keeping the home environment cool and moist
Written By: Jessica Caporuscio, Fact checked by: Ann Marie Griff, O.D.
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