DR. SRINIVAS K. RAO, DR. SUJATHA MOHAN, AND DR. MOHAN RAJAN
How to deal with tired, burning eyes.
Our eyes are constantly in use throughout the day. Apart from optical systems that ensure perfect sight, the eye is also provided with exquisite feedback systems that ensure freedom from infection, a healthy ocular surface, and comfort.
One of these systems is the tear film. Composed largely of a watery component, it is supplemented by an oily secretion from the lids and some mucus from glands in the conjunctiva. The secretion and release of these components occurs in an integrated manner without our conscious effort or involvement. When the functioning of this delicate system is altered, ocular comfort decreases and the resulting condition is best described as an itching, burning eye.
Symptoms
After a long day, most of us have experienced a gritty, tired eye, which appears red. The hot, dry, burning sensation makes us want to rub our eyes vigorously, which makes things worse. In some people, however, this occasional episode tends to be more common and, in others, can be a constant state. Recent increases in this symptom can be related to changes in our lifestyle — altered sleep patterns, constant use of computers, low humidity air conditioned environments, stress, irregular dietary and sleep habits, use of systemic medications, and ambient pollution.
When confronted with such a problem, the doctor must first take a detailed history paying close attention to the various elements detailed above. Unless the specific trigger is detected, it is unlikely that adequate relief can be obtained. The commonest causes are decrease in the quality and quantity of tears produced in the eye, allergies to various environmental sources, chronic low-grade infections or inflammations of the lids, and weakness in the muscles of the eye, often due to overuse or poor work habits.
A decrease in the tear film can be due to causes inherent in the patient — aging, hormonal changes, and alterations in the connective tissues responsible for producing the tears — although more commonly it is due to extraneous, correctable factors. Constantly working in a low humidity environment can increase evaporation from the eyes, while outdoor work exposes the eyes to dust, heat and other irritants. Appropriate modifications in the work environment can help address these issues. Sometimes, dandruff-like changes in the eyelashes can result in a similar problem and these can be controlled by good lid hygiene.
Allergies can also cause such problems. They are often accompanied by the symptoms of itching, redness and watering. They can be commoner in those with other conditions, like hay fever, asthma and skin allergies. Infections in the eye result in a constant discharge from the eyes, often evident on awakening in the morning.
Diagnosis
A thorough evaluation of symptoms and a detailed examination of the lids, lashes, tear film, conjunctiva and cornea, and a review of the refractive status, ocular movement and adequacy of the focusing mechanisms is required to arrive at the proper diagnosis. Depending on the findings and diagnosis, treatment can include the need for artificial tears, anti-allergics, antibiotics, glasses, and exercises to strengthen ocular muscle systems. However, given the delicate nature of the ocular surface homeostasis, it is ideal to use only necessary options, since indiscriminate use of medication can worsen the condition.
Paying attention to the details described gives adequate relief in most patients. It is important to remember that, while medications can be useful, often the underlying basis for the condition may also need to be altered. This could include lifestyle changes — work and sleep habits, dietary patterns, controlling stress, adequate ocular hygiene when using computers, and proper protective eyewear.
The writers are Consultant Ophthalmologists based in Chennai.