Dry Eye Syndrome or Keratoconjunctivitis Sicca

Dry Eye Syndrome (DES) and Keratoconjunctivitis Sicca (KCS) are often used interchangeably, but there are some differences in usage:

1. Dry Eye Syndrome (DES)

A broad term describing a condition where the eyes don’t produce enough tears, or the tears evaporate too quickly.
Can be caused by age, screen time, environment, medications especially allopathic, or autoimmune diseases.
Symptoms: Dryness, irritation, redness, burning, blurry vision.

2. Keratoconjunctivitis Sicca (KCS)

A more medical and specific term for chronic and severe dry eye disease.
Often associated with autoimmune conditions like Sjogren’s syndrome.
Involves inflammation of the cornea and conjunctiva due to tear deficiency.
Symptoms: More severe discomfort, possible corneal damage, light sensitivity.

Key Difference:

DES is a general condition, while KCS is usually a chronic and medical diagnosis with inflammation.
If an ophthalmologist diagnoses KCS, it often means the dryness is significant and may require medical treatment.

Dry Eye Syndrome or Keratoconjunctivitis Sicca facts

A disturbance of the tear film characterizes dry eye syndrome, a very common and usually benign condition. This abnormality may result in disruption of the ocular surface, causing a variety of symptoms and signs and interference with quality of life.

To help keep the eyes comfortable and vision optimal, a normal, thin film of tears coats the eyes.

Three main layers make up this tear film:

The innermost layer is the thinnest. It is a layer of mucin (or mucus). The cells in the conjunctiva (the clear skin that lines the eye) produce a very thin layer of mucus. The mucus helps the overlying watery layer to spread evenly over the eye.
The middle (or aqueous) layer is the largest and the thickest. This layer is essentially a very dilute saltwater solution. The lacrimal glands under the upper lids and the accessory tear glands produce this watery layer. The function of this layer is to keep the eye moist and comfortable, as well as to help flush out any dust, debris, or foreign objects that may get into the eye. Defects of the aqueous layer are the most common cause of dry eye syndrome, also referred to as dry eye or keratoconjunctivitis sicca (KCS).
The most superficial layer is a very thin layer of lipids (fats or oils). The meibomian glands and the glands of Zeis (oil glands in the eyelids) produce these lipids. The main function of this lipid layer is to help decrease evaporation of the watery layer beneath.

Dry Eye Syndrome or Keratoconjunctivitis Sicca and Contact Lenses

A properly fit contact lens should ride or float on the eye on a thin film of fluid (tear film). With each blink, this film of fluid between the contact lens and the eye is replaced with fresh fluid, allowing debris to be washed away and fresh oxygen that is dissolved in the fluid to reach the cornea. If this film is compromised in quantity or quality, the contact lens may become uncomfortable or even unhealthy to wear.

At each exam, the ophthalmologist will evaluate the fit of the contact lens and look for signs of early damage to the cornea that may be a result of a compromised tear film.

What causes of dry eye syndrome?

What are the types of dry eye disease?

Dry Eye Syndrome occurs when your eyes don’t produce enough tears, or your tears evaporate too quickly. Causes are often divided into tear production problems and tear evaporation issues.

1. Decreased Tear Production (Aqueous Deficiency)

Aging – Tear production decreases with age, especially after 50.
Hormonal Changes – Common in menopause, pregnancy, or birth control use.
Autoimmune Diseases – Conditions like Sjogren’s syndrome, rheumatoid arthritis, lupus etc can reduce tear production.
Medications – Certain allopathic drugs reduce tear production, for example:
- Antihistamines (for allergies),
- Antidepressants & anti-anxiety medications,
- Diuretics (for high blood pressure),
- Beta-blockers (for heart conditions),
- Birth control pills.
Medical Conditions – Diabetes, thyroid disorders, vitamin A deficiency.
Nerve Damage – Eye surgery (LASIK, cataract surgery) or trauma can affect tear gland function.

2. Increased Tear Evaporation (Meibomian Gland Dysfunction – MGD)

Screen Time & Reduced Blinking – Staring at screens for long periods causes less blinking, leading to dryness.
Meibomian Gland Dysfunction (MGD) – Blocked oil glands prevent a healthy tear film, making tears evaporate too fast.
Contact Lens Use – Long-term wear can disrupt tear film stability.
Environmental Factors – Wind, smoke, air conditioning, dry climates.
Allergies – Inflammation from allergies can worsen dryness.
Eyelid Problems (Blepharitis, Ectropion/Entropion) – Inflammation or improper eyelid position affects tear distribution.

3. Other Contributing Factors

LASIK or Cataract Surgery – Can temporarily reduce tear production.
Dehydration – Not drinking enough water affects tear quality.
Omega-3 Deficiency – Poor diet may contribute to dry eyes.

If blinking decreases or if the eyelids cannot be closed, the eyes may dry out because of tear evaporation. While reading, watching TV, or performing a task that requires close attention with the eyes, a person may not blink as often. This decreased blinking allows excessive evaporation of the tears. Certain health conditions, such as stroke or Bell’s palsy, make it difficult to close the eyes. As a result, the eyes may become dry from tear evaporation.

Abnormal production of mucin by the conjunctiva may occur. This can result from chemical (alkali) burns to the eye or because of different autoimmune diseases, such as Stevens-Johnson syndrome and cicatricial pemphigoid. This abnormal production leads to poor spreading of the tears over the surface of the eye. The surface of the eye can dry out and even become damaged despite the presence of sufficient watery tears.

Insufficient lipid layers are the result of meibomian gland dysfunction, rosacea, or following oral isotretinoin medication. Meibomian glands are the oil glands in the eyelids that produce the lipid layer. If these oil glands become blocked or if the oil is too thick, there may not be enough oil to cover the watery tear layer to prevent its evaporation.

In addition, if an infection is present along the eyelids or the eyelashes (blepharitis) the bacteria may break down the oil, so there may not be enough oil. This may lead to evaporative loss of tears and dry eyes.

Risk factors for Dry Eye Syndrome or Keratoconjunctivitis Sicca

Dry eye syndrome is more common with increasing age, female sex, and Asian ethnicity. Menopause can increase the risk of dry eye syndrome. Paradoxically, postmenopausal women on hormone replacement therapy, especially estrogens alone, have a higher prevalence of dry eyes than postmenopausal women who don’t take hormones.

Occupational and environmental factors increasing risk include low humidity, high room temperature, wind exposure, pollution and poor air quality, smoking, and decreased blink rates due to sustained computer use or reading.

Diseases associated with dry eyes include vitamin A deficiency (historically known as xerophthalmia), acne rosacea, autoimmune/connective tissue disease, hepatitis C infection, HIV infection, Sjögren’s syndrome, sarcoidosis, diabetes mellitus, and androgen or estrogen deficiency.

Wearing contact lenses increases the risk of dry eye syndrome. Refractive surgery, especially LASIK, frequently causes dry eyes.

A diet low in omega-3 fatty acids or a diet with a relatively high amount of omega-6 fatty acids relative to omega-3 fatty acids can also increase the risk of dry eye syndrome.

Various types of allopathic medications, including systemic chemotherapy, diuretics, antidepressants, antihistamines and beta-adrenergic blockers, may cause dry eyes as a side effect of the medication.

Irregularities of the conjunctival surface as seen with pinguecula or pterygia, can cause dry eye symptoms. Abnormalities of the blink mechanism or mechanical lid abnormalities can also produce DES symptoms.

Symptoms and signs

A person with dry eye syndrome may experience dry, gritty/scratchy, or filmy feeling, burning or itching, redness of the eyes (conjunctivitis), blurred vision, foreign body sensation, and light sensitivity.

Dry eye symptoms seem to worsen in dry or windy climates and with higher temperatures and lower humidity. Symptoms may also be worse with prolonged use of the eyes (for example, while reading and watching TV) and toward the end of the day.

Sometimes a symptom of dry eye syndrome may actually be intermittent excessive tearing. With dry eye, when the eyes become slightly dry and irritated, it may initiate reflex tearing with the production of a large number of tears all at once to try to get moist and comfortable again. Unfortunately, the eyes can only handle so many tears at any one time; the rest pour over the eyelids and down the cheeks. A short time later, the eyes will become slightly dry and irritated again and the whole process may repeat itself.

Tests to diagnose dry eye syndrome

During an eye examination, an ophthalmologist will most likely be able to diagnose dry eye syndrome just by hearing the patient’s complaints about his/her eyes. A health care professional can confirm the diagnosis of dry eyes by observing signs of dry eyes. As part of the eye examination, a doctor may:

examine the front of the eyes is examined using slit lamp.
inspect the amount and thickness of the tear film.
assess the stability of the tear film by checking the tear breakup time.
inspect the eyelids for signs of inflammation.
examine the Meibomian glands of the lids and their openings into the tear film.
assess the conjunctiva to determine if it is too dry or inflamed.
check the cornea to see if it has dried out or become damaged. If both the cornea and conjunctiva are involved, the condition is known as keratoconjunctivitis.

Dyes test

An ophthalmologist may use different dyes during a patient’s eye examination. An eye care specialist will place the dyes into the tears in the form of a drop. Fluorescein is a yellow dye that stains the cornea where epithelial (surface) cells have been worn away because of the lack of an adequate protective tear film.

Rose Bengal is a red dye that stains the cornea and the conjunctiva where the cells are dead or dying as well as where healthy cells are inadequately protected by the tear film.

Lissa mine Green is a green dye that can help differentiate between normal and abnormal surface cells of the cornea and conjunctiva.

Schirmer tests measure the amount of tears produced by the eyes. The ophthalmologist places the end of a thin strip of filter paper just inside the lower eyelid. After a minute, the doctor removes the filter paper, and the amount of wetting is measured. Less wetting of the filter paper is more indicative of dry eye syndrome.

The osmolarity (salt content) of the tears may be measured. This test aids in the diagnosis of dry eye syndrome, in which tear osmolarity is increased over normal levels.

New Tear Tests: What They Can Detect

Recent advancements in tear-based testing allow doctors to diagnose various eye and systemic conditions. These tests analyze tear composition, proteins, and inflammatory markers. A new test on the tears can detect the presence of MMP-9 (matrix metalloproteinase 9).

1. Dry Eye Disease (DED) & Inflammation

Tear Osmolarity Test (TearLab, i-Pen) – Measures tear salt concentration; high levels indicate dry eye syndrome.
Inflammation Dry Test – Detects MMP-9, an inflammatory marker in dry eye disease.

2. Autoimmune Diseases (Sjogren’s Syndrome, Lupus, RA)

Tear Biomarkers for Sjogren’s Syndrome – Elevated levels of certain proteins can indicate Sjogren’s syndrome, an autoimmune cause of severe dry eye.

3. Diabetes & Metabolic Diseases

Tears contain glucose and metabolic markers, which could help detect diabetes or monitor blood sugar levels.

4. Neurological & Alzheimer’s Disease

Some studies show tear protein changes may indicate early signs of Alzheimer’s and other neurodegenerative conditions.

5. Infectious & Viral Diseases

Tears may contain viral RNA/DNA for diseases like COVID-19, herpes, or conjunctivitis-causing viruses.

6. Cancer Detection

Research suggests tear fluid could help identify biomarkers for breast cancer and other malignancies.

Allopathic treatments for dry eye syndrome

Although no cure exists in allopathy for dry eye syndrome or Keratoconjunctivitis Sicca, many experimental treatments are available. Treatment is dependent on the severity of the condition; some patients may only require a humidifier, or occasional eye drops while others may require surgery to help decrease dry eyes.

Over-the-counter lubricating eye drops, commonly referred to as artificial tears, may help relieve dry eyes. One should avoid tear substitutes containing a vasoconstrictor such as naphazoline, tetrahydrozoline, phenylephrine, and oxymetazoline. A doctor may also prescribe medications to help a patient with dry eye syndrome.

What types of allopathic medications for dry eye syndrome?

A major portion of the ophthalmologist’s decision about prescription treatment of DES is based on determining whether the problem is primarily evaporative or aqueous-deficient, or a combination of both. There is a great deal of overlap between evaporative and aqueous-deficient dry eye.

An eye care professional may prescribe eye lubricants, such as Lacrisert, an artificial tear insert. The insert is similar to a contact lens, and the patient will need to insert the eye lubricant one to two times a day. Cellulose is contained in the insert and acts to stabilize and thicken the film of tears over the eyes and to prolong the time the tear film works. Corneal abrasion may occur if the artificial tear insert isn’t inserted properly.

Certain prescription allopathic medications may help with dry eye syndrome or Keratoconjunctivitis Sicca. Cyclosporine A 0.5% (twice a day) helps decrease any inflammation on the surface of the eye. This inflammation decreases the ability of the eyes to maintain a healthy tear film.

Lifitegrast 5% is another eye drop that reduces inflammation in the tear glands. Corticosteroid drops either alone or used in conjunction with cyclosporine or Lifitegrast, reduce the signs and symptoms of dry eye. Although this group of drops for the medical treatment of dry eye syndrome, many ophthalmologists prescribe, is not yet approved scientifically.

Corticosteroid drops, if used in excess, may have some sever and serious side effects. Like all allopathic medications, patients should only use these under a doctor’s supervision and according to instructions.

Nonsteroidal anti-inflammatory drops likewise reduce the inflammation associated with dry eye syndrome.

Antibiotic

Patients with blepharitis or meibomian gland dysfunction need antibiotics ophthalmic drops or ointments, such as erythromycin, azithromycin and bacitracin, among others, for about seven to 10 days to decrease the number of bacteria that break down the lipid layer of the tear film. In ointment form, these also lubricate the eyes overnight.

Oral antibiotics, particularly azithromycin and doxycycline, minocycline, tetracycline, azithromycin etc not only help to decrease the number of bacteria but also help to make the oil more fluid so it flows out of the oil glands more easily. This is often used if a person has rosacea.

Sometime physician prescribed medications may include drops prepared by a compounding pharmacy such as autologous serum or hormonal drops.

Homeopathic Treatment for Dry Eye Syndrome

Homeopathy aims to treat dry eye syndrome by addressing underlying causes and stimulating the body’s natural healing. It involves individualized remedies based on symptoms. Here are some commonly used homeopathic treatments:

1. Common Homeopathic Remedies for Dry Eyes

Euphrasia

Inflaming the conjunctival membrane. Catarrhal affections of mucous membranes especially of eyes and nose. Profuse acrid lachrymation and bland coryza; worse, evening. Hawking up of offensive mucus. Bursting headache with dazzling of eyes. Catarrhal headache, with profuse discharge from eyes and nose. Profuse, fluent coryza, with violent cough and abundant expectoration.

Catarrhal conjunctivitis; discharge of acrid matter. The eyes water all the time. Discharge thick and excoriating. Burning and swelling of the lids. Frequent inclination to blink. Sticky mucus on cornea; must wink to remove it. Pressure in eyes. Blisters on cornea. Opacities. Rheumatic iritis. Ptosis.

Ammonium Bromatum

Edges of lids red and swollen, also Meibomian glands. Eyeballs feel large and pain around eyes into head.

Calcarea Carbonica

Sensitive to light. Lachrymation in open air and early in morning. Spots and ulcers on cornea. Lachrymal ducts closed from exposure to cold. Easy fatigue of eyes. Far sighted. Itching of lids, swollen, scurfy. Chronic dilatation of pupils. Cataract. Dimness of vision, as if looking through a mist. Lachrymal fistula; scrofulous ophthalmia.

Aconitum Napellus

Eyes red and inflamed, with intolerable pains. Profuse lachrymation. Heat and burning in the eyes, with pressive and shooting pains. Swelling of the eyes. Dilated pupils. Lids feel dry, hard, heavy, sensitive to air. Red, hard swelling of the lids. Eyes sparkling, convulsed, and prominent. Look fixed. Excessive photophobia; or a strong desire for light. Black spots and mist before the eyes, flickering. Vision as if through a veil; difficult to distinguish faces; with anxiety and vertigo. Sudden attacks of blindness. A sensation of drawing in the eyelids with drowsiness. Ophthalmia, very painful, with blear-eyedness, or from foreign bodies having come into the eyes (dust, sparks), from surgeries.

Mercurius Corrisivus

Pain behind eyeballs, as if forced out. Phlyctenule; deep ulcers on cornea. Excessive photophobia and acrid lachrymation. Iritis, ordinary or syphilitic. Pain severe at night; burning, shooting, tearing. Tendency to pus formation. Iris muddy in color, thick, and neither contracts nor dilates. Retinitis albuminuric, ophthalmia neonatorum. Lids edematous, red, excoriated. Severe burning. Soreness of the eyes.

Gelsemium Sempervirens

Ptosis; eyelids heavy; patient can hardly open them. Double vision. Disturbed muscular apparatus. Corrects blurring and discomfort in eyes even after accurately adjusted glasses. Vision blurred, smoky. Dim-sighted; pupils dilated and insensible to light. Orbital neuralgia, with contraction and twitching of muscles. Bruised pain back of the orbits. One pupil dilated, the other contracted. Deep inflammations, with haziness of vitreous. Serous inflammations. Albuminuric or degenerative chorio-retinitis. Detached retina, glaucoma and descemetitis. Hysterical amblyopia.

Phosphorus

Cataract. Sensation as if everything were covered with a mist or veil, or dust, or something pulled tightly over eyes. Floaters before eyes. Patient sees better by shading eyes with hand. Fatigue of eyes. Green halo about the light. Letters appear red. Atrophy of optic nerve. Edema of lids and about e eyes. Pearly white conjunctiva and long curved lashes. Partial loss of vision from abuse of tobacco. Pain in orbital bones. Paresis of extrinsic muscles. Diplopia, due to deviation of the visual axis. Glaucoma. Thrombosis of retinal vessels and degenerative changes in retinal cells. Degenerative changes where soreness and curved lines are seen in old people. Retinal trouble with lights and hallucination of vision.

Nux Vomica

Photophobia; much worse in morning. Smarting dry sensation in inner canthi. Infra-orbital neuralgia, with watering of eyes. Optic nerve atrophy, from habitual use of intoxicants. Paresis of ocular muscles; worse, tobacco and stimulants. Orbital twitching radiating towards the occiput, Optic neuritis.

Causticum

Cataract with motor disturbances. Inflammation of eyelids; ulceration. Sparks and dark spots before eyes Ptosis. Vision impaired, as if film were before eyes. Paralysis of ocular muscles.

Apis Mellifica

Lids swollen, red, oedematous, everted, inflamed; burn and sting. Conjunctiva bright red, puffy. Lachrymation hot. Photophobia. Sudden piercing pains. Pain around orbits. Serous exudation, oedema, and sharp pains. Suppurative inflammation of eyes. Keratitis with intense chemosis of ocular conjunctiva. Staphyloma of cornea following suppurative inflammation. Styes, also prevents their recurrence.

Sulphur

Burning ulceration of margin of lids. Halo around lamp-light. Heat and burning in eyes (Ars; Bell). Black motes before eyes. First stage of ulceration of cornea. Chronic ophthalmia, with much burning and itching. Parenchymatous keratitis. Cornea like ground glass.

Zincum Metallicum

Pterygium; smarting, lachrymation, itching. Pressure as if pressed into head. Itching and soreness of lids and inner angles. Ptosis. Rolling of eyes. Blurring of one-half of vision; worse, stimulants. Squinting. Amaurosis, with severe headache. Red and inflamed conjunctiva; worse, inner canthus.

Natrum Muriaticum

Eyes feels bruised, with headache. Eyelids heavy. Muscles weak and stiff. Letters run together. Sees sparks. Fiery, zigzag appearance around all objects. Burning in eyes. Give out on reading or writing. Stricture of lachrymal duct with suppuration. Escape of muco-pus when pressing upon sac. Lachrymation, burning and acrid. Lids swollen. Eyes appear wet with tears. Tears stream down face on coughing. Asthenopia due to insufficiency of internal recti muscles. Pain in eyes when looking down. Cataract incipient.

Belladonna

Throbbing deep in eyes on lying down. Pupils dilated. Eyes feel swollen and protruding, staring, brilliant; conjunctiva red; dry, burn; photophobia; shooting in eyes. Exophthalmos. Ocular illusions; fiery appearance. Diplopia, squinting, spasms of lids. Sensation as if eyes were half closed. Eyelids swollen. Fundus congested.

Arsenicum Album

Burning in eyes, with acrid lachrymation. Lids red, ulcerated, scabby, scaly, granulated. Edema around eyes. External inflammation, with extreme painfulness; burning, hot, and excoriating lachrymation. Corneal ulceration. Intense photophobia; better external warmth. Ciliary neuralgia, with fine burning pain.

Homeopathic Eye Drops

Cineraria Maritima – Often used in homeopathic eye drops to reduce irritation and improve tear production.
D-Eye drops – it has been used by thousands of patients with 99.8% successful results. D-Eye drops remove cataract in few days, increases eyesight, soothe dry eyes, cure inflammations, treats conjunctivitis. It could be use regularly as precautionary or for overall eye health.
Euphrasia Eye Drops – Helps soothe dry, red, and inflamed eyes.

Complications of dry eye syndrome

Most people with dry eye syndrome or Keratoconjunctivitis Sicca have nothing to worry about aside from an annoying inconvenience. Although if treated with allopathy, the symptoms might make activities of daily living (for example, reading, watching TV, driving) miserable, no long-term vision loss is to be expected, for those with more severe dry eye syndrome or Keratoconjunctivitis Sicca, significant drying of the surface of the eye can lead to an increased risk of serious infections. Ultimately, scarring, thinning, and even perforation of the cornea may occur. As a result, vision, or even the eye itself, may be permanently damaged or function lost, that’s why till now Homeopathy offers the treatment options for dry eye syndrome or Keratoconjunctivitis Sicca.

What is the prognosis of dry eye syndrome?

Although dry eye syndrome or Keratoconjunctivitis Sicca can be very symptomatic, it is seldom a cause of ulcers of the cornea can occur, significant visual loss if not treated with Homeopathy.

P. S: This article is only for doctors having good knowledge about Homeopathy and allopathy, for learning purpose(s).

For proper consultation and treatment, please visit our clinic.

Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.

Senior research officer at Dnepropetrovsk state medical academy Ukraine.

Location: Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.

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ByDr Qaisar Ahmed