Dry Eye Syndrome
Disease Details
Family Health Simplified
- Description
- Dry eye syndrome is a condition where the eyes do not produce enough tears or the right quality of tears to keep them properly lubricated.
- Type
- Dry eye syndrome, also known as keratoconjunctivitis sicca, is primarily influenced by environmental factors, lifestyle, and underlying health conditions rather than genetic factors. It is not typically inherited in any specific genetic transmission pattern. However, certain genetic predispositions may contribute to the risk of developing conditions associated with dry eye syndrome, such as autoimmune diseases.
- Signs And Symptoms
- Typical symptoms of dry eye syndrome are dryness, burning and a sandy-gritty eye irritation that gets worse as the day goes on. Symptoms may also be described as itchy, stinging or tired eyes. Other symptoms are pain, redness, a pulling sensation, and pressure behind the eye. There may be a feeling that something, such as a speck of dirt, is in the eye. The resultant damage to the eye's surface increases discomfort and sensitivity to bright light. Both eyes usually are affected.There may also be a stringy discharge from the eyes. Although it may seem contradictory, dry eye can cause the eyes to water due to irritation. One may experience excessive tearing such as if something got into the eye. These reflex tears will not necessarily make the eyes feel better since they are the watery tears that are produced in response to injury, irritation, or emotion which lack the lubricating qualities necessary to prevent dry eye.Because blinking coats the eye with tears, symptoms are worsened by activities in which the rate of blinking is reduced due to prolonged use of the eyes. These activities include prolonged reading, computer usage (computer vision syndrome), driving, or watching television. Symptoms increase in windy, dusty or smoky (including cigarette smoke) areas, in dry environments high altitudes including airplanes, on days with low humidity, and in areas where an air conditioner (especially in a car), fan, heater, or even a hair dryer is being used. Symptoms reduce during cool, rainy, or foggy weather and in humid places, such as in the shower.Most people who have dry eyes experience mild irritation with no long-term effects. However, if the condition is left untreated or becomes severe, it can produce complications that can cause eye damage, instability of the tear film, neurosensory changes, impaired vision, or (rarely) in the loss of vision.
- Prognosis
- Keratoconjunctivitis sicca usually is a chronic problem. Its prognosis shows considerable variance, depending upon the severity of the condition. Most people have mild-to-moderate cases, and can be treated symptomatically with lubricants. This provides an adequate relief of symptoms.When dry eyes symptoms are severe, they can interfere with quality of life. People sometimes feel their vision blurs with use, or severe irritation to the point that they have trouble keeping their eyes open or they may not be able to work or drive.
- Onset
- Dry Eye Syndrome can develop gradually, with the onset varying greatly among individuals. It can be influenced by factors like aging, environmental conditions (e.g., dry climates, prolonged screen use), medical conditions (e.g., autoimmune diseases), and medications. There's no specific nan (nanosecond) measurement related to the onset of Dry Eye Syndrome.
- Prevalence
- The prevalence of dry eye syndrome varies widely based on factors such as age, gender, and geographic location. It is estimated that between 5% to 30% of the global population is affected, with higher rates observed among older adults and women.
- Epidemiology
- Keratoconjunctivitis sicca is relatively common within the United States, especially in patients aged 40 or older. 10–20% of adults experience Keratoconjunctivitis sicca. Approximately 1 to 4 million adults (age 65–84) in the US are affected.While persons with autoimmune diseases have a high likelihood of having dry eyes, most persons with dry eyes do not have an autoimmune disease. Instances of Sjögren syndrome and keratoconjunctivitis sicca associated with it are present much more commonly in women, with a ratio of 9:1. In addition, milder forms of keratoconjunctivitis sicca also are more common in women. This is partly because hormonal changes, such as those that occur in pregnancy, menstruation, and menopause, can decrease tear production.In areas of the world where malnutrition is common, vitamin A deficiency is a common cause. This is rare in the United States.Racial predilections do not exist for this disease.
- Intractability
- Dry eye syndrome, also known as keratoconjunctivitis sicca, is generally not considered intractable. While it is a chronic condition and can be persistent, there are various treatments available that can help manage symptoms effectively. These treatments include artificial tears, prescription eye drops, lifestyle changes, and in some cases, surgery. The goal of treatment is to reduce dryness and discomfort, improve quality of life, and prevent any potential damage to the eye surface.
- Disease Severity
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Dry eye syndrome, also known as dry eye disease, can vary in severity from mild to severe. Severity levels can be classified based on symptoms, clinical findings, and impact on daily activities:
1. **Mild**: Occasional discomfort, mild symptoms such as slight irritation, and infrequent use of artificial tears.
2. **Moderate**: More consistent symptoms like increased dryness, redness, and a feeling of grittiness, requiring more frequent application of artificial tears or other treatments.
3. **Severe**: Persistent and significant symptoms, including chronic dryness, pain, visual disturbances, and potential damage to the surface of the eye, which may necessitate advanced treatments such as prescription medications, punctal plugs, or surgery.
The severity can impact quality of life and often requires tailored management strategies. - Healthcare Professionals
- Disease Ontology ID - DOID:10140
- Pathophysiology
- Having dry eyes for a while can lead to tiny abrasions on the surface of the eyes. In advanced cases, the epithelium undergoes pathologic changes, namely squamous metaplasia and loss of goblet cells. Some severe cases result in thickening of the corneal surface, corneal erosion, punctate keratopathy, epithelial defects, corneal ulceration (sterile and infected), corneal neovascularization, corneal scarring, corneal thinning, and even corneal perforation.Another contributing factor may be lacritin monomer deficiency. Lacritin monomer, active form of lacritin, is selectively decreased in aqueous deficient dry eye, Sjögren syndrome dry eye, contact lens-related dry eye and in blepharitis. The ocular surface microbiome, composed of a diverse community of microorganisms, has been implicated in the pathogenesis of dry eye syndrome, potentially influencing the ocular surface inflammation and homeostasis.
- Carrier Status
- Dry eye syndrome is not a condition that has a carrier status. It typically results from inadequate tear production or poor tear quality, leading to dryness and discomfort in the eyes. It is primarily associated with environmental factors, aging, certain medications, and underlying health conditions rather than genetic inheritance.
- Mechanism
-
Dry Eye Syndrome, also known as keratoconjunctivitis sicca, primarily results from insufficient tear production or excessive tear evaporation. The multifactorial mechanisms involve:
1. **Mechanism**:
- **Quantitative Tear Deficiency**: Impaired lacrimal gland function leads to inadequate tear volume.
- **Qualitative Tear Deficiency**: Disrupted tear film stability due to abnormal composition.
- **Evaporative Loss**: Increased evaporation due to meibomian gland dysfunction or environmental factors like low humidity.
2. **Molecular Mechanisms**:
- **Lacrimal Gland Dysfunction**: Inflammatory cytokines such as IL-1, IL-6, and TNF-α can impair tear secretion by damaging the lacrimal gland.
- **Meibomian Gland Dysfunction (MGD)**: Hyperkeratinization and inflammation of the meibomian glands reduce lipid secretion, increasing tear evaporation.
- **Tear Film Instability**: Reduced mucin production from conjunctival goblet cells compromises tear film integrity, exacerbating ocular surface desiccation.
- **Hyperosmolarity of Tear Film**: Leads to cellular stress and further inflammation on the ocular surface.
- **Immune Response**: Chronic inflammation involves a complex interplay of immune cells (e.g., T-cells) and mediators that perpetuate ocular surface damage.
Addressing these pathways can help in developing targeted treatments for managing Dry Eye Syndrome effectively. - Treatment
- A variety of approaches can be taken to treat dry eye syndrome. Approaches include: avoidance of exacerbating factors (things that make it worse), tear stimulation and supplementation, increasing tear retention, eyelid cleansing, and treatment of eye inflammation.Conditions such as blepharitis can often co-exist and paying particular attention to cleaning the eyelids morning and night with mild soaps and warm compresses can improve both conditions.
- Compassionate Use Treatment
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For Dry Eye Syndrome (DES), several compassionate use treatments, off-label, or experimental treatments may be considered:
1. **Compassionate Use Treatments:**
- **Autologous Serum Eye Drops:** These are made from the patient's own blood and can provide growth factors and nutrients to support eye surface healing.
2. **Off-Label Treatments:**
- **Low-Dose Naltrexone:** Although typically used for opioid dependence, low doses are sometimes used off-label for their immunomodulatory effects to reduce inflammation.
- **Platelet-Rich Plasma (PRP) Eye Drops:** Often used for healing wounds, these eye drops contain concentrated platelets from the patient's own blood to promote tissue repair.
3. **Experimental Treatments:**
- **Intranasal Tear Neurostimulation Devices:** These devices stimulate the trigeminal nerve through the nasal cavity, promoting natural tear production.
- **Regenerative Medicine Techniques (e.g., Stem Cell Therapy):** Experimental approaches that use stem cells to regenerate damaged tissue on the ocular surface.
It's important for patients to consult with their healthcare provider to discuss the efficacy, risks, and suitability of these treatments for their specific case. - Lifestyle Recommendations
-
For dry eye syndrome, lifestyle recommendations include:
1. **Stay Hydrated**: Drink plenty of water throughout the day.
2. **Blink Regularly**: Especially when using screens or reading.
3. **Use a Humidifier**: Add moisture to the air in your home or office.
4. **Wear Sunglasses**: Protect your eyes from wind and harsh sunlight.
5. **Take Breaks During Tasks**: Follow the 20-20-20 rule; every 20 minutes, look at something 20 feet away for at least 20 seconds.
6. **Adjust Your Environment**: Avoid smoking and limit exposure to fans or air vents blowing directly in your face.
7. **Follow a Balanced Diet**: Include omega-3 fatty acids, which can be found in fish like salmon or in supplements.
8. **Use Warm Compresses**: Apply to your eyes to help open clogged oil glands.
9. **Good Sleep Hygiene**: Ensure you get adequate rest to help your eyes recover.
Implementing these habits can help manage and reduce the symptoms of dry eye syndrome. - Medication
- Inflammation occurring in response to tears film hypertonicity can be suppressed by mild topical corticosteroids or with topical immunosuppressants such as ciclosporin (Restasis, Vevye). Elevated levels of tear NGF can be decreased with 0.1% prednisolone.
- Repurposable Drugs
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Repurposable drugs for dry eye syndrome include:
1. **Cyclosporine**: Originally used as an immunosuppressant in transplant patients, it is now available in eye drop form (Restasis) to increase tear production.
2. **Lifitegrast**: Initially developed for treating inflammatory conditions, this drug (Xiidra) targets proteins involved in the inflammatory pathway of dry eye.
These drugs have been found effective in addressing the underlying inflammation and improving tear production associated with dry eye syndrome. - Metabolites
-
For dry eye syndrome, the term "metabolites" generally refers to the small molecules that are involved in or produced by the body's metabolic processes that may be related to the condition. These can include inflammatory markers, lipids, and proteins in the tear film or ocular surface. Specifically, in the context of dry eye syndrome:
1. **Lipid metabolites**: Alterations in lipid composition in the tears can affect tear film stability and contribute to dryness. For instance, reduced levels of meibum lipids (produced by the meibomian glands) can lead to increased tear evaporation.
2. **Inflammatory cytokines**: Elevated levels of inflammatory cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-α), are often found in the tears of individuals with dry eye syndrome.
3. **Reactive oxygen species (ROS)**: Increased oxidative stress and ROS can damage the ocular surface and exacerbate the symptoms of dry eye syndrome.
Understanding these metabolites' role can help in diagnosing and developing targeted therapies for dry eye syndrome. - Nutraceuticals
- There isn't substantial scientific evidence to support the efficacy of nutraceuticals for the treatment of dry eye syndrome. However, some studies suggest that omega-3 fatty acids, such as those found in fish oil, may help improve symptoms. Always consult a healthcare professional before starting any new supplement regimen.
- Peptides
- Peptides have shown promise in the treatment of dry eye syndrome due to their roles in modulating inflammation, promoting healing, and improving tear film stability. Topical peptide treatments can potentially enhance the health and function of the ocular surface. Specific peptides are being researched and developed to target various aspects of dry eye pathology, including increasing mucin production and reducing ocular surface inflammation. However, clinical use and availability may vary based on ongoing research and regulatory approval.