A healthy tear film bathes our ocular surface, including the cornea, in moisture and nutrients with every blink. Dry eye occurs when our lacrimal glands do not make enough tears, or the tear film evaporates too quickly because the quality of the tear film is poor. Without the proper balance of water, oil and proteins (mucins), our tear film cannot nourish, moisturize, clean and protect the ocular surface. When out of balance, tear film instability can lead to inflammation and damage to the ocular surface. Dry eye disease is a type of ocular surface disease.

There are many contributing factors to dry eye, from medication side effects (i.e., oral antihistamine or blood pressure meds), to a dry, dusty or smoky environment, or not blinking for long periods such as long hours staring at digital screens. Dry eye from contact lens use has its name, CLIDE, for contact lens-induced dry eye. All those mentioned above are modifiable factors that contribute to dry eye. Still, other common causes such as aging, eye surgery and effects from underlying conditions (thyroid, diabetes, rheumatoid arthritis, Sjogren’s syndrome or Parkinson’s) can be more difficult to correct. Common causes of ocular surface dysfunction are meibomian gland dysfunction (MGD), anterior blepharitis, allergic conjunctivitis and anterior uveitis.

Treatment is a multi-prong approach that depending on the cause, aims to reduce inflammation and restore the function of the lacrimal gland to meibomian gland, thereby restoring the integrity of the tear film. Steroids are often used to treat inflammation in ocular surface disease. But they can only be used for short durations and have serious side effects, such as increasing the risk of glaucoma. Thankfully, new anti-inflammatory options that aren’t steroids are under development and are better tolerated with minimal side effects.

Reena Mukamai’s article on “Improved Dry Eye Drugs for 2022 and Beyond” details improved and safer treatment options under development for common conditions linked to ocular surface disease, including MGD, anterior blepharitis caused by Demodex mite infestation, allergic conjunctivitis and anterior uveitis (www.aao.org).

If you are experiencing dry eye symptoms, get a comprehensive eye evaluation by an optometrist or ophthalmologist specializing in dry eye. Dry eye does not get better on its own and can become a chronic condition requiring long-term treatment. Dry eye is more successfully treated in the early stages. Self-treating with over-the-counter lubricating eye drops will provide some relief but may delay medical assessment and treatment, which can allow the disease to progress and become harder to manage.

Deborah Kotob
Pro to Pro Director
[email protected]