Chronic Dry Eye Syndrome
By Charles C. Hogge, MD
Dominion Eye Care
Chronic Dry Eye Syndrome
Wow just as the Baby Boomers have finally started to get used to that predictable sign of advancing age reading glasses they are now being confronted with yet another challenge to comfortably growing older, dry eyes.
It is estimated that over 20 million people in the US are currently affected by dry eyes, though it is often under recognized and under treated. For over four million people over age 50, it has a clinically significant impact on their lives. Because it primarily affects older adults it will become an increasing public health issue as “boomers” retire.
Research in recent years has found that inflammation of the ocular surface is a key component of dryness. Numerous factors can trigger inflammation by affecting tear production or quality, New therapies directed at controlling inflammation have recently been developed.
Several epidemiologic studies have found the prevalence of dry eyes to be three times greater for women than men. Known risk factors, besides age and sex, include menopausal hormone therapy, low levels of essential fatty acid intake, connective tissue diseases, and lasik surgery. Other possible risk factors include low androgen levels, use of certain medications, exposure to pollution and airborne particulate matter, diabetes, and genetic predisposition.
Compared to healthy patients, those with severe chronic dry eyes tend to have a lower quality of life and may suffer from decreased productivity and depression; they are more likely to have problems with night driving, reading, computer use, and watching television.
In a dry eye condition symptoms include a sense of grittiness or foreign body sensation, ocular fatigue, pain, soreness, stinging or burning, redness, itching, light sensitivity, and blurred or fluctuating vision. Your ophthalmologist will look for signs of dry eyes by microscopically evaluating your lids, tear film, conjunctiva and cornea.
The treatment of dry eyes is viewed as a continuum which ranges from palliative therapy for mild or episodic cases to major invasive therapy for severe disease.
Essentially all patients benefit from palliative treatment including education, control of exacerbating factors, and ocular lubrication. Preserved tears are recommended for use only once or twice a day, since at higher dosing frequencies the toxic effects of the preservatives may become significant. Nonpreserved solutions may be used as often as needed. Different types of lubricants may selectively benefit different components of the natural tear film. Ointments provide prolonged lubrication but are mostly used during sleep because of their blurring effects.
Patients with more severe or chronic symptoms usually benefit significantly from the use of topical cyclosporine-A (Restasis). It's potent anti-inflammatory effects improve the ocular surface and it has few adverse effects with long-term use. It is the only FDA-approved therapy at present. A new eyedrop medication which appears to stimulate the tear gland to secrete more tears is currently in clinical trials but has not yet received, FDA approval
While ophthalmologists can expect to see more patients with dry eyes over the next 20 years, we are gaining a better understanding of the underlying disease process and developing more effective therapies to control those symptoms that most interfere with an active, healthy lifestyle.