Scratchy, stinging dry eyes are common as the seasons change, and it's not always because of allergies. Dry eyes occur when there is insufficient amount or poor quality of tears in the eyes – a condition called keratoconjunctivitis sicca. Tears wash away particles and bacteria, and allow the eye to move smoothly. Without good quality tears and plenty of them, the eye is at risk of corneal scratches, infections, ulcers and vision problems – serious complications of chronically dry eyes known as “dry eyes syndrome”.

Symptoms of Dry Eyes:

• Unpleasant sensations in the eyes – e.g. stinging, burning or scratching
• Feeling of having something in the eye, or a gritty, pulling sensations
• Sharp stabbing pain
• Eye redness
• Stringy mucus in or around the eyes
• Sensitivity to light
• Blurred vision
• Eye fatigue
• Difficulty driving at night
• Difficulty wearing contact lenses
• Frequent blinking
• Watery eyes – while this may seem like the opposite of having “dry” eyes, but this watery substance doesn't contain the same lipids and proteins as tears, and is not as lubricating.

Symptoms usually improve in humid environments such as the shower, or in environments that are cool, rainy or foggy.

Causes of Dry Eyes

Tears are a mixture of water, fatty oils, mucus and proteins designed to keep the surface of the eyes smooth, clear and protected against infection. The oil helps to create a film over the water and proteins to prevent their evaporation. When the oil layer formed by the tears is too thin or patchy, the water in the mixture is quickly evaporated, leading to dryness and lack of lubrication.

In some cases, the quality of the tears is fine but the tear ducts do not produce adequate amounts of tears, or the tears cannot be released effectively.

Causes of Dry Eyes include:

• Dehydration
• Poor oil quality in the tears due to issues with tear glands, skin oils, or insufficient dietary fatty acid intake
• Environmental irritants – dry, windy, dusty or smoky air (including exposure to cigarette smoke)
• Prolonged focus on reading, computer work, driving or watching television
• Ageing
• Drugs including antihypertensives, diuretics, sedatives, oral contraceptives and anticholinergics
• Inability to completely close the eyes at night
• Slow blinking due to other conditions (e.g. Parkinson disease) [1]

Risk Factors for Dry Eye Syndrome:

• Trauma to the eye
• Laser eye surgery
• Poor care of contact lenses
• Autoimmune diseases such as Sjögren's syndrome , rheumatoid arthritis, autoimmune thyroid conditions, or systemic lupus erythematosus
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• Bell's palsy or stroke that results in difficulty closing the eyes
• Acne rosacea
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• Blepharitis [1]
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Natural Therapies for Dry Eyes

1. Hydration & Humidity

Dry eyes need moisture! Staying hydrated is the first step towards relief – increase your intake of water, herbal teas and foods that are hydrating like cucumbers, soups and stews. Stay away from cigarettes, coffee and alcohol as these vices can dehydrate the body and reduce the quality of tears.

• A 2012 study concluded that whole-body hydration has a direct impact on the severity and symptoms of dry eye syndrome [8].

If you are exposed to a dry climate, try running a humidifier to add moisture to the air or regularly use a facial steamer. Many humidifiers also act as essential oil diffusers, so take advantage of this feature and try some aromatherapy for dry eyes – menthol-containing essential oils such as peppermint and spearmint can boost tear production (more on this below!).

2. Warm Compress

Holding a warm, damp cloth against the eyes for 10 minutes has been shown to reduce symptoms of dry eyes, increase the flow of tears, and improve their quality. It almost seems too simple but it is one of the most effective treatments for dry eyes.

CAUTION: Eye compresses can temporarily blur the vision, so they are best done before bed.

• A 2003 study showed that applying warm, moist compresses to the closed eyelids increased the thickness of the lipid layer of tears by more than 80% after 5 minutes, and an extra 20% after an additional 10 minutes [3].
• A study in 2017 found that adding menthol to a warm, moist compress further improved the volume of tear fluid and the stability of the tears in people with dry eyes. Menthol creates a feeling of coldness, which stimulates the nerves in the cornea to signal for increased tear production! Try peppermint and spearmint essential oils, or try a pure menthol extract. [4] 

NB: Always patch test for reactions to essential oils before using on the face or eyes. Add 1 – 2 drops of essential oil to a warm, moist face-washer or flannel. Place the cloth onto closed eyes for 10 – 15 minutes. CAUTION: If you experience burning or unpleasant sensations, remove compress immediately and rinse eyes with plenty of water.

3. Healthy Fats

Doctors recommend increasing dietary intake of omega-3 and omega-6 fatty acids for the treatment of keratoconjunctivitis sicca and dry eyes [1]. These healthy fats help to create the oily lipids in the tears which form a protective film over the eye and lock in moisture. Omega-3 fatty acids are also anti-inflammatory and promote the smooth flow of fats through the lymphatic system and tear secreting glands.

• In a 2013 randomised controlled trial, participants who took 325mg of EPA and 175mg of DHA omega-3 fatty acids per day showed significant improvement in symptoms, quality of tears, and health of the eyes [2].

To increase your dietary intake of healthy fats, eat more nuts, seeds, avocados and olive oil. Try an algae omega-3 supplement for concentrated doses of anti-inflammatory essential fatty acids.
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4. Eyebright

Herba Euphrasiae goes by the common name “eyebright” – there's a hint in there for what it's good for! Herbalists use eyebright to treat a wide range of eye conditions including keratoconjunctivitis sicca and symptoms of dry eyes. Ethanol extracts of eyebright have been shown in vitro to reduce inflammation in corneal cells which may help to relieve burning, itchy and redness of the eye [5]. Eyebright supplements and extracts can found as liquids, tablets and capsules, or the fresh flowers can be brewed into a tea. Speak to a naturopath for personal advice.

5. Bilberry

Bilberry is another herb that is often used to improve eye health. It has antioxidant properties that protect the small capillary blood vessels in the eyes and relieve symptoms of eye strain, fatigue, vision loss and redness [7]. Its anti-inflammatory actions may also help to relieve stinging, burning and stabbing pain associated with dry eyes. Even better, it may improve the quality and flow of tears:

• A 2017 study showed that taking 80mg standardised bilberry extract in a trademarked formula,  improved the volume of tear secretion in people with dry eye syndrome [6].

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References

[1] Roat, M. I. (2016) Keratoconjunctivitis Sicca. Merck Manual Online Database Professional. https://www.msdmanuals.com/en-au/professional/eye-disorders/corneal-disorders/keratoconjunctivitis-sicca

[2] Bhargava, R., et al. (2013) A randomized controlled trial of omega-3 fatty acids in dry eye syndrome. Int J Ophthalmol., 6:6, 811–816. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874521/

[3] Olson, M. C., et al. (2003) Increase in tear film lipid layer thickness following treatment with warm compresses in patients with meibomian gland dysfunction. Eye Contact Lens., 29:2, 96 – 99. https://www.ncbi.nlm.nih.gov/pubmed/12695712

[4] Arita, R., et al. (2017) Effects of a warm compress containing menthol on the tear film in healthy subjects and dry eye patients. Sci Rep., 7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5381094/

[5] Paduch, R., et al. (2014) Assessment of Eyebright (Euphrasia Officinalis L.) Extract Activity in Relation to Human Corneal Cells Using In Vitro Tests. Balkan Med., 31:1, 29 – 36. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4115993/

[6] Riva, A., et al. (2017) The effect of a natural, standardized bilberry extract (Mirtoselect®) in dry eye: a randomized, double blinded, placebo-controlled trial. European Review for Medical and Pharmacological Sciences, 21, 2518 – 2525. http://www.europeanreview.org/wp/wp-content/uploads/2518-2525-Bilberry-extract-in-dry-eye.pdf

[7] Ozawa, Y., et al. (2015) Bilberry extract supplementation for preventing eye fatigue in video display terminal workers. J Nutr Health Aging., 19:5, 548 – 554. https://www.ncbi.nlm.nih.gov/pubmed/25923485

[8] Walsh, M. P., et al. (2012) Is whole-body hydration an important consideration in dry eye? Invert Ophthalmol Vis Sci., 53:10, 6622 – 6627. https://www.ncbi.nlm.nih.gov/pubmed/22952120