- Dry eye disease is one of the most common, chief-complaints presenting in clinical practice, with a prevalence of up to 50% of the population.
- Evaporative dry eye, as a result of meibomian gland dysfunction (abnormal functioning of the oil glands on the top and bottom eyelid margins), is thought to be the biggest contributing factor.
- Female gender, increasing age, Asian ethnicity and autoimmune diseases such as Sjogren’s syndrome and endocrine disorders such as diabetes mellitus and thyroid disease.
- Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis or natural balance of the tear film, and accompanied by ocular symptoms, in which the tears film is not stable on the eye’s surface and the tears can become salty and of poor quality. Ocular surface inflammation and damage can result over time.
- Contributing causes include aging changes, medications (both eye drop and oral medications), hormonal changes, eye allergies, eye surgery, contact lens use and neurological conditions and digital device use.
In the clinic, a comprehensive dry eye diagnostic workup includes:
- Dry Eye Related Symptom Questionnaires, General Health and Medication History, Eye History, Previous Dry Eye Treatment History
- Tests of tear film quality and quantity
- Examination of the eyelids, lid margins and ocular surface usual the slit lamp biomicroscope and digital imaging devices and staining of the eye’s surface tissues using short-acting vital (non-toxic) surface dyes
- Examination of blinking patterns and completeness
Dry eye syndrome is a chronic and typically progressive condition. Depending on its cause and severity, it may not be completely curable. But in most cases, dry eyes can be managed successfully, usually resulting in noticeably greater eye comfort, fewer dry eye symptoms, and sometimes sharper and more stable vision as well.
Restoration of tear film quality and quantity is the ultimate goal in the management of dry eye disease. Determining whether the major cause(s) of an individual’s dry eye is predominantly to aqueous tear deficiency or to evaporative causes such as meibomian gland dysfunction, or both, is critical in helping select the most appropriate management strategy.
Recognised, validated and approved treatments include:
- Education regarding the condition, its management, treatment and prognosis
- Modification of local environment and behaviours- increased oral hydration, blink training, removing eye makeup thoroughly, eye lid cleaning, taking frequent breaks during digital device use, use of desk side and bedside humidifiers
- Education regarding potential dietary modifications (including oral essential fatty acid supplementation)
- Identification and potential modification/elimination of causative systemic and topical medications
- Ocular lubricants of various types including lipid-based lubricants, gels and ointments and non-preserved
ocular lubricants to minimize preservative-induced toxicity
- Tear conservation using punctal occlusion/cautery and moisture chamber spectacles/goggles
- In-office, physical heating and expression of the meibomian glands
- In-office intense pulsed light therapy
- Prescription drugs to manage dry eye disease including topical antibiotic or antibiotic/steroid combination applied to the lid margins, topical corticosteroid (limited-duration use), topical secretagogues, topical immunomodulatory drugs (such as cyclosporine and lifitegrast), oral macrolide or tetracycline antibiotics, oral secretagogues, autologous/allogeneic serum eye drops, Manuka honey eye drops
- Therapeutic contact lens options: soft bandage lenses and rigid scleral lenses
- In advanced cases of dry eye disease surgical interventions such as amniotic membrane grafts, corrective eyelid positional surgery and tarsorrhaphy may be considered.
What is dry eye disease?
Dry eye disease is a chronic condition that occurs when you do not produce enough tears or the tears are of poor quality. It typically affects women more than men but can be a real problem for both men and women. Types of dry eye disease include the following:
Meibomian gland dysfunction causing poor tear quality and high tear evaporation rates; and aqueous tear deficiency with or without an underlying autoimmune disease.
What factors worsen symptoms of dry eye?
Low humidity environments (dry, windy weather, air-conditioning) increase tear evaporation from the surface of the eye. Activities that reduce blink rate and completeness such as screen based digital devices. Taking medications orally that reduce tear production such as anti-histamines, some blood pressure medications, anti-depressant and antianxiety medications, oral contraceptives and hormone replacement therapy and acne medications such as isotretinoin.
My eyes are watery but I have been told I have dry eye – why is this so?
Ironically, an early symptom of dry eye can be watery eyes. Under lower humidity conditions, an unstable tear film can evaporate quickly exposing the eye’s surface tissue and ocular surface feedback mechanism results increased tear production.
Additionally, chronic dry eye is associated with inflammation of the eye’s surface tissues and this can retard the drainage of the tears from the eye leading to an overflow of tears onto the lids.
Can Dry Eye Be Cured?
Dry eye is a chronic progressive condition in most cases. Treatment can improve signs and symptoms but not cure the condition. Ongoing management with home-based based and clinic-based treatments may be required in moderate to severe dry eye cases.
Can I lose vision from dry eye?
Yes. In moderate to severe cases of dry eye, fluctuations in vision are common.
Chronic damage to the surface of the eye can lead to superficial ocular surface damage which can resolve completely with treatment.
More severe chronic damage can lead to corneal scarring, increased risk of sight threatening eye infection and poorer outcomes from eye surgery procedures.
Is there anything I can do to prevent getting dry eye?
Yes. Increasing your oral hydration, increasing your Omega 3 intake in your diet, reducing your exposure to dehydrating temperature-controlled environments and removing eye make up well.