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At ���ϸ����� Langone, our skilled ophthalmologists use modern technology to diagnose and identify the cause of dry eye disease, and determine the best treatment for you.

Dry eye disease occurs when the tear film, which is a natural layer of water, oil, and mucus that coats the surface of the eyes, does not adequately lubricate them. This can cause damage to the cornea and other parts of the eye’s surface, preventing them from functioning correctly. Inflammation and neurosensory abnormalities may also play a role.

The cornea, which is the transparent, dome-like structure on the front of the eye, is lined with a protective layer of cells called the corneal epithelium. With the help of the tear film, the epithelium prevents any foreign particles from entering the eye.

The tear film has several important functions: to keep the eye moist, to keep the cornea clear for light to pass through, and to wash dust and debris away from the eye. Tears also help protect the eye from bacteria and other pathogens.

If there isn’t enough oil, water, or mucus in the tear film, the eye is not lubricated properly, potentially damaging the epithelial cells on the surface of the cornea. If left untreated, this can lead to discomfort and, over time, the breakdown and loss of the protective layer of epithelial cells. The damage is usually reversible, but sustained loss of the epithelial cells can cause discomfort, vision loss, increased risk of infection, and possibly the permanent scarring of the cornea.

Symptoms of Dry Eye Disease

Most people feel like their eyes are dry from time to time. Long periods of looking at a computer monitor or TV screen or being inside a heated room can lead to dry eyes. But if you begin to experience dry eyes frequently and they do not resolve with rest or conservative measures, dry eye disease may be the cause of your symptoms.

If you have dry eye disease, you may feel constant or intermittent dryness in your eyes. You may also notice frequent stinging, burning, itching, irritation or light sensitivity of the eyes. They may seem to tire easily, and it may become increasingly uncomfortable to wear contact lenses. Chronic redness of the eye is also a common symptom, as is occasional blurred vision.

Another common symptom of dry eye disease is frequent bouts of excessive tearing, which is the body’s response to the lack of moisture in the eye. These so-called reflex tears do little to lubricate the eye and can affect the clarity of eyesight.

Causes of Dry Eye Disease

One of the most common causes of dry eye disease is blepharitis, an inflammation of the oil glands along the rim of the eyelid. The inflammation prevents proper oil secretion to the eye, which leads to more rapid evaporation of the tear film. The oil glands, called meibomian glands, may become blocked by eye makeup and other cosmetics, by natural oils if your skin tends to be oily, or by flaky skin from conditions such as dandruff and seborrheic dermatitis.

Another form of blepharitis, demodex blepharitis, is caused by an infestation of skin mites along the lid margin and lashes. Exposure to dusty environments, or to areas with debris or chemical irritants, can also put you at risk for dry eye disease.

Other conditions associated with dry eye disease include diabetes, thyroid disorders, and autoimmune disorders such as Sjögren’s Disease and systemic lupus erythematosus. Bone marrow transplants can cause inflammation of the lacrimal gland, which produces the watery component of tears, or meibomian glands, which produce the oily layer of tear film.

When taken for long periods, certain medications—such as antihistamines, antihypertensive medications, prescription pain medications, and some acne medications and chemotherapeutic medications can cause eyes to become dry. Dryness may also occur because of vitamin A deficiencies or hormonal changes.

Dry eye disease is worsened by activities involving screens or overusing contact lenses, as these reduce blinking and lead to the tear film evaporating faster than normal.

Diagnostic Tests

If your eyes often feel dry or irritated, an ophthalmologist can perform several tests during a routine eye exam to determine the cause. These tests are meant to determine whether you have dry eye disease and, if so, whether it has damaged the epithelial layer protecting the cornea, which may cause further eye irritation.

Epithelial Staining Test

An epithelial staining test is the most accurate way to diagnose dry eye disease. Your ophthalmologist administers a drop into each eye that stains any abnormal, or devitalized, epithelial cells in the cornea and conjunctiva, which is a protective membrane that lines the eyelids and covers parts of the sclera, or white of the eye. Using a microscope, the doctor can then closely examine the epithelial cells for signs of damage.

Schirmer’s Test

During a Schirmer’s test, an ophthalmologist numbs both eyes with drops and places a special strip of filter paper on the inside of both lower lids. After five minutes, the doctor gauges how much moisture each eye produced based on indicators on the paper. If your eyes produce less than a certain amount of moisture, this indicates you may have dry eye disease.

Point-of-Care Office Test

A point-of-care office test can quickly assess your tear film during your visit, measuring its concentration and checking for inflammation markers. This allows for faster diagnosis and treatment.

Advanced Imaging Systems

Advanced imaging systems are available to evaluate abnormalities in the eyelids, tear film, ocular surface, and corneal nerves. These tests are beneficial for patients experiencing persistent symptoms after initial treatment, and the results can help accurately diagnose underlying causes of dry eye disease.