Severe Dry Eye

August 10, 2020


Today, we’re covering more about Severe Dry Eye, including symptoms, causes and treatments. Plus a special contact lens that can give significant relief from severe dry eye.

Ever had something in your eye? If so, you’ll know how sore it is.

severe dry eye

Severe dry eye can make every day uncomfortable

What are the symptoms of severe dry eye?

Severe dry eye can cause symptoms like:

  • Severe or disabling pain
  • Episodes of stinging, burning or scratchy sensation in your eyes.
  • Frequent red eyes and red-rimmed eyes
  • Constant blurred vision or eye fatigue
  • Ongoing problems and reduced quality of life

Severe dry eyes can have bad days and not-so-bad days. Your environment can play a role in how your eyes feel.

You may experience constant watery eyes in an air-conditioned room . You may have staring at a computer screen for a few hours. Dry eyes can make it difficult to perform everyday activities, such as reading, driving or watching television.

Why don’t I have enough tears?

Your tears are a complex mixture of water, fatty oils and mucus. This mixture helps make the surface of your eyes smooth and clear, and it helps protect your eye from infection.

For some people the cause of dry eyes is increased tear evaporation and an imbalance in the makeup of your tears.

For others the cause of dry eyes is decreased tear production.

The tears protect the surface of the eye from infection. They also help things to stay in focus. Without adequate tears, you may have eye inflammation, abrasion of the corneal surface and if left untreated lead to corneal ulcer and vision problems.

Are there any auto-immune connections?

Autoimmune diseases such as:

  • Rheumatoid arthritis
  • Behcet disease
  • Lupus
  • Multiple Sclerosis
  • Reiter’s syndrome,
  • Diabetes type 1

These are some of the autoimmune diseases that affect the eye and contribute to severe dry eyes. They can cause symptoms like:

  • Filminess
  • Cloudiness
  • Blurriness
  • Pain
  • Dryness
  • Light sensitivity

In this article, we’ll discuss two medical conditions in more detail.

What is Stevens Johnsons Syndrome?

Steven Johnsons syndrome is a rare, serious disorder of the skin and mucous membranes triggered by medication, an infection or both.

It usually starts with fever, a sore mouth and throat, fatigue and burning eyes.

As the condition develops, it includes widespread skin pain, a red or purplish rash that spreads.

Blisters may form on your skin and mucous membrane of the mouth, nose, eyes and genitals and shedding of the skin within days after blisters form.

Stevens-Johnson syndrome is a medical emergency that usually requires hospitalisation.

Treatment for Stevens Johnsons Syndrome

Treatment focuses on removing the cause (i.e. ceasing the medication), caring for wounds, controlling pain and minimising complications as skin regrows. It can take weeks to months to recover.

During this stage, artificial tears or topical steroid is used to reduce inflammation of the eyes and mucous membrane.

Another autoimmune condition that affects the eyes is Sjogrens Syndrome.

What is Sjogrens Syndrome?

Sjogren syndrome is a disorder of your immune system identified by its two most common symptoms – dry eyes and a dry mouth.

The condition often accompanies other immune system disorders, such as rheumatoid arthritis and lupus.

Sjogrens Syndrome affects the mucous membranes and moisture-secreting glands of your eyes and mouth first. This causes decreased tears and saliva.

Treatment for Sjogrens Syndrome

Treatment for Sjogren syndrome depends on the parts of the body affected. Many people manage the dry eye and dry mouth of Sjogren’s syndrome by using over-the counter lubrication eyedrops and drinking water more frequently.

However, some people need prescription medications to reduce inflammation, such as:

  • Cyclosporine (anti-inflammatory drops)
  • Autologous serum

What is autologous serum?

Autologous serum is customised eyedrop made from patient’s own blood diluted in sterile saline or hyaluronic acid.

It serves as lacrimal gland substitute to provide lubrication and its composition of the serum resembles that of tears.

It’s composed of a mixture of naturally occuring things in the body like:

  • Vitamin A,
  • Lysozyme
  • Transforming growth factor B  (TGF-B)
  • Fibronectin
  • Immunoglobulin A (IgA)
  • Epithelial growth factor (EGF)
  • Vitamin C which promote healing of the ocular surface.

Autologous serum typically made in a concentration of around twenty percent. This is based on the concentration of biological factors in actual tears, although higher concentration have been used.

Research has shown autologous serum is more effective than over-the counter lubrication in patients with severe dry eye, This is because the serum is composed of a complex mix of growth factors, proteins, antioxidants and lipids which are not found in over-the counter lubrication eyedrops.

Some people may even need surgical procedures, to seal the tear ducts and help preserve tears on the eyes (i.e. punctal cauterisation).

Preservative vs preservative-free eye drops for severe dry eye

A variety of lubrication eyedrops are available over-the counter. Eyedrops with preservatives can be used up to four times a day. Preservatives help the eyedrop bottle to last longer.

However, preservatives drops more often can cause eye irritation in people with dry eye syndrome.

If you rely on eyedrops more than four times a day or allergic to preservatives, non-preservative drops are safer.

Lubricating eye ointments coat your eyes, providing longer lasting relief from dry eyes but are thicker than eyedrops and can cloud your vision.

What are Scleral Lenses?

Scleral Contact Lenses

Contact lenses for severe dry eyes

Scleral lenses can provide significant pain relief for people with severe dry eye.

Regular soft contact lenses sit on the cornea, which can be extremely irritating and act as sponges soaking up moisture on the surface of the eye.

Scleral contact lenses help trap moisture around the front of the eye (dark blue area)

Scleral lenses, on the other hand, sit on the sclera, the white part of the eye and vault over the cornea.

These lenses do not touch the corneal surface at all, making this a very comfortable option.

Furthermore, when inserting a scleral lens into your eye, you first apply a saline solution which fills the gap between the cornea and the lens.

This provides moisture for the irritated eye and promotes healing by ensuring consistent hydration of the eye and shielding the cornea from external irritants, such as blinking from the eyelids and environmental irritants.

Scleral lenses significantly reduce discomfort, eye redness and simultaneously provide clear, crisp vision.

Ezekiel Eyes has a keen interest in Scleral Contact Lenses. Book an appointment with us now to discuss Scleral Contact Lenses.

During our long experience as Perth optometrists, we’ve seen people like you get significant relief from severe dry eye. We look forward to meeting you!


In addition to owning and managing Ezekiel Eyes, Damon is a contact lens consultant to various research organisations. He regularly lectures and conducts workshops in contact lens practice throughout Australia, Asia and the United States. Damon graduated from the University of NSW with a Bachelor of Optometry in 1989. He is now married with two children and enjoys running, hockey, swimming, piano, travelling and trekking.

Damon’s professional associations include:
President of the International Society of Contact Lens Specialists
Practising Fellow of the Scleral Lens Education Society
Fellow of the Cornea & Contact Lens Society of Australia
Fellow of the American Academy of Optometry
Member of Optometry Australia
Member of the Orthokeratology Society of Australia
Member of Alcon Australia advisory panel