Dry eye disease is caused by decreased tear production, excessive evaporation of tears, or both. It leads to inflammation of the surface of the eye. This inflammation typically results in a gritty or burning sensation and blurred vision. Dry eye disease affects about 5% of the U.S. population and is more common in women and individuals older than 50 years. Risk factors include the use of contact lenses, certain medications (diuretics, antihistamines, isotretinoin, and some antidepressants), connective tissue diseases like Sjogren syndrome, and a history of stem cell transplant. Dry eye disease may also be caused by vitamin A deficiency (can occur with weight loss surgery and malnutrition) or Bell palsy (the eye on the affected side cannot fully close). A higher risk of dry eye is seen in those with a sedentary lifestyle, metabolic syndrome (increased blood pressure, blood glucose, cholesterol levels, and excess abdominal fat), and anxiety and depression, even without the use of psychiatric medications.
Dry eye disease is usually diagnosed based on symptoms and an eye examination. Care must be taken to differentiate from other conditions that present similar to dry eye such as a foreign body in the eye, infection, allergic conjunctivitis, and toxic conjunctivitis (eye inflammation caused by medication or environmental exposure). Initial treatment is usually the use of artificial tears, which lubricates the eye. It is important to be aware of the fact that some over-the-counter artificial tears products contain a preservative that limits the number of times a day the product may be used. Overuse can cause toxic conjunctivitis. Likewise, products that reduce eye redness by constricting blood vessels (i.e., Visine) should also be used sparingly. Ophthalmic gels and ointments may cause blurred vision and should only be used before bedtime.
Aerobic exercise should be encouraged as it increases tear production. Also, ingestion of low-glycemic-index foods like vegetables and whole grains have been associated with improvement in symptoms. For individuals who wear contact lenses, decreased frequency of use or total cessation of use may be recommended. Patients with moderate to severe symptoms should be referred to an ophthalmologist, as should those who fail to improve on initial therapy. Ophthalmologists may prescribe anti-inflammatory medications such as steroids or cyclosporine, autologous serum eye drops (made from components of the patient’s blood), or platelet-rich plasma. Another form of treatment may involve the use of scleral contact lenses. These have a built-in reservoir for tears or ophthalmologic medication. Rarely, surgery may be recommended for patients with abnormal eyelid function or anatomy.
For more information go to the National Eye Institute at:
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