What you need to know
DRY, irritated eyes are becoming an increasingly common complaint among people in Fiji. From office workers staring at computer screens to farmers working long hours under the tropical sun, dry eye disease is affecting individuals across all age groups. While often dismissed as a minor discomfort, dry eyes can significantly affect vision, work productivity, and overall quality of life if left untreated.
What is dry eye disease?
Dry eye disease occurs when the eyes do not produce enough tears, or when the tears evaporate too quickly. Tears are essential for keeping the eyes comfortable, clear, and protected from infection. In Fiji’s warm, windy, and often air-conditioned environments, the natural tear film can be disrupted more easily, leading to dryness and irritation.
Common symptoms include burning or stinging sensations, redness, gritty or sandy feeling in the eyes, blurred or fluctuating vision, sensitivity to light, and paradoxically, excessive watering of the eyes.
Understanding the tear film and pathophysiology
The tear film has three layers: an oily layer, a watery layer, and a mucus layer. Together, they keep the eye surface smooth and moist. Dry eye disease develops when one or more of these layers is affected.
The central mechanism involves tear film instability and increased tear saltiness, known as hyperosmolarity. This triggers inflammation of the eye surface, damaging cells that produce protective mucus and worsening dryness. Over time, this creates a vicious cycle of irritation, inflammation, and tear film breakdown.
Major types of dry eye disease
Dry eye disease is broadly divided into two main types, though many patients have features of both.
Aqueous Deficient Dry Eye occurs when the lacrimal glands fail to produce enough tears. This is more common in older individuals and in those with autoimmune diseases.
Evaporative Dry Eye is the most common form seen in Fiji. It occurs when tears evaporate too quickly, often due to dysfunction of the meibomian glands in the eyelids. These glands produce oil that slows tear evaporation. Blocked or inflamed glands, often worsened by dust, smoke, and prolonged screen use, contribute significantly to this condition.
Systemic and lifestyle factors
Several systemic and environmental factors common in Fiji increase the risk of dry eyes:
Diabetes mellitus, which is prevalent in Fiji, can damage corneal nerves and reduce tear production.
Autoimmune conditions, such as rheumatoid arthritis and Sjögren’s syndrome, can severely affect tear glands.
Hormonal changes, particularly in postmenopausal women.
Medications, including antihistamines, blood pressure drugs, and antidepressants.
Climate and environment, including heat, trade winds, dust, and prolonged exposure to sunlight.
Digital eye strain, with increasing use of mobile phones and computers.
Air-conditioned offices and vehicles, which dry the surrounding air.
Treatment options
Dry eye disease is manageable, especially when diagnosed early. Treatment is tailored based on severity and cause.
For mild cases, lifestyle changes such as taking regular screen breaks, conscious blinking, wearing sunglasses outdoors, and staying well hydrated can help.
Artificial tears, widely available in pharmacies across Fiji, are often the first line of treatment. Preservative-free drops are preferred for frequent use.
When inflammation is present, prescription eye drops, including short courses of anti-inflammatory medications, may be required under medical supervision.
For patients with eyelid-related problems, warm compresses and lid hygiene play a crucial role. In some cases, oral medications may be prescribed to improve oil gland function.
More advanced options include punctal plugs to reduce tear drainage and specialised eye drops, such as serum-based treatments, available through specialist care.
When to seek help
Persistent eye discomfort, redness, or blurred vision should not be ignored. Early consultation with an optometrist or ophthalmologist can prevent complications and improve long-term eye health.
