Knowing that dealing with dry eye is everywhere, Dr. Margarita Cabanás, an ophthalmologist at Clínica Baviera, recommends certain guidelines beyond environmental prevention. “Habits such as blinking more often, resting your eyes periodically, or regularly cleaning the eyelashes with warm compresses are effective in eliminating or alleviating the tear deficit in the eyes,” she warns.
In addition, after medical supervision, there are specific solutions, such as “applying lubricating ointments before going to sleep,” as it explains that “some specialists maintain that the origin of the dry eye symptoms lies in the fact of sleeping with the eyes slightly open.”
Along with these guidelines, it also indicates certain recommendations based on our lifestyle, such as the use of contact lenses, for which it advises “to select materials with better tolerability and oxygen permeability, reduce their use and opt for the glasses, as far as possible. ”
In a similar sense, it endorses the ventilation of rooms or reducing the environmental dryness with humidifiers, while citing food as another way of ‘taking care of dry eyes, such as “betting on a diet rich in Omega 3 and eating liquids suitable for keeping us hydrated, especially in summer. ”
And if, as is almost inevitable, we spend our lives between screens, she emphasizes “striving to frequently blink periodically and make use of artificial tears as well.”
All this to combat a truly invisible, silent enemy that becomes the first cause of visiting the ophthalmologist and to which we can stand up – dry eye, we mean – more than we think.
With age, all body tissues degenerate, including the exocrine glands. Around the age of 30, tear secretion decreases but continues to exceed basal needs greatly. Around 45 years of age, the critical level between production and needs is reached. Around the age of 60, everyone occasionally experiences moments of dry eyes in certain circumstances (when wearing contact lenses; when entering under the action of air conditioning; at night, when the circadian rhythm reduces tear production to a minimum, etc.).
With age, everyone has pan-endocrinopathy sicca, which affects the eyes, mouth, throat, etc. Age dry eye is usually mild to medium (grades 1 or 2).
Certain endocrine glands are closely related to exocrine receptors and secretion, and the main hormones involved are androgens, estrogens, and prolactin. Castration, antiandrogen treatment, aging, hypogonadism, oophorectomy, climacteric, postmenopause, estrogenic contraceptives, and lactation are situations in which aqueous, serious, and lipidic tear secretion decreases. These are usually mild dry eyes.
After menopause (48-52 years), all women tend to have dry eyes. Hormonal dry eye is usually associated with multiexocrine dryness and is mild or medium (grades 1 or 2).
Some medications have secondary exocrine hyposecretory effects: anxiolytics, antidepressants, sleeping pills and hypnotics, antiparkinsons, antihistamines, anticholinergics, arterial antihypertensives, diuretics, etc.
Topical anesthetics (tetracaine, proparacaine, cocaine, lidocaine) or eye drop preservatives (benzalkonium chloride, EDTA, thiomersal, chlorobutanol) cause epitheliopathies that are manifested by conjunctive-corneal dryness.
The systemic drugs described tending to cause multiexocrine dryness. Sleeping pills are usually taken at night, precisely when the circadian rhythm further lowers tear secretion. Pharmacological dry eye is usually medium or moderate (grades 1 or 2).
There is a group of autoimmune diseases that selectively attack the exocrine glands. They are currently called Sjögren’s syndromes: Sjögren’s syndromes type I attack the exocrine glands and frequently cause vasculitis due to immune complex deposits, and more rarely, lymphoma or pseudolymphoma. Sjögren’s type II syndromes are associated with autoimmune connective tissue diseases such as rheumatoid arthritis, lupus erythematosus systemic, scleroderma, dermatomyositis, etc.
Another type of laminopathies preferentially attacks the tissues that contain the exocrine glands, affecting them (ocular scar pemphigoid, Stevens-Johnson syndrome, Lyell syndrome). Graft versus host disease is another variant of immunometric dry eye.
Immunopathol syndromes are frequently multiexocrine and can reach medium or severe degrees of severity (grades 2 or 3). Retractile mucositis (pemphigoid, Stevens-Johnson, Reiter’s syndromes, etc.) can be very serious (grade 3 plus).
Xerophthalmia due to hypovitaminosis A was the most common cause of severe dry eye for millennia and continues to be so in underdeveloped countries today. Avitaminosis A causes generalized exocrine dryness, with very characteristic ocular manifestations, such as Bitot’s spots on exposed conjunctival trigons, corneal keratomalacia or melting, and night blindness.
In developed countries, they are rare and are usually caused by intestinal malabsorption (alcoholism, Crohn’s disease, intestinal resections, etc.) or by following diets lacking in fat.
Vitamin A causes multiexocrine dryness, and if left to progress, it can lead to severe or very severe dry eyes (grades 3 or 3 plus).
They are due to embryo-fetal malformations, which may have a genetic or occasional origin. In the first case, they can be hereditary, and in the second not. Like those of the other groups of this second half of the Ethio-pathogenic Decalogue, they can affect several exocrine systems, or only the lacrimal of one or both eyes, or even only one of the 3 glandular subsystems of the eye (aqueous, mucinous, or lipidic). Examples of the dry eye affecting a single glandular subsystem are those that affect the watery dacryoglands (alacrimia, some anhidrotic ectodermal dysplasias), lipids (epicanthus-blepharophimosis syndrome, first branchial arch syndromes, anhidrotic ectodermal dysplasia, keratopathy-ichthyoid disease syndrome, deafness), and mucous membranes (aniridia, Bietti syndrome).
In the evolution of medical language, the terms congenital and genetic (from the Greek genes, birth) were initially applied to what appeared or manifested with or from birth. But little by little, “genetic” has been applied more and more to what is related to genes (that is, hereditary), which has displaced the semantic content of the term “congenital” to what appeared from birth, but not necessarily related with genes (and therefore includes non-hereditary embryo-fetal malformations of a toxic, inflammatory, mechanical type, etc.).
Inflammatory or adenitis
Inflammations, generally infectious, of the tear glands (fungal, tuberculous), of the substrate of the goblet cells of the conjunctiva (cicatricial conjunctivitis due to trachoma, adenoviruses, etc.), or the meibomian glands (blepharitis that can be improved or not with Thermo massage).
Mechanical or physical destruction of the glands can produce watery (tumor ablation, irradiation), lipid (eyelid destruction, eyelid reconstruction, Webster’s operation), and murine (chemical causticization, thermal destruction, surgical conjunctive to my) eye dryness.
The severity of traumatic dry eyes is highly variable depending on the extent of the trauma. Sometimes it acquires serious degrees.