The Key Message
Dry eye is not only a disease but also a physiological-psychological problem. There are many potential factors that can cause it, such as bright light, high temperature stimulation, excessive time spent reading books, watching TV or computer screens, the use of atropine, anti-hypertensive and cardiac arrhythmia drugs, and inflammatory reactions on the ocular surface. Pay attention to eye care in daily life and use artificial tears under the guidance of ophthalmologist, most patients’ symptoms can be relieved. Liang Qingfeng, Department of Cornea, Tongren Hospital, Beijing, China Zhou Zhiyun, Department of Ophthalmology, Xinjiang Corps Hospital
The Basic Knowledge
1, Definition: As an evolution from aquatic life to terrestrial life, humans have developed an ocular surface tear film with complex structural and biochemical properties to adapt to changes in the surrounding environment. The normal human eye surface is covered with a layer of tear film of 6 to 10 millimeters, which moistens the eye surface and ensures the comfort of the eye. Then the instability of the tear film caused by various reasons is called dry eye.
2, etiology: Tears are mainly produced by the tear glands in the outer upper corner of both eyes, which are coated on the surface of the eye by blinking movement to keep the eye moist and smooth. When the tear glands are dysfunctional, it can cause insufficient secretion of aqueous humor and produce dry eyes; in addition, if the aqueous humor production is sufficient, but the evaporation loss from the eye surface is too fast also causes dry eyes. Clinically, it is common in middle-aged women, especially menopausal women, who have decreased lacrimal gland secretion and tear secretion, resulting in dry eye discomfort, which is often accompanied by dry mouth and arthritis. Patients who have suffered from conjunctivitis, especially “pink eye”, may suffer from dry eyes due to the destruction of the cupular cells on the surface of the eye, although the inflammation is cured. Long-term use of some drugs such as anti-hypertension, cardiac arrhythmia, depression drugs can also cause dry eyes.
3. Performance: If you have bloodshot eyes, dryness, photophobia, tearing, foreign body sensation, burning sensation, eye fatigue and inability to gaze at something for a longer period of time, you should consider whether you are suffering from dry eye disease. If the symptoms are relieved by rest, gazing into the distance or increasing sleep, it may be reversible. If the symptoms persist for more than three months without relief or progressive aggravation, it is necessary to seek further examination and treatment.
4. Diagnosis: We designed a set of questions, including: Have you ever had a dry feeling in your eyes? Have you ever had a foreign body sensation in your eyes? Have you ever had a burning sensation in your eyes? Have you ever had redness or astringency in your eyes? Have you ever had hard flakes on your eyelashes? Do you have trouble opening your eyes in the morning? Do you need to close your eyes after looking at a computer screen or watching TV for a short while? If you have frequent or persistent dry eye, you may have dry eye and need to go to the hospital for some simple tests to confirm the diagnosis, such as eye surface examination, tear production test and tear evaporation test.
5.Treatment: Since the causes of dry eye vary, individualized treatment is needed for different patients.
① When you find that your dry eye symptoms are severe or persistently cannot be alleviated, you should receive diagnosis and treatment from your ophthalmologist. If you are diagnosed with dry eye, you should receive medication and other treatments in strict accordance with your doctor’s prescription. If your eye strain is caused by the discomfort of glasses or contact lenses, you can reconfigure suitable glasses according to the prescription of your ophthalmologist and pay attention to eye care in your daily life.
② Paying attention to eye care in daily life is very important to treat mild dry eyes. For example, pay attention to mental relaxation and take appropriate rest when you feel eye fatigue; try not to look upward, place the TV or computer at a position below eye level, and do not watch TV or use the computer for too long; keep the room at a certain humidity level.
③The most direct method of dry eye treatment is to moisten the eyes, that is, drops of artificial tears. Natural tears are complex in composition, while artificial tears cannot be completely replaced; natural tears are continuously secreted, while artificial tears are used intermittently. To overcome these problems, some drugs add substances containing adhesive components to prolong the contact time of artificial tears with the eye surface.
④ Blocking the tear dots is one of the most useful and practical treatments for preserving tears. This technique will reduce the amount of tear outflow and allow the eye surface to be moistened for a long time.
6. Prevention.
①The best way to effectively prevent dry eye disease is to develop the habit of blinking more often. Professionals believe that dry eye disease is a stress-related condition, and the problem lies in the eyes staring in one direction for a long time. It is recommended that you blink more often to ensure that the “tear film” can disperse water to the cornea to prevent dry eyes. The best way to relieve eye strain is to take proper rest and not to operate continuously. If you are an eyeglass wearer, it is important to have the right pair of glasses; for people over 40, it is best to use bifocal lenses or wear glasses with a lower prescription when typing. The working posture and distance is also important, try to keep on 60cm to distance, adjust a most appropriate posture, so that the line of sight can be kept down about 30o, such an angle can make the neck muscles relax, and make the eye surface exposed to the air to minimize the area.
②Those who are engaged in long-term computer operation should eat more fresh vegetables and fruits and increase the intake of vitamins A, C and E at the same time.
③In order to avoid reflections or unclear fluorescent screen, the computer should not be placed on the opposite or back side of the window, the ambient lighting should be soft, and if there is a window behind the operator should draw the curtain to avoid the bright light directly to the screen to reflect the bright image caused by eye fatigue. Usually, the average person blinks less than 5 times per minute to dry out the eyes. A person working in front of a computer blinks only one-third as often as usual, thus reducing the secretion of intraocular lubricants and enzymes. You should blink more often and give your eyes a break at least once every hour.
Common Misconceptions
1. Many patients and clinicians misdiagnose dry eye as conjunctivitis and use antibacterial drugs for a long time, but the antiseptics and antimicrobials in antibacterial drugs have a destructive effect on the cells of the eye surface, which aggravates the patient’s condition and does not relieve the symptoms of dry eye.
2. Patients with conjunctivitis and blepharitis should actively treat the primary disease and use artificial tears on this basis.
3. Patients who feel that their symptoms are severe or persistently cannot be relieved should seek timely medical attention from an ophthalmologist and be psychologically prepared for long-term use of medication.