Are You Having a Dry Eye Flare Up?

What is a Dry Eye Flare?

A dry eye flare is an episode of worsening dry eye symptoms that occurs in response to an external trigger in patients who have dry eye disease. Dry eye is a multifactorial condition, which typically requires a multi-step approach to manage. This condition can be related to the poor quality of the tear film, inadequate tear production, eyelid or ocular surface inflammation, or even corneal nerve abnormalities

Doctors estimate that about 80% of patients with dry eye disease experience flares up to several times a year. Due to dry eye disease typically being a chronic condition, even though the symptoms may be improved, a flare can cause a return or worsening of symptoms. These symptoms can include red eyes, burning, tearing, grittiness, blurred or fluctuating vision or a desire to close your eyes. 

What Causes a Dry Eye Flare?

A flare can happen suddenly and it’s your body’s inflammatory response to a trigger. Some of these triggers include windy conditions, extended screen time, contact lens wear, seasonal allergies, lack of sleep, drier climate or low humidity, which can include an airplane ride as well. 

Also certain makeup products and inadequate removal of makeup can irritate the eyes and cause them to flare up. On the other hand, failing to take prescribed medications for your dry eye disease or the lack of being compliant with your at-home treatment can also cause a flare.

As mentioned earlier, changes in the environment plays a big role in worsening dry eye symptoms. For example, you may notice worsening dry eye symptoms with allergy flare-ups. This could be due to an increase in antihistamine use and eyes becoming more bothersome from allergens. 

Even though antihistamines will help manage your allergy symptoms, they can worsen dry eye symptoms. Just like the antihistamine works to dry a runny nose, it can also affect the moisture of the eyes and reduce tear production. Due to this side effect, it’s beneficial to mention to your doctor if you experience allergy flares and it may help to add a topical antihistamine instead of oral antihistamines if your allergy symptoms are only localized to the eyes. 

Worsening Dry Eye After Surgery

Cataract or refractive surgery, such as LASIK, can also commonly cause worsening dry eye symptoms. As mentioned earlier, dry eye could be related to nerve abnormalities. 

When a surgery is done on the ocular surface, there is damage to the corneal nerve endings. This damage can temporarily cause a decrease in tear production and corneal sensation. A flare-up after ocular surgery can last for a few weeks to months. As the eye heals overtime and by initiating some dry eye therapy, we expect these symptoms to resolve.

Due to surgery typically worsening dry eye symptoms temporarily, it is important to pre-treat the dry eye before any surgery to minimize the symptoms and give better visual outcome from the surgery.

How to Manage a Dry Eye Flare?

There are a few over the counter treatment options that can help relieve your symptoms. It’s helpful to pinpoint what may be contributing to your dry eye flare, such as environmental changes or seasonal allergies. Cool compresses or refrigerated preservative-free lubricating eye drops may help relieve your eyes from allergy flare ups.

Also limiting screen time and giving your eyes frequent blinking breaks can be beneficial. If screen time is hard to reduce due to your work schedule, try to practice the 20-20-20 rule. This involves taking a break every 20 minutes, looking at something 20 feet away for 20 seconds. This will create a good habit of taking a break from your digital devices as well.

Additionally, staying hydrated and keeping a cool mist humidifier by your workspace or bedside at nighttime can help relieve the symptoms by creating more moisture. A humidifier is especially helpful if you’ve been told you sleep with your eyes open as this can be causing exposure to the dry air or air conditioning while sleeping.

If your dry eye symptoms have worsened and it’s difficult to control them with your current therapy or over the counter options, it is best to visit your optometrist or ophthalmologist. They can determine if a short-term steroid course can be beneficial to you or an adjustment may be needed in your treatment protocol.

Think of a steroid eye drop like a rescue life jacket or an inhaler when you experience an asthma attack. If your symptoms suddenly flare up, the steroid eye drop can help calm the inflammation and get you feeling better quicker. It is also important to be extra diligent and compliant with your home treatments during a flare. 

Dry eye flares are temporary and can last a few days to a few weeks. We understand that experiencing a dry eye flare can be discouraging, but it’s important to remember that it is normal and initiating treatment immediately can help resolve the symptoms quickly.

The key is to be gentle with your eyes and provide extra lubrication and protection during a dry eye flare-up. With proper dry eye management, we aim to reduce the frequency of flares and provide you with the proper tools to manage a flare when it occurs!

-Norin Ali, OD