Understanding
Dry Eye Disease
Dry Eye Disease in Clinical
Practice
The TFOS DEWS II Epidemiology Report (widely cited in dry eye research) summarizes evidence showing **worldwide prevalence estimates range from about 5% to 50%, depending on geographic region and diagnostic criteria.
RISK FACTORS
REFRACTIVE SURGERY
PROLONGED USE OF ELETRONIC DEVICES
REDUCED INTAKE OF OMEGA 3
ENVIRONMENTAL FACTORS
PROLONGED USE OF CONTACT LENSES
FEMALES
SMOKING
AGEING
SYSTEMIC DRUGS
ENVIRONMENTAL FACTORS
REFRACTIVE SURGERY
PROLONGED USE OF ELETRONIC DEVICES
REDUCED INTAKE OF OMEGA 3
ENVIRONMENTAL FACTORS
PROLONGED USE OF CONTACT LENSES
FEMALES
SMOKING
AGEING
SYSTEMIC DRUGS
ENVIRONMENTAL FACTORS
Causes
Dry eye disease can be caused by a variety of factors that disrupt the healthy tear film, which consists of
three layers, from inside to outside, Mucin, Aqueous and Lipid.
Three layers, from inside to outside, Mucin, Aqueous and Lipid.
Common causes include:
HYPOLACRIMATION
Quantitative defect in aqueous component of tears
DYSFUNCTIONAL LACRIMATION
Quantitative or qualitative defect of mucous or lipid component (like dysfunction of the meibomian glands that leads to excessive evaporation).
NORMAL TEARS
iso-osmolar tears
Normal concentration of solutes
TEARS IN A PATIENT WITH DRY EYES
Hyperosmolar tears
High concentration of solutes and decrease in volume
SymptomS
DED may cause a wide range of ocular symptoms including:
- Redness & Itching
- Mucus secretion
- Intolerance to eye contacts
- Blurry vision
- Halos & giare
- Sensitivity to pain
This is typically accompanied by fluctuating vision with blurred or double vision. These symptoms can significantly impact patients’ quality of life and lead to reduced work and learning efficiency.
DIAGNOSIS
Assessment of the symptoms:
Results – score obtained x25 and :12:
0-12
13-22
23-32
33-100
Normal eye
Mild dry eye
Medium dry eye
Severe dry eye
Assessment of signs:
Ocular surface staining
Using eye stains like fluorescein or lissamine green for evaluation of ocular surface integrity and tear film stability
Schirmer's test
Assesses the tear volume by placing a small strip of paper under the lower eyelid
TBUT test
Measures tear film stability
Treatment
Managing dry eye disease often requires a combination of treatments tailored to the underlying cause.
Common treatments include:
PHASE I:
- Diet variation
- Elimination of systemic drugs that cause DED
- Treatments with artificial tear
PHASE II:
- Topical anti-inflammatory drugs
- Tetracyclines
- punctal plugs
- moisturising lenses
PHASE III:
- Topical anti-inflammatory drugs
- Tetracyclines,
- punctal plugs
- moisturising lenses
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References:
1. Stapleton, F., Alves, M., Bunya, V. Y., Jalbert, I., Lekhanont, K., Malet, F., Na, K.-S., Schaumberg, D., Uchino, M., Vehof, J., Viso, E., Vitale, S., & Jones, L. (2017). TFOS DEWS II Epidemiology Report. The Ocular Surface, 15(3), 334–365.
2. Craig, J. P., Nichols, K. K., Akpek, E. K., Caffery, B., Dua, H. S., Joo, C.-K., Liu, Z., Nelson, J. D., Nichols, J. J., Tsubota, K., & Stapleton, F. (2017). TFOS DEWS II Definition and Classification Report. The Ocular Surface, 15(3), 276–283.
3. Bron, A. J., de Paiva, C. S., Chauhan, S. K., Bonini, S., Gabison, E. E., Jain, S., Knop, E., Markoulli, M., Ogawa, Y., Perez, V. L., Sanchis-Gimeno, J. A., Schaumberg, D. A., Uchino, M., Vehof, J., Willcox, M. D., & Stapleton, F. (2017). TFOS DEWS II Pathophysiology Report. The Ocular Surface, 15(3), 438–510.