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Lifestyle and Dry Eye Disease

Your lifestyle puts you at risk for dry eye disease

7 min read

Jovi Boparai MD Profile Picture
Written byJovi Boparai, MD
Reviewed by Deepak Ramesh, MD Amanda C. Kahn, MD
Jovi Boparai MD Profile Picture
Jovi Boparai, MDCo-founder & CEO of CorneaCarePhiladelphia, PA

Bio

Dry eye disease is tough! I get it. I have struggled with dry eyes for several years from contact lens use, and from spending countless hours looking at computer screens. In college, my dry eyes got so bad that I couldn’t wear contact lenses, because of a constant “foreign body sensation” when I had them in. I had to stop reading every 30 minutes because my eyes would start to burn and my vision would get blurry. I tried a plethora of treatments and nothing seemed to work. Dry eye disease was not only impacting my eyes, but also my emotional wellbeing. It was preventing me from enjoying life, and getting in the way of my professional training. I felt overwhelmed, frustrated and hopeless.

It was only when I realized that my dry eyes were linked to my lifestyle, environment and overall health did things start to make sense. I noticed that on days when I spent less time on the computer, my eyes felt better. My symptoms would flare when it was windy, or when there was low humidity. I knew that if I wanted to get ahead of my dry eyes, I needed to not only treat my eyes, but to also address my lifestyle. I started a consistent regimen of artificial tears and eyelid hygiene. I switched from monthly contact lenses to daily contact lenses. I started taking scheduled breaks from looking at a computer. I ate a healthier diet focused on anti-inflammatory/antioxidants foods, and I bought a humidifier for my room. In the beginning doing all this seemed impossible, but over time it became part of my usual routine. Not only did my eyes feel better, but I was overall healthier and happier! Turns out what is good for my eyes, was also good for my mind and body. I carried this lesson with me as I started my career to become an ophthalmologist and ophthalmic surgeon.

Because of my personal journey and professional training, I believe dry eye treatment starts by listening to and empowering the patient. I listen for the struggles and cue in on their strengths, while picking up on their lifestyle. Only then do we together start building a treatment plan that incorporates good eye hygiene with small, but impactful lifestyle changes. Our sight is our most important sense, and it is intimately linked to our very being. I want dry eye patients to not only get their dry eyes under control, but to also enjoy good mental and physical health, and live a fulfilling life. What is good for the eyes should also strengthen the mind and fortify the body!

Get to know me a little better!

Hobby: vintage watches
Food: peanut butter
Superhero: Superman
Guilty pleasure: desserts
Secret power: has never had a headache

Training:

Undergraduate: University of Pittsburgh Honors College
Medical school: Weill Cornell Medicine
Ophthalmology residency: Wills Eye Hospital.

Deepak Ramesh, MD
Deepak Ramesh, MDOculo-facial Plastic SurgeonSomerset, NJ

Bio

Dr. Ramesh is a fellowship trained oculoplastics specialist with deep expertise in ophthalmology and facial plastic surgery. Dr. Ramesh's unique training allows him to provide excellent general eye care along with specialized reconstructive and aesthetic procedures, both surgical and non-surgical. Through his clinical practice, Dr. Ramesh has come to appreciate the impact of eyelid anatomy and systemic diseases on dry eye disease. He believes that dry eye treatment should start with the eyes and eyelids, and extend from there to encompass the mind and body.

Get to know Dr. Ramesh a little better!

Hobby: basketball
Favorite food: briyani
Superhero: Batman, of course
Guilty pleasure: Downton Abbey
Greatest weakness: my kid(s)
Secret power: worlds best at giving piggyback rides

Training:

Medical school: UT Southwestern
Ophthalmology residency: UT Southwestern
Oculo-facial plastic surgery fellowship: UCLA Jules Stein Eye Institute

Amanda C. Kahn, MD
Amanda C. Kahn, MDPrimary Care PhysicianPhiladelphia, PA

Bio

Dr. Kahn is a primary care physician who is passionate about delivering comprehensive, personalized care to her patients. Being at the frontline of healthcare, Dr. Kahn takes care of a diverse patient population. Many of her patients endorse dry eye symptoms, and simply telling them to use artificial tears does not solve the problem. Dr. Kahn has come to appreciate the multifaceted nature of dry eye disease, and how a treatment plan needs to address eye hygiene, along with lifestyle modifications. As a primary care physician, she believes that what is good for the eyes should also be good for the mind and body.

Get to know Dr. Kahn a little better!

Hobby: swimming
Favorite food: brie
Superhero: Jean Grey
Guilty pleasure: dark chocolate
Greatest weakness: Instagram
Secret power: cooking

Training:

Undergraduate: Columbia University
Medical school: Weill Cornell Medicine
Primary care residency: Thomas Jefferson University Hospital

Lifestyle and dry eye disease

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Table of Contents

Key points

  • Lifestyle has a large impact on dry eye disease.
  • Digital screens, low humidity, air pollution, air allergens, intense sunlight and smoking can all worsen dry eye disease.
  • Small lifestyle changes can significantly improve your dry eye symptoms.

Keywords 

Air pollution, allergens, digital screens, humidity, nutrition, smoking

Taking the first step

Dry eye disease (DED) is also known as dry eye syndrome, keratoconjunctivitis sicca and ocular surface disease. Lifestyle has a significant impact on DED.1 When we say lifestyle, we mean everything you do, how you live, and your surroundings. Lifestyle impacts all aspects of your life, including your eye health.2 Lifestyle is seldom addressed in DED, but it represents one of the easiest ways to improve your dry eye treatment and increase your overall quality of life. Having a discussion about lifestyle with your eye doctor (ophthalmologist or optometrist) is an important part of treating of dry eyes.

Mindfulness and dry eye disease

You may be wondering why we’re talking about mindfulness in the lifestyle section?3 Well, it’s difficult to critically look at one’s lifestyle and identify DED risk factors. It requires paying attention to yourself and your surroundings, which is easier said than done. Many of us are used to a routine, and a routine by its very nature is difficult to perceive when we’ve done the same thing so many times over. It’s similar to driving or walking in your neighborhood, where you get around without thinking about it. So the first step about learning how your lifestyle impacts your DED is to pay attention to your lifestyle. Start by being mindful of yourself and your behavior, then expand that to your surroundings, and then encompass your environment.

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    Impact of work life on dry eye disease

    Most jobs these days require hours of work on computers and smart devices. When you stare at a computer screen, or any smart device, your blinking decreases significantly.4 Blinking helps replenish the tear film, which is essential for making your eyes feel comfortable, for protecting the corneal surface, and for giving you clear vision. So, when your blinking decreases, you essentially get dry eyes. You may often experience eye strain, blurred vision, burning, dryness and the need to squeeze your eyes tightly. Doing tedious work on a computer, like writing, working on an excel sheet, or doing accounting can be very challenging.If your work involves driving or other focused tasks like manufacturing or handiwork, you may also experience dry eyes. This is because when you focus, you may naturally blink less. With driving, not only are you focused on the road, but you may also have the car vents blowing air into your eyes, causing tear evaporation.

    The workplace and dry eye disease

    Of course, the impact of your work-life on your eyes has only gotten worse during the coronavirus (COVID-19) pandemic. This is because so much of our work now is remote, and requires countless hours of video calls! With office workers spending most of the workday on a computer, the prevalence of DED during the pandemic has likely increased.5

    Social life and dry eye disease

    Humans are social beings, and spending quality time with family and friends, or pursuing hobbies and interests, is a human necessity. Watching TV or online streaming is a major source of entertainment for us and our families. Just like with working on a computer screen, staring at a TV has the same effect: blinking less leads to symptoms of dry eyes.6 The same thing happens when you are watching a movie in a movie theater. 

    Social impacts of dry eye disease

    Doing household chores, such as cooking, doing finances, handiwork and yard work can all exacerbate dry eye symptoms. These tasks require you to focus, and may expose your eyes to irritants or allergens in the air. Even your hobbies and activities may affect DED. For example, if you enjoy outdoor activities, such as running, gardening, walking, tennis or golf, the changes in humidity, UV light exposure and air quality can worsen dry eye symptoms. Reading books or magazines, writing or painting all require focus, and therefore you may blink less, leading to an inadequate tear film and causing dry eye symptoms.

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    Even going to social events, such as concerts, bars and restaurants, can expose your eyes to irritants and other environmental conditions. Moreover, some individuals prefer to wear contact lenses when out in social situations. Contact lenses are an important risk factor for DED. Wearing certain types of make-up may lead to dry eye symptoms. During the COVID-19 pandemic, many of us have to wear masks while in social settings. Masks can lead to mask-associated DED, which results from the air that is directed from the mask towards the surface of the eye. It’s similar to sleeping under a fan, or having your car vent blowing in your face. 

    Tobacco smoking and e-cigarettes can harm your body, and cause several eye problems, including chronic dry eyes. The smoke from tobacco and e-cigarettes is irritating to the eyes, may cause rapid tear evaporation (tears dry up too fast) or decreased tear production (not making enough tears), and directly cause inflammation on the surface of the cornea and conjunctiva.

    Indoor conditions affecting dry eye disease

    Impact of nutrition on dry eye disease

    The importance of your diet cannot be overstated.7 Nutrition is the foundation of eye, physical and mental health, and plays an important role in eye care, and in managing several eye conditions. But let’s face it, not many of us actually consume a balanced diet with protein, carbs, essential fatty acids, vitamins and minerals and drink enough water. We get it. It’s very difficult to do this. But if you have DED, paying attention to your nutrition is key.

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    Not drinking enough water may cause dry eye symptoms. One of the signs of DED is having tears with high osmolarity, which basically means your tears do not have enough aqueous (water). An easy way to think about this is that not drinking enough water leads to dehydration for the body and for your tears.

    Nutritional health and dry eye disease

    Essential fatty acids, specifically Omega-3 fatty acids, may be beneficial for DED. However, the average diet consists mostly of Omega-6 fatty acids (found in vegetable oil), with few amounts of Omega-3s. In fact, we consume 15 times more Omega-6s compared to Omega-3s. While Omega-6s are helpful in many ways, when you consume such a disproportionate amount compared to Omega-3s, it can actually cause inflammation. The other essential nutrients for DED include Vitamins A, B6, B12, C, D and E, coenzyme Q10, zinc, copper, selenium, lactoferrin and curcumin. You will typically find these in fish, meat, whole grains, leafy vegetables, fortified cereals, seeds, fruits and vegetables, legumes, and fish. Can you remember the last time you consumed all these on a daily, or even a weekly basis? 

    Environmental impact on dry eye disease

    The environment has a significant impact on DED.8 The key environmental risk factors are high winds, low humidity, extreme temperatures, high UV index (intense sunlight), allergens, and pollution.9 High winds can cause rapid tear evaporation, which you may encounter outdoors or even inside your home (fan or air conditioner) or your car (vents). Low humidity in arid climates or in your home can lead to an unstable tear film. Airborne allergens such as pollen and air pollution can cause irritation to the eyes, leading to inflammation. Even the treatment for seasonal allergies (antihistamines) can worsen DED symptoms. Finally, extreme temperatures and intense sunlight can worsen dry eye symptoms.

    Environmental conditions that affect dry eye disease

    Physical and mental health linked to dry eye disease

    Your overall physical and mental health are important in your lifestyle, and in your eye care.10 Several eye conditions can impact DED. For example, most currently available eye drops contain benzalkonium chloride (BAK), a preservative that prolongs the shelf-life of eye drops, but can be toxic to the ocular surface. You may be on eye drops for glaucoma, or for eye surgery. It’s important to discuss the impact of drops on your ocular surface with your eye doctor, and explore alternative treatment options if needed. 

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    Autoimmune conditions, such as Sjögren’s syndrome, rheumatoid arthritis and lupus, are important risk factors for DED. Rosacea can cause meibomian gland dysfunction and blepharitis, leading to evaporative DED. Developing symptoms of dry eye is a notable side effect of several oral medications, like antihistamines, antidepressants, birth control pills, diuretics, decongestants, beta blockers, chemotherapy, and hormone replacement therapy. These are all important considerations in making lifestyle changes for your overall health and eye health.

    Putting it all together

    At CorneaCare believe that DED should not get in the way of you living your life! You should not have to fear the impact of your lifestyle on your DED. It would be exhausting if you were worrying about your DED every time you wanted to go outdoors, or read a book, or watch your favorite TV show. 

    If your lifestyle puts you at risk for dry eye symptoms, then coming up with a good treatment plan is a must. This includes having a daily regimen with a combination of over-the-counter artificial tears, eyelid hygiene, and nutrition. It also entails making small lifestyle interventions, such as buying a humidifier, or dimming the brightness on your computer screen, or taking a break from TV to relax your eyes. Making these small, but important, changes and sticking to them will let you get ahead of your DED, so that you can live your life how you want to!

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      What’s next

      Finally, let’s learn how to treat dry eye disease!

      Bibliography

      1. Tear Film & Ocular Surface Society. Dry Eye Workshop II Report. Ocular Surface Journal, 2017. TFOS DEWS II Report, http://www.tfosdewsreport.org/.
      2. NYU Langone Health. “Lifestyle Modifications for Dry Eye Syndrome.” NYU Langone, 2020, https://nyulangone.org/conditions/dry-eye-syndrome/treatments/lifestyle-modifications-for-dry-eye-syndrome. Accessed 30 July 2021.
      3. Zigler, Travis. “11 Natural Ways to Relieve Stress and Depression Associated with Dry Eye.” Eyes Love the Sun, 2021, https://eyelovethesun.com/blogs/dry-eyes/relieve-stress-and-depression-naturally. Accessed 15 July 2021.
      4. Kawashima, Motoko, et al. “Impact of lifestyle intervention on dry eye disease in office workers: a randomized controlled trial.” Journal of Occupational Health, vol. 60, no. 4, 2018, pp. 281-288. Wiley Online Library, https://onlinelibrary.wiley.com/doi/abs/10.1539/joh.2017-0191-OA.
      5. Barabino, Stefano. “A Narrative Review of Current Understanding and Classification of Dry Eye Disease with New Insights on the Impact of Dry Eye during the COVID-19 Pandemic.” Ophthalmology and Therapy, vol. 10, 2021, pp. 495–507. Springer Link, https://link.springer.com/article/10.1007%2Fs40123-021-00373-y#citeas.
      6. Wang, Michael TM, et al. “Modifiable lifestyle risk factors for dry eye disease.” Contact Lens and Anterior Eye, vol. ePub from print, 2021. Science Direct, https://www.sciencedirect.com/science/article/abs/pii/S1367048421000084.
      7. Sanford, Katherine. “Diet: Why Dry Eye Hangs in the Balance.” Review of Optometry, 2020, https://www.reviewofoptometry.com/article/diet-why-dry-eye-hangs-in-the-balance. Accessed 15 July 2021.
      8. WebMD. “Climate, Environment and Dry Eye.” WebMD, 2021, https://www.webmd.com/eye-health/dry-eye-irritants. Accessed 8 August 2021.
      9. Berg, Erich J., et al. “Climatic and Environmental Correlates of Dry Eye Disease Severity: A Report From the Dry Eye Assessment and Management (DREAM) Study.” Translational Vision Science and Technology, vol. 9, no. 5, 2020. ARVO Journals, https://tvst.arvojournals.org/article.aspx?articleid=2765460.
      10. Mastrota, Katherine M. “Lifestyle interventions to prevent dry eye disease.” Optometry Times, 2020, https://www.optometrytimes.com/view/lifestyle-interventions-to-prevent-dry-eye-disease. Accessed 18 August 2021.

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