Complications and Risks from Untreated Chronic Dry Eye

Chronic dry eye happens when the eyes are not able to produce enough tears. This may be due to inflammation in or around the eyes or due to the tears evaporating too quickly. Chronic means you have had dry eyes for a long time. Chronic dry eye is generally caused by an underlying condition that may involve the eye glands, allergies, or certain skin diseases near the eyes. Just like any other condition, if you leave chronic dry eyes untreated, it may cause certain complications and risks. Here are some of the complications and risks from untreated chronic dry eye.

Overview of Chronic Dry Eye

Chronic dry eye is a long-term condition where the eyes do not produce enough tears, or they may be producing low-quality tears.(1,2,3) This is an uncomfortable condition that can cause symptoms like redness or a gritty sensation in the eyes.(4) The severity of dryness caused by dry eyes varies from person to person. In milder cases of dry eye, you may simply choose to shrug it off, but if it is not going away or seems to be worsening, you should seek immediate treatment to avoid further complications risks.(5)

Tears are necessary for maintaining the natural health of your eyes. They are required for lubricating the eyes and also help in washing away any debris that can cause irritation. If you leave this condition untreated, dry eye can progress to become worse and cause complications that can impact the quality of your life. Here are some of the complications that can happen if you do not seek proper treatment for chronic dry eye.(6,7)

Complications and Risks from Untreated Chronic Dry Eye

Conjunctivitis

One of the most common complications of an untreated dry eye could be the inflammation of the conjunctiva. Conjunctiva is the clear layer of cells that covers the white parts of the eyeball as well as the inner surface of the eyelids. This inflammation occurs is known as conjunctivitis.(8,9)

Symptoms of conjunctivitis include:

It is essential to understand that this type of conjunctivitis is different from bacterial conjunctivitis. This type of conjunctivitis that occurs as a complication of untreated, dry eye is typically milder and does not need treatment most of the time. However, you should consider seeing an eye doctor if the inflammation does not improve or if your condition worsens.(10)

Corneal Ulcer

Another common complication that may occur from untreated dry eye is a corneal ulcer, which is an open sore that develops on the cornea. The cornea is the clear, outer protective layer of the eyes that protects the eyes. Corneal ulcers usually happen after some type of injury, but severely dry eyes that have been left untreated can also lead to corneal ulcers.(11,12)

Debris, like dirt or any other particles, can sometimes enter the eyes, and if your tear glands are not producing an adequate amount of tears, your eyes are not able to wash such particles and debris away. If left in the eye, this debris can scratch the surface of the cornea. This can further worsen if bacteria enter the scratch, causing an infection, which can develop into an ulcer.

Corneal ulcers can be treated with antibiotic eye drops.(13) However, if you leave it untreated, corneal ulcers can spread and even scar the eyeball, causing partial or complete blindness.

Difficulty driving or reading

Leaving dry eye untreated can cause your vision to become blurry. If you wear eyeglasses or contact lenses, you may simply assume that the power has changed and you need a stronger prescription. However, blurry vision is also a symptom of untreated chronic dry eye. If you do not seek treatment for chronic dry eye, this blurriness may start to worsen over a period of time, and you may even develop double vision.(14,15)

If this happens, you may experience trouble driving a car and reading. In many cases, working on the computer or working itself can be impacted, and it may even become impossible to work with blurry or double vision.

Discomfort in wearing contact lenses

If you wear contact lenses, your eyes should produce enough tears to allow the lenses to feel comfortable. If there is a lack of tears, your contact lenses will become overly dry. This can cause further irritation, a gritty sensation, and redness.

When your contact lenses are dry, they will also stick to the eyeball, making it difficult to remove them. Since the contact lenses need moisture, having chronic dry eye can prevent you from wearing contact lenses. You will need to switch over to wearing eyeglasses instead.(16)

Challenging to keep your eyes open

If you have not gotten proper treatment for dry eye and depending on the severity of your dry eye, you may experience difficulty in keeping your eyes open. This is more likely to happen if you feel there is something in the eye or if you have increased sensitivity to light.

Using artificial tears can help add some moisture to keep your eyes open, but you may still not be able to open them fully. You can squint, especially when exposed to computer light or sunlight. Remember that if you are having trouble keeping your eyes open, it also makes it impossible to drive, and you should avoid driving in such cases.

Headaches

While more research is still needed, but there appears to be a link between dry eyes and frequent headaches. Even though this association is not completely understood, some people who are diagnosed with dry eye tend to experience headaches.

A recent study discovered that people who have migraine headaches are much more likely to have dry eyes as compared to people who do not have a migraine.(17)

Dealing with frequent headaches can start affecting every area of your life. It becomes challenging to concentrate, and you begin to lose interest in your favorite activities with your friends and family. It can also have an effect on your productivity at school or work. If you are experiencing chronic headaches and have dry eye, it is best to consult your doctor.

Depression

Research has also found a connection between untreated dry eye and depression or other mood disorders. This is believed to be because dry eye syndrome can impact your quality of life, making it difficult for you to carry out your everyday tasks even. This can slowly take a toll on your emotional well-being also.

A 2015 study analyzed the association between dry eye and depression in over 6,000 female participants. The research team found that women who were diagnosed with dry eye had a greater chance of having high psychological stress, anxiety, and depressive moods.(18)

While this link is not clearly understood, it could be that certain medications that are prescribed for treating depression are having a drying effect on the eyes. The other reason could be that dry eyes are restricting your activity to such a degree that you become anxious, depressed, and withdrawn.

Conclusion

Chronic dry eye is a common problem that many people experience. However, if the condition is left untreated, it can cause severe complications like conjunctivitis, blurry vision, and even corneal ulcers. Many people are able to treat dry eyes by using over-the-counter artificial tears. If these eye drops don’t work for you, you should talk to your ophthalmologist or optometrist to find the right treatment. The correct treatment can help improve the quality and amount of your tears, thus improving the quality of your life and also preventing complications.

References:

  1. Baudouin, C., 2001. The pathology of dry eye. Survey of ophthalmology, 45, pp.S211-S220.
  2. Lemp, M.A. and Foulks, G.N., 2007. The definition and classification of dry eye disease. Ocul Surf, 5(2), pp.75-92.
  3. Smith, J.A., 2007. The epidemiology of dry eye disease. Acta Ophthalmologica Scandinavica, 85.
  4. Moss, S.E., Klein, R. and Klein, B.E., 2000. Prevalence of and risk factors for dry eye syndrome. Archives of ophthalmology, 118(9), pp.1264-1268.
  5. Messmer, E.M., 2015. The pathophysiology, diagnosis, and treatment of dry eye disease. Deutsches Ärzteblatt International, 112(5), p.71.
  6. Calonge, M., 2001. The treatment of dry eye. Survey of ophthalmology, 45, pp.S227-S239.
  7. Gayton, J.L., 2009. Etiology, prevalence, and treatment of dry eye disease. Clinical ophthalmology (Auckland, NZ), 3, p.405.
  8. Hom, M.M., Nguyen, A.L. and Bielory, L., 2012. Allergic conjunctivitis and dry eye syndrome. Annals of Allergy, Asthma & Immunology, 108(3), pp.163-166.
  9. Kyburg, H.E., 1970. Conjunctivitis. In Induction, acceptance and rational belief (pp. 55-82). Springer, Dordrecht.
  10. Azari, A.A. and Barney, N.P., 2013. Conjunctivitis: a systematic review of diagnosis and treatment. Jama, 310(16), pp.1721-1730.
  11. Garg, P. and Rao, G.N., 1999. Corneal ulcer: diagnosis and management. Community eye health, 12(30), p.21.
  12. Wang, A.G., Wu, C.C. and Liu, J.H.J.H., 1998. Bacterial corneal ulcer: a multivariate study. Ophthalmologica, 212(2), pp.126-132.
  13. Gangopadhyay, N., Daniell, M., Weih, L. and Taylor, H.R., 2000. Fluoroquinolone and fortified antibiotics for treating bacterial corneal ulcers. British journal of ophthalmology, 84(4), pp.378-384.
  14. Nichols, K.K., Begley, C.G., Caffery, B. and Jones, L.A., 1999. Symptoms of ocular irritation in patients diagnosed with dry eye. Optometry and vision science: official publication of the American Academy of Optometry, 76(12), pp.838-844.
  15. Miljanović, B., Dana, R., Sullivan, D.A. and Schaumberg, D.A., 2007. Impact of dry eye syndrome on vision-related quality of life. American journal of ophthalmology, 143(3), pp.409-415.
  16. Mackie, I.A., 1985. Contact lenses in dry eyes. Transactions of the Ophthalmological Societies of the United Kingdom, 104, pp.477-483.
  17. Ismail, O.M., Poole, Z.B., Bierly, S.L., Van Buren, E.D., Lin, F.C., Meyer, J.J. and Davis, R.M., 2019. Association between dry eye disease and migraine headaches in a large population-based study. JAMA ophthalmology, 137(5), pp.532-536.
  18. Na, K.S., Han, K., Park, Y.G., Na, C. and Joo, C.K., 2015. Depression, stress, quality of life, and dry eye disease in Korean women: a population-based study. Cornea, 34(7), pp.733-738.

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