Symptoms, Causes, and Diagnosis
of Dry Eye
Click the links below to learn more about Dry Eye symptoms, causes of Dry Eye, and how to determine if you are suffering from Dry Eye.
Dry Eye develops on the ocular surface as a result of tear film instability.1 A weakened tear film cannot adequately lubricate or protect the cornea and conjunctiva.2 This can often lead to symptoms, such as3-5:
- Excessive tearing
- Foreign body sensation
- Blurred vision
- Conjunctival hyperemia
Patients will not always come into your office with an understanding of what they are experiencing. In this video, Susan lists some of the Dry Eye symptoms that she has been feeling. These symptoms would be an indication that Susan is suffering from Dry Eye.
Keep in mind that there is no single cause for your patient’s Dry Eye.6 Risk factors associated with Dry Eye include:
- Hyposecretion due to natural aging—Tear production naturally slows around age 30. But generally, patients don’t begin to experience the symptoms until around age 607
- Menopause—Women are more likely to feel Dry Eye symptoms due to insufficient production of androgen and estrogen, which can affect the function of ocular exocrine glands (including the lacrimal and meibomian glands)7
- Hyperevaporation due to extrinsic environmental conditions, such as6-9:
- Air pollution
- Dry air
- Direct wind
- Air conditioning
- High altitude
- Contact lens wear—Lenses tend to reduce the lipid layer of the tear film and require rewetting of the ocular surface more often. About 50% of contact lens wearers report Dry Eye symptoms1,7
- Taking medications, such as antidepressants, antihistamines, diuretics, and hypnotics7,8
- Ocular surgical procedures, such as LASIK or PRK, which can block the neural connections in the eyes and decrease corneal sensation, leading to less blinking and overexposure of the tear film6,7
- Medical disorders, including autoimmune diseases such as lupus, Sjögren’s syndrome, or rheumatoid arthritis, which attack the exocrine glands (or tissues that contain them) throughout the body7,9
- Nutritional deficiencies, including inadequate levels of omega-36,8 or vitamin A1,9
Because there is no single diagnostic test, it may be difficult to determine if your patients are suffering from Dry Eye. You may have to make a determination based only on patient-reported symptoms. Questionnaires (such as those provided by the Dry Eye Epidemiology Project, McMonnies Dry Eye History, and the Ocular Surface Disease Index) can be an effective way of assessing these symptoms.6
Moderate to severe Dry Eye patients may also exhibit objective signs of Dry Eye. Common tests for objective signs can include9:
- Slit lamp examination—Microscope that allows a detailed evaluation of the
- Schirmer’s test—Strips of filter paper held inside the patient’s lid on the surface of the eye to measure ocular moisture. A finding of ≤10 mm of wetting indicates some degree of Dry Eye10
- Surface staining, such as lissamine green or rose bengal—Colored dyes used to reveal dry spots on the ocular surface
- Tear film break-up time (TFBUT)—Fluorescein dye strips applied to the eyes to evaluate the amount of time it takes the tear film to vanish from the ocular surface. A TFBUT of ≤10 seconds is evidence of Dry Eye10
These tests and questionnaires can help to better assess your patient’s individual case and its severity8.
Indications and Usage
LACRISERT® is indicated in patients with moderate to severe Dry Eye syndromes, including keratoconjunctivitis sicca. LACRISERT® is indicated especially in patients who remain symptomatic after an adequate trial of therapy with artificial tear solutions. LACRISERT® is also indicated for patients with exposure keratitis, decreased corneal sensitivity, and recurrent corneal erosions.
Important Safety Information
LACRISERT® is contraindicated in patients who are hypersensitive to hydroxypropyl cellulose. Instructions for inserting and removing LACRISERT® should be carefully followed. If improperly placed, LACRISERT® may result in corneal abrasion. Because LACRISERT® may cause transient blurred vision, patients should be instructed to exercise caution when driving or operating machinery. Patients should be cautioned against rubbing the eye(s) containing LACRISERT®.
The following adverse reactions have been reported, but were in most instances, mild and temporary: transient blurring of vision, ocular discomfort or irritation, matting or stickiness of eyelashes, photophobia, hypersensitivity, eyelid edema, and hyperemia.
References: 1. The definition and classification of dry eye disease: Report of the Definition and Classification Subcommittee of the International Dry Eye Workshop (2007). Ocul Surf. 2007;5(2):75-92. Available at: http://www.tearfilm.org/dewsreport. Accessed January 5, 2009. 2. Rolando M, Zierhut M. The ocular surface and tear film and their dysfunction in dry eye disease. Surv Ophthalmol. 2001;45(Suppl 2):S203-S210. 3. De Paiva CS, Pflugfelder SC. Diagnostic approaches to lacrimal keratoconjunctivitis. Dry Eye and Ocular Surface Disorders. New York, NY: Marcel Dekker; 2004:269-308. 4. Pflugfelder SC. Dry eye: the problem. In: Pflugfelder SC, Beuerman RW, Stern ME, eds. Dry Eye and Ocular Surface Disorders. New York, NY: Marcel Dekker; 2004:1-10. 5. Stern ME, Beuerman RW, Pflugfelder SC. The normal tear film and ocular surface. Dry Eye and Ocular Surface Disorders. New York, NY: Marcel Dekker; 2004:41-62. 6. The epidemiology of dry eye disease: Report of the Epidemiology Subcommittee of the International Dry Eye Workshop (2007). Ocul Surf. 2007;5(2):93-107. Available at: http://www.tearfilm.org/dewsreport. Accessed January 5, 2009. 7. Murube J, Benítez del Castillo JM, Chenzhuo L, Berta A, Rolando M. The Madrid triple classification of dry eye. Arch Soc Esp Oftalmol. 2003;78(11):587-594.
Available at: http://www.oftalmo.com/seo/archivos/articulo.php?idSolicitud=1252&numR=11&mesR=11&anioR=2003&
idR=76. Accessed January 7, 2009. 8. Management and therapy of dry eye disease: Report of the Management and Therapy Subcommittee of the International Dry Eye Workshop (2007). Ocul Surf. 2007;
5(2):163-178. Available at: http://www.tearfilm.org/dewsreport. Accessed January 5, 2009. 9. Bartlett JD, Jaanus SD, eds. Clinical Ocular Pharmacology. 4th ed. Boston, MA: Butterworth-Heinemann; 2001:324,325,406,407,523,527,528,532,582. 10. Katz JI, Kaufman HE, Breslin C, Katz IM. Slow-release artificial tears and the treatment of keratitis sicca. Ophthalmology. 1978;85(8):787-793.