Does Dry Eye Disease Cause Eye Inflammation or Is it the Other Way Around?

If you’re one of the millions of people who suffer from dry eye disease, you know this condition is much more than just a nuisance. The burning and stinging in your eyes can drive you to distraction. Worse, your eyes always appear bloodshot, you often need to shield them from the light, and your vision is blurry.

What gives? As with so many other diseases, inflammation is the smoking gun behind dry eye disease. The telltale signs of dry eye inflammation are redness, irritation, swelling, and pain.

What is eye inflammation?

Inflammation is your body's way of protecting you from harm. In response to threats, your body releases a torrent of inflammatory proteins to the injured area in an attempt to repair it. That’s fine — except when it gets out of hand, and causes illness in your body.

Inflammation of the eye can be both the chicken and the egg when it comes to dry eye disease and its symptoms.

Can dry eyes cause eye inflammation?

Dry eye inflammation is any immune response that causes dry eye swelling in or around the eyes. If there’s inflammation in the tear or lacrimal glands that line your lids, cornea (your eye's clear outer layer), or conjunctiva (outermost layers of your eyes), your body may not make enough tears or your tears may not contain the right mix of water, oils, and salts.

The unfortunate result? Dry eyes.

What is dry eye disease?

An ocular surface disorder, dry eye disease happens when your eyes don’t produce enough tears or if they make the wrong kind of tears. The medical name for dry eye disease is keratoconjunctivitis sicca.

The two types of dry eye are:

Aqueous tear deficiency

Aqueous tear deficiency is a dry eye inflammation condition that occurs when your tear glands don't produce enough tears.

Evaporative dry eye

Evaporative dry eye is the most common type of dry eye. It occurs if you have deficient tear film, which increases the rate that your tears evaporate. Your tear is comprised of several layers:

• An oily layer on the outside
• A watery layer in the middle
• A mucus layer on the inside

Symptoms of dry eye disease

According to the National Eye Institute, dry eye symptoms may include:

• A scratchy, gritty feeling in your eye,
• Feeling like there’s something in your eye
• Stinging or burning in your eye
• Red eyes
• Light sensitivity
• Blurry vision

Causes of dry eye inflammation

Fiery inflammation in and around your eyes and dry eye can be due to the presence of  a few diseases, like:

Uveitis

Uveitis is a dry eye mechanism that strikes the middle layer of your eyeball, causing it to become inflamed, red, and swollen.

Juvenile arthritis

Juvenile arthritis is a type of joint pain and inflammation that affects kids. It can lead to dry eye inflammation.

Graves’ disease

With Graves’ disease, your thyroid gland is overactive and produces too much thyroid hormone.

Rheumatoid arthritis

An autoimmune disease, rheumatoid arthritis occurs when your body misfires against its own joints and bones.

Sjogren’s Syndrome

Sjogren’s syndrome happens when your body engages in friendly fire against its tear and salivary glands, causing dry eye inflammation and dry mouth,

Diabetes

High blood sugar, a hallmark of diabetes, can damage nerves throughout your eyes, including the nerves in your tear glands, decreasing blood flow and leading to a reduction in tear production. High blood sugars can also kickstart an “inflammatory cascade” that affects the function of your tear glands.

Blepharitis

Inflammatory diseases of your eyelid such as blepharitis can result in swelling and irritation. When this happens, your cornea can dry out or become inflamed. This can lead to keratitis, an inflammation of the cornea, can develop, according to the National Eye Institute.

Sometimes called a corneal ulcer, keratitis symptoms can include:

• Redness of the eye
• Severe pain
• Inflammation
• Intense tearing
• Pus or other discharge from your eyes
• Blurry vision
• Light sensitivity
• Swollen eyelids

Lupus

Systemic lupus is an autoimmune disease that can impact your entire body. Lupus can cause dry eyes, and dry eye inflammation of the white outer layer of your eyes.

Eye inflammation can also be acute (short-lived). That’s the case when a bacterial stye forms, according to the American Academy of Ophthalmology.

Other common causes of dry eyes

There are other potential causes of dry eye, including medication side effects, living in dry environments, too much time spent staring at screens without blinking, and some types of laser eye surgery.

Medications linked to dry eye disease include:

• High blood pressure drugs
• Antihistamines for allergies and colds
• Sleeping pills
• Anti-anxiety and antidepressant medicines
• Heartburn drugs

Dry eye disease and inflammation: A vicious cycle

Left untreated, severe dry eyes may lead to other issues. Your tears are tasked with spreading protective lubricant across the front surface of the eye (your cornea). When they fall short of this important task, you can develop a scratched or torn cornea (keratitis) and vision loss.

Without proper tears, your eyes can’t get rid of dirt, dust, and/or germs, which can lead to painful scratched corneas and/or infections. Making matters worse, stress from the infection or a scratched cornea triggers more dry eye inflammation, further drying out your eyes.

Dry eye and irritation treatment

Effective treatment for dry eye disease starts with identifying the underlying cause, whether it is inflammation, a medication side effect, or possibly something in your environment that’s drying out your eyes.

Often, treating the underlying disease will help improve symptoms of dry eye as well. For example, getting tighter control over your blood sugar if you have diabetes will decrease your dry eye symptoms too. Drugs that cool the inflammation that underlies conditions such as rheumatoid arthritis, lupus, and other autoimmune diseases may also improve dry eye symptoms.

There are many treatments available for dry eye disease and dry eye inflammation that aim to either add or save tears.

They include:

Artificial tears

Over-the-counter artificial tears work quickly in the moment. The American Optometric Association (AOA) recommends choosing preservative-free artificial tears as they contain fewer additives, which can irritate already-inflamed eyes.

Heat masks

Heat masks can help moisten dry eyes and treat meibomian gland dysfunction (MGD), That’s a common disorder that can cause dry eyes. MGD occurs when the glands in your eyelids don’t produce enough oil, or if the oil doesn’t release into tears. Oil helps prevent the water layer in tears from evaporating. Heated eye masks boost oil production, reducing tear evaporation.

Eyelid cleaners

Eyelid cleaners can help reduce dry eye inflammation around the surface of your eyes. These are mild, non-irritating cleansers that can remove oil and contaminants like mold spores or pollen from your eyelids, before they get into your eyes.

Thermal pulsation

Thermal pulsation systems use heat and pressure to unblock your meibomian glands (the oil glands that line the margins of your eyelids).  Results appear gradually and can last up to nine months.

Dry eye inserts

Punctal plugs can be placed in your tear duct to stop tears from draining. These plugs can last for a few days to months. Some need to be removed while others will dissolve on their own.

Hydroxypropyl cellulose (Lacrisert) inserts can also be inserted between your lower eyelid and your eyeball once a day. These inserts dissolve slowly and release a substance that moistens your eyes.

Surgery

Some  surgical procedures can permanently close your tear ducts so tears can’t drain. A corrective surgery called dacryocystorhinostomy (DCR) may be needed to reverse this.

Prescription eye drops

Prescription dry eye drops such as cyclosporine (Restasis) or lifitegrast (Xiidra) can decrease dry eye inflammation in severe dry eye disease. Antibiotic or steroid eye drops can also reduce the inflammation of dry eye.

Preventing dry eye disease

There’s also a role for prevention when it comes to dry eye disease, including:

• Taking blink breaks. Blinking cleans the surface of your eye with fresh tears. Try to blink often, especially when staring at a computer screen.
• Turning off fans or other direct air that can dry out tears.
• Using a humidifier to add moisture to the air.
• Wearing wraparound sunglasses to shield your eyes from wind.
• Staying hydrated. The American Optometric Association suggests aiming for 8 to 10 glasses of water every day.
• Adding omega-3 fatty acids to your diet.

Inflammation-fighting omega-3s are found naturally in flaxseeds and in oily fish (for example, salmon, tuna, sardines, anchovies, and trout). The American Heart Association recommends eating 2 servings of oily fish per week.

Inflammation from dry eyes - In summary

Inflammation is at the heart of dry eye disease, as both a cause and a symptom. It can be caused by several health conditions like uveitis, rheumatoid arthritis, and diabetes. Treatments like artificial tears, eyelid cleaners, and heat masks can help.

Say goodbye to dry eye inflammation for good: Take this Visionology dry eye quiz now. The results will help you develop a customized treatment plan for your dry eye disease.

Sources:

American Academy of Ophthalmology. Inflammation. https://www.aao.org/eye-health/symptoms/inflammation

National Eye Institute. Dry Eye. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/dry-eye

American Optometric Association. Dry eye. https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/dry-eye?sso=y

American Association for Pediatric Ophthalmology & Strabismus. Meibomian Gland Dysfunction and Treatment. https://aapos.org/glossary/meibomian-gland-dysfunction-and-treatment

Lupus Foundation of America. How lupus affects the eyes. https://www.lupus.org/resources/how-lupus-affects-the-eyes

American Heart Association. Fish and Omega-3 Fatty Acids. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/fish-and-omega-3-fatty-acids