Dry Eyes in Older People - Causes, Symptoms, and Treatment.

Introduction:

Dry eye disease is a condition that is caused by inadequate production of tears or the production of low-quality tears. It is a very unpleasant condition, and a person with dry eyes may experience a burning or stinging sensation in their eyes.

Tears have many functions, including:

1. Keep the eyes moist and nourished.

2. Wash away dust particles.

3. Helps in keeping the eyes clean.

4. Prevent or decrease the risk of eye infections.

If a tear is healthy, it will contain oil, mucus, and water. However, any problem with these elements can affect the production of tears leading to dry eyes. Instability in tear production can lead to inflammation and damage to the eye's surface.

What Are the Causes of Dry Eyes in Older People?

Being above 50 is an important risk factor for developing dry eyes. As a person ages, the amount of tears produced by the lacrimal gland decreases. The following are the causes of dry eyes in older people:

1. Medications: As people above the age of 50 years develop more diseases, the number of medications they take also increases. Medications such as antidepressants, nasal decongestants, and medications for diseases like diabetes (a disease that results in too much sugar in the blood), arthritis (inflammation of joints resulting in joint stiffness), and Parkinson’s disease (a disorder of central nervous system that results in tremors) can cause dry eyes as their side-effect.

2. Menopause: The average age of women attaining menopause is 51 years. Many women during menopause or after this period may develop dry eyes.

3. Exposure Keratitis: It is a medical condition that affects the cornea of the eye due to the long exposure of the ocular surface to the outside environment. It commonly occurs in people who sleep with partially opened eyes or with any condition like facial nerve palsy (weakness in one side of the face).

4. Thyroid Disorders: Both hyperthyroidism and hypothyroidism (increase or decrease in thyroid hormone levels) can affect the moisture of the eyes. In addition, the production of tears and oils in the eyes also decreases, leading to dryness of the eyes.

5. Sjogren’s Syndrome: It is an immune system disorder characterized by dry eyes and dry mouth. It usually occurs with other immune system disorders like rheumatoid arthritis and lupus (autoimmune conditions).

6. Meibomian Gland Degeneration: The lipids and essential oils in the eyes that reduce the rate of evaporation of tears are secreted by the meibomian glands present in the eyelids. During aging, these glands get blocked and degenerate, leading to meibomian gland dysfunction.

What Are the Clinical Manifestations of Dry Eyes in Older People?

The clinical manifestations of dry eyes include:

1. Red eyes.

2. Persistent itching.

3. Burning sensation.

4. Watery eyes or excessive tearing.

5. Feeling stinging in eyes.

6. Blurred vision.

7. Sensitivity to light.

8. Sore eyes.

9. Inflammation in the eyelids.

10. Sandy eyes or feeling of having sand in the eyes.

11. Discomfort while reading or using the computer.

12. Foreign body sensation in the eyes.

How Are Dry Eyes Diagnosed?

The following tests are conducted by ophthalmologists or eye doctors to determine the cause of dry eyes.

1. Overall Eye Examination: The eye doctor will take a detailed medical history to check for any medical conditions or medications that cause dry eyes. This, along with a proper eye examination, may help the doctor to come to a diagnosis.

2. Test to Measure the Volume of Tears: Schirmer’s test is used to measure the volume of tears. Before the test, the eye doctor will apply numbing eye drops to prevent the production of tears due to irritation during the test. A strip of non-toxic filter paper will be placed inside the lower eyelid of each eye. The doctor will advise the patient to close their eyes gently for 5 minutes. After 5 minutes, strips are removed, and the number of tears is measured in millimeters. The normal amount of tearing is 10 millimeters. The amount of tearing above 15 millimeters is considered an overproduction of tears.

3. Test to Determine the Quality of Tears: The quality of tear film is assessed by tear film breakup time (TFBUT). It is used for the evaluation of evaporative dry eye disease. In this test, fluorescein dye is instilled into the tear film of the patient. The patient is asked to look at the cobalt blue light, and the doctor will view the dye under this light.

4. Tear Osmolarity Test: The presence of water and the composition of particles in tears is measured by the tear osmolarity test.

What Is the Treatment for Dry Eyes in Older People?

Based on the severity of dry eyes disease, the treatment varies and includes:

1. Medications: To reduce the inflammation of eyelids, anti-inflammatory drugs are prescribed. It can increase the production of tears as well as prevent damage to the cornea. They are also prescribed in the form of eye drops. Tear-stimulating drugs, which are cholinergic, are also prescribed. They are also available in the form of eye drops or gels.

2. Artificial Tears: Artificial tears eye drops can improve eye moisture. It is one of the most common treatments for dry eyes. However, it works only in mild to moderate cases. In moderate to severe cases of dry eyes, eye inserts that work similarly to artificial tears are advised.

3. Lacrimal Plug: They are used to block the drainage holes in the eye corners. It reduces the loss of tears and is a painless and reversible medical procedure.

4. Light Therapy and Eyelid Massage: It is indicated in severe cases where eye drops, and medication won't help. The light therapy employed is intense pulsed light therapy (IPL) which uses visible light. It can reduce inflammation in the eyes. Light therapy followed by eyelid massage is a good treatment of choice for people with severe dry eyes.

5. Surgery: Surgery is advised in severe cases of dry eyes. In the procedure, the drainage holes in the corners of the eyes are permanently plugged to maintain a sufficient amount of tears.

Conclusion:

Dry eyes are a common condition. In older people, it can occur due to numerous factors, such as various medical conditions, including immune system disorders, certain medications, menopause in women, thyroid disorders, and so on. Eye doctors use different tests to diagnose the exact cause of dry eyes. Nowadays, there are many treatment options available for dry eyes in older people. With proper medical care and support, dry eyes can be successfully treated in older people.