Ocular surface | Dry eye disease

Dry eye disease occurs when tears are not able to produce adequate moisture and the ocular surface becomes inflamed. It is especially common in older people and women. 

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Overview

Dry eye disease, also called dysfunctional tear syndrome, is a common condition affecting about one in 11 people worldwide.1  Inflammation and tear osmolarity are the underlying mechanisms that cause dry eye. When tears are not able to produce adequate moisture, the ocular surface becomes inflamed.

 

Quality of life and daily activities can be greatly impacted by dry eye symptoms, creating a significant psychological impact. Patients have reported a willingness to trade years at the end of their lives to be free of dry eye disease.2

 

Identifying patients with dry eye and related ocular surface diseases provides the ability to categorize these patients for better dry eye or perioperative management, which leads to many clinical advantages, such as better outcomes, reduced complications and better patient care.

 

Symptoms of dry eye include: 

 

  • Dryness

  • Burning

  • Light sensitivity

  • Foreign body sensation 

  • Ocular pain

  • Blurred vision

  • Visual fatigue

  • Discomfort 

Dry eye is not contagious. It is a condition that occurs in some people. The prevalence of dry eye increases with age and is more common in women. Risk factors include:

 

  • Use of certain medications, including antihistamines, antidepressants and long-term use of glaucoma drops

  • Autoimmune inflammatory diseases

  • Contact lens wear 

  • LASIK and refractive surgery

  • Menopause

  • Rheumatoid arthritis

  • Sjogren’s syndrome  

For those destined to develop dry eye disease, there is currently no known way to prevent the disease. However, there are recommended ways to alleviate the symptoms to avoid drying out eyes such as:

 

  • Using a home air filter, especially in cities with air pollution 

  • Using a home humidifier 

  • Limiting use of fans and hair dryers

  • Avoiding smoke

  • Wearing protective eyewear

  • Blinking more frequently

  • Using artificial tears

The lack of correlation between clinical signs and symptoms of dry eye disease makes diagnosing and treating patients a challenge. Oftentimes, inflammation is present before the clinical signs of dry eye. Tests to measure tear volume, tear quality and elevated matrix metalloproteinase-9 can help diagnose dry eye disease.

 

Dry eye disease may require an extensive treatment plan and continuous therapy. Various dry eye disease treatment plans are available, based on the discretion of a medical professional. Treatments options can include:

 

  • Over-the-counter artificial tears, gels, and ointments

  • Topical anti-inflammatory therapy, such as cyclosporine, corticosteroids and azithromycin 

  • Oral anti-inflammatory medications, such as doxycycline

  • Oral omega-3 supplements

  • Punctal plugs

References

  1. Papas EB. The global prevalence of dry eye disease: A Bayesian view. Ophthalmic Physiol Opt. 2021;41(6):1254-1266. https://doi.org/10.1111/opo.12888

  2. Schiffman RM, Walt JG, Jacobsen G, et al. Utility assessment among patients with dry eye disease. Ophthalmology. 2003;110(7):1412-1419. https://doi.org/10.1016/S0161-6420(03)00462-7

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