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The whole story behind: Watery crying sore red eyes?

Watery crying sore red eyes?



“Why do my eyes look so red rimmed and I appear to cry?

The reality is that my eyes feel scratchy and irritated, I am always aware of them all the time, I wake up at night with pain, my vision blurs towards the end of the day. I have trouble opening my eyes in the morning. Today I have a business lunch in a posh restaurant with prospective clients and all I want to do is go home and rest or go for a walk in the fresh air. My eyes feel so bad after staying up last night on the computer preparing the spread sheets and brief, that I hardly got any sleep. I have to wear my eye make-up and contact lenses to make an impression which makes my eyes feel worse afterwards. And my 14 year old has their GCSEs!”

This is a fictional story, a composite of the typical watery and dry eye patient aged 40 to 55 years, just into their first reading glasses, type A personality, holding down a busy banking or executive job and with family to look after. My example is a determined female – as women are at least twice as more likely to get dry eyes and meibomian gland dysfunction – but it could easily be a young man who likes Play station and computer games all evening, or a young male banker with 5 screens. I call the latter “5 screen man”.

The current dry eye definition according to the DEWS II (Craig et al. TOS 2017) is “Dry eye is a multifactorial disease of the ocular surface characterised by a loss of homeostasis of the tear film and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play an etiological role.”

Dry Eye Disease is highly prevalent and increasing with our lifestyles, dominated by screen use, laptops, mobile phones etc. Also called ‘dry eye’ or ‘dysfunctional tear syndrome´. There can be a lack of tears produced, Aqueous deficiency dry eye (ADDE) often from a medical illness but also with increasing age. More common is evaporative dry with blepharitis / meibomian gland dysfunction where the oily layer is deficient, or where there is a goblet cell deficiency, or the eye does not have a full blink causing exposure-related dry eye. Literally the lower part of the surface of the eye dries out and a whole cascade of inflammatory response ensues, typified by pain, blurred vision and tired eyes, and even reflex watering.

Meibomian gland dysfunction and rosacea can cause quite red puffy eyes and eyelids, making it look as if the person has not had any sleep. Mites or ocular demodicosis is where Demodex folliculorum and Demodex brevis live in the lash roots and cause lash loss.

The TFOS Lifestyle Report Executive Summary: A lifestyle Epidemic – Ocular Surface Disease, by leading doctors and scientists highlighted in 2023 the impact of cosmetics, screen use (digital eye strain), indoor sedentary lifestyle, on the ocular surface.

The International Society of Dacryology and Dry Eye (ISD-DE) is holding its Congress in London´s County Hall 29th to 31st May to hear the latest advances in watery and dry eye diagnosis and management.

ISD-DE aims to unite Watery and Dry Eye Ophthalmologists, Optometrists and Allied  Healthcare Professionals. It links watery and dry eyes science and clinical practice, helping ameliorate  an epidemic of sore watery eyes, and educate the public. This is one of the fastest growing areas of medicine, managing patients at the community level as well as in Clinica London and hospitals.

The story was written by Ms Jane Olver, Consultant Ophthalmologist, Oculoplastic Surgeon. Clinica London

President International Society Dacryology and Dry Eye, organizer of the London Meeting 2024 Year of the Tear.