Aqueous-deficient dry eye disease: Preferred practice pattern guidelines on clinical approach, diagnosis, and management

Abstract

Dry eye disease (DED) is a broad term that includes a diverse group of clinical disorders. Aqueous-deficient dry eye (ADDE), a subtype of DED, is characterized by decreased tear production by the lacrimal gland. It can be seen in up to one-third of individuals with DED and can be comorbid with a systemic autoimmune process or occur secondary to an environmental insult. Since ADDE can be a source of long-term suffering and severe visual impairment, early identification and adequate treatment are imperative. Multiple etiologies can underlie ADDE, and it is critical to identify the underlying cause to not only improve the ocular health but also to improve the overall quality of life and well-being of affected individuals. This review discusses the various etiologies of ADDE, highlights a pathophysiology-based approach for evaluating underlying contributors, outlines various diagnostic tests, and reviews treatment options. We present the current standards and discuss ongoing research in this field. Through this review, we propose a treatment algorithm that would be useful for an ophthalmologist in diagnosing and managing individuals with ADDE.

Cellular Senescence Exacerbates Features of Aging in the Eyes

“…However, when the lacrimal gland is removed in old mice, SASP proteins in tear fluid, including GDF15, MMP, and vascular endothelial growth factor (VEGF), become concentrated under DE conditions, resulting in stronger ocular phenotypes characterized by corneal opacity and angiogenesis. Similar clinical findings are detected in refractory ocular surface diseases, such as Stevens-Johnson Syndrome 59 , graft versus host disease 60 , ocular cicatricial pemphigoid 61 , or Sjögren's syndrome 62 , which are all associated with severe DE.…”

Seeing through tears: Understanding and managing dry eye disease

“…Although a mixed etiology is common, the primary involvement is either of the lacrimal or meibomian glands. [ 8 , 11 ] This differentiation can be made clinically, does not need sophisticated gadgets, and clarifies the prognosis and need for systemic evaluation or medications. Several medications, both topical and systemic, can be responsible for causing or exaggerating the problem, and therefore the role of these medications needs to be ruled out.…”