Burning Eyes: An In-depth Exploration

Introduction

Burning eyes, a sensation that can range from mild irritation to severe discomfort, is a common complaint among people of all ages. In India, with its diverse climates, rapid urbanisation, and widespread use of digital screens, burning eyes have become a frequent concern.

What is the Burning Eyes Condition?

The term “burning eyes” describes a sensation of heat, discomfort, or stinging in the eyes. It may occur in one or both eyes and can be accompanied by redness, watering, itching, sensitivity to light, or blurred vision. Burning eyes are not a disease in themselves but rather a symptom of various underlying conditions ranging from benign to serious.

Common Causes of Burning Eyes

Burning eyes may result from a multitude of factors. Understanding these is crucial for effective treatment. The causes can be broadly classified into environmental, lifestyle-related, medical, and infectious categories.

1. Environmental Factors

• Air Pollution: Exposure to smoke, dust, and chemical fumes is a significant cause, especially in urban Indian cities where air quality often dips below recommended levels.
• Allergens: Pollen, animal dander, and moulds, particularly during certain seasons, can trigger allergic conjunctivitis leading to burning sensations.
• Climate: Extremely dry or windy weather can cause rapid evaporation of the tear film, resulting in dry, burning eyes.

2. Lifestyle and Occupational Factors

• Prolonged Screen Time: With the increasing use of computers, smartphones, and tablets, digital eye strain (computer vision syndrome) is becoming rampant. Reduced blinking while staring at screens leads to tear evaporation and burning.
• Contact Lens Use: Improper use or extended wear of contact lenses may irritate the eyes and disrupt the natural tear film.
• Exposure to Irritants: Swimming in chlorinated pools, working with chemicals, or being exposed to smoke (from chulhas or cigarettes) can aggravate eye burning.

3. Medical Conditions

• Dry Eye Syndrome (Keratoconjunctivitis Sicca): One of the most common causes, especially in older adults and post-menopausal women. It occurs when the eyes do not produce enough tears or the tears evaporate too quickly.
• Blepharitis: Inflammation of the eyelids, often due to bacterial infection or skin conditions like dandruff, can cause burning, itching, and crusting.
• Conjunctivitis: Also known as “pink eye”, this can be viral, bacterial, or allergic and is associated with burning, redness, and discharge.
• Autoimmune Disorders: Conditions like Sjögren’s syndrome, rheumatoid arthritis, and lupus can affect tear production and cause burning eyes.
• Meibomian Gland Dysfunction: These glands line the eyelids and secrete oils that prevent tear evaporation. Dysfunction leads to dry, burning eyes.

4. Infections and Other Causes

• Eye Infections: Bacterial, viral, or fungal infections can directly irritate the eye surface.
• Foreign Bodies: Dust, grit, or a small insect may cause mechanical irritation and a burning sensation.
• Systemic Illnesses: Fever from infections (like dengue, flu, or COVID-19) can present with burning eyes as a symptom.
• Hormonal Changes: Changes during pregnancy, menopause, or thyroid dysfunction can impact tear film stability.

Symptoms and Associated Signs

The sensation of burning may be the primary complaint, but it often occurs alongside other symptoms:

• Redness of the eyes
• Watery eyes or excessive tearing
• Itching or foreign body sensation
• Light sensitivity (photophobia)
• Blurred or fluctuating vision
• Grittiness, as if sand is in the eyes
• Swelling of eyelids or conjunctiva
• Discharge (watery, mucoid, or purulent)

The presence of severe pain, sudden vision loss, or seeing halos around lights may indicate more serious conditions requiring immediate medical attention.

Diagnosis of Burning Eyes

Diagnosing the underlying cause of burning eyes involves a combination of medical history, examination, and sometimes specialised tests.

1. Medical History

• Duration and pattern of symptoms (acute or chronic)
• Exposure to irritants or allergens
• Use of contact lenses or eye drops
• Associated systemic symptoms (joint pain, dryness of mouth, skin rashes, etc.)
• History of autoimmune diseases or recent infections

2. Eye Examination

• Visual Acuity Test: To assess any impact on vision.
• Slit-Lamp Examination: A specialised microscope helps evaluate the cornea, conjunctiva, eyelids, and tear film.
• Eyelid and Meibomian Gland Evaluation: To check for blepharitis or gland dysfunction.
• Tear Break-up Time (TBUT): Measures tear film stability to diagnose dry eye.
• Schirmer’s Test: Quantifies tear production via litmus paper strips.
• Fluorescein Staining: Highlights areas of dryness or damage on the eye surface.

3. Laboratory and Special Investigations

• Swab and culture of conjunctival discharge (if infection suspected)
• Blood tests (to check for autoimmune markers or systemic diseases)
• Allergy testing (skin prick or blood tests)

Management and Treatment

Management depends on the underlying cause. Below are the commonly used strategies:

1. General Measures

• Environmental Modifications: Use of air purifiers, avoiding exposure to smoke or dust, and wearing protective eyewear in polluted or windy environments.
• Workplace Ergonomics: Adjust computer screens to eye level, maintain proper lighting, and follow the “20-20-20 rule” (every 20 minutes, look at something 20 feet away for 20 seconds).
• Hydration: Drink adequate water (at least 2-3 litres per day), especially in hot climates.
• Humidifiers: Use in dry indoor environments to maintain optimal humidity.

2. Eyecare Practices

• Artificial Tears: Lubricating eye drops are often the first-line therapy for dry eyes. Preservative-free variants are preferred for frequent use.
• Warm Compresses: Applying a warm, moist cloth over closed eyelids can help in blepharitis and meibomian gland dysfunction.
• Proper Eyelid Hygiene: Cleaning eyelids daily with diluted baby shampoo or commercial eyelid cleansers.
• Contact Lens Hygiene: Always follow the recommended cleaning and replacement schedule. Remove lenses at the first sign of irritation.

3. Medications

• Antihistamine Eye Drops: For allergic conjunctivitis.
• Antibiotic or Antiviral Eye Drops: Prescribed if infection is confirmed.
• Anti-inflammatory Drops: Steroid or non-steroidal drops may be used in severe inflammation under medical supervision.
• Immunomodulatory Agents: For chronic dry eye not responding to standard therapies (e.g., cyclosporine eye drops).

4. Treating Underlying Conditions

• Managing systemic diseases like diabetes, thyroid disease, or autoimmune disorders with the help of specialists.
• Allergic conditions may require oral antihistamines, nasal sprays, or allergy avoidance strategies.

5. Advanced Therapies

• Punctal Plugs: Tiny devices inserted into tear ducts to reduce tear drainage and keep the eyes moist.
• Intense Pulsed Light Therapy: Used for certain cases of meibomian gland dysfunction.
• Surgical Correction: Rarely required for anatomical problems or severe cases.

Prevention of Burning Eyes

While not all cases can be prevented, the following measures can reduce the likelihood or severity of burning eyes:

• Minimise exposure to smoke, dust, and chemical irritants.
• Adopt safe screen usage habits (frequent breaks, correct posture, adequate lighting).
• Wear sunglasses or protective eyewear outdoors, especially in dusty or sunny conditions.
• Maintain good personal and contact lens hygiene.
• Avoid rubbing eyes with unwashed hands to prevent infection.
• Manage allergies proactively, especially during high pollen seasons.
• Eat a balanced diet rich in omega-3 fatty acids (found in flaxseeds, walnuts, and fish) which may support eye health.

When to Seek Medical Attention

While mild burning eyes often resolve with simple measures, urgent medical attention is needed if you experience:

• Sudden vision loss or blurring
• Severe pain or sensitivity to light
• Trauma or chemical exposure
• Profuse discharge or swelling
• Failure to improve with over-the-counter remedies

Prompt evaluation by an ophthalmologist can prevent complications and ensure appropriate management.

Myths and Misconceptions

• Myth: All eye drops are safe for burning eyes.
• Fact: Some drops (especially those with steroids or preservatives) can worsen certain conditions and should only be used as prescribed.
• Myth: Splashing eyes with cold water cures burning.
• Fact: While it may provide temporary relief, it does not address the underlying cause and may not be effective for all types.
• Myth: Eye burning is always caused by infection.
• Fact: Many non-infectious causes (like dry eye or allergy) are also common.

Nursing Care of a Patient with Burning Eyes

Nursing Interventions

Immediate Relief Measures:

• Encourage the patient not to rub or touch the eyes.
• Advise gentle washing of the eyes with clean, cool water if a chemical or irritant exposure is suspected.
• Apply cold compresses to the closed eyelids to reduce burning and inflammation.

Medication Administration:

• Administer prescribed lubricating eye drops or artificial tears to alleviate dryness and irritation.
• If infection is suspected, administer antibiotic or antiviral eye drops as ordered.
• Antihistamine or anti-allergy drops may be used if an allergic reaction is identified.

Environmental Control:

• Ensure the patient is in a well-ventilated, dust-free environment.
• Advise avoidance of exposure to smoke, strong odours, or chemical fumes.
• Adjust lighting to avoid glare and eye strain.

Patient Education:

• Educate the patient on proper hand hygiene before touching the eyes.
• Demonstrate the correct technique for instilling eye drops.
• Advise on the importance of not sharing towels, handkerchiefs, or cosmetics.
• Instruct on the need to avoid contact lens use until symptoms subside and as advised by a physician.

Monitoring and Evaluation:

• Regularly assess for improvement or worsening of symptoms.
• Monitor for signs of complications such as persistent redness, vision changes, or severe pain, and report promptly to the physician.

Prevention and Health Promotion

• Encourage the use of protective eyewear when exposed to dust, chemicals, or working in hazardous environments.
• Promote regular eye check-ups, especially for patients with chronic eye conditions or systemic diseases affecting the eyes.
• Advise maintaining hydration and blinking frequently, especially during prolonged screen use.

When to Seek Medical Attention

• Sudden loss of vision or severe pain.
• Persistent redness, swelling, or discharge despite initial care.
• History of chemical splash or trauma to the eye.

REFERENCES

1. American Academy of Ophthalmology. Burning Eyes. https://www.aao.org/eye-health/symptoms/burning-eyes.
2. Dupuis P, Prokopich CL, Hynes A, et al. A contemporary look at allergic conjunctivitis. Allergy Asthma Clin Immunol. 2020;16:5. doi: 10.1186/s13223-020-0403-9.
3. Centers for Disease Control and Prevention. Help protect yourself from getting and spreading pink eye (conjunctivitis). https://www.cdc.gov/conjunctivitis/infographics/protect-yourself.html.
4. National Eye Institute. Blepharitis.https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/blepharitis.
5. Rokohl AC, Loreck N, Wawer Matos PA, et al. More than loss of taste and smell: Burning watering eyes in coronavirus disease 2019. Clin Microbiol Infect. 2020 Nov; 26(11): 1560.e5–1560.e8. doi: 10.1016/j.cmi.2020.08.018
6. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Sjögren’s syndrome.. https://www.niams.nih.gov/health-topics/sjogrens-syndrome
7. Bartlett JD, Keith MS, Sudharshan L, Snedecor SJ. Associations between signs and symptoms of dry eye disease: a systematic review. Clin Ophthalmol. 2015;9:1719-1730. doi:10.2147/OPTH.S89700

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