Current Approach to Dry Eye Disease

Abstract

Dry eye disease (DED) is a multifactorial disease of the tears and ocular surface that causes tear film instability with potential damage to the ocular surface. The prevalence of dry eye in the world population ranges from 6 to 34 %. It is more common in those aged over 50, and affects mainly women. Since the introduction of the Schirmer's test in 1903, other tests have been developed to evaluate dry eye, such as biomicroscopy, the tear film breakup time (BUT), vital dyes (lissamine green and rose bengal), fluorescein, leaf fern test, corneal sensitivity test, conjunctiva impression cytology, optical coherence tomography (OCT), and tear osmolarity measurement. Although there is no gold standard, it is advisable to combine at least two tests. Strategies for treating DED have recently been modified and include patient education, tear substitute, corticosteroids, secretagogues, fatty acids, immunomodulators, occlusion of lacrimal puncta surgery and, tarsorrhaphy. Biological therapy and new topical immunomodulators such as tacrolimus, tofacitinib and IL-1 receptor inhibitor are being tested. In this review, the evaluation tests for dry eye are compared and the main studies on treatment are presented, with emphasis on studies in patients with Sjögren's syndrome. The authors propose an approach for the management of dry eye.

Analysis of novel Sjogren’s syndrome autoantibodies in patients with dry eyes

“…Because the use of tear osmolarity has been suggested as a good indicator for lacrimal gland dysfunction in early Sjogren’s syndrome [11], we evaluated tear osmolarity in normal controls and patients with keratoconjunctivitis sicca. Figure 1 demonstrates that tear osmolarity did not distinguish these two groups ( p  = .388).…”

Variations of dry eye disease prevalence by age, sex and geographic characteristics in China: a systematic review and meta-analysis

“…Although these debilitating symptoms do not lead to severe visual impairment and blindness, they are highly related to the reduction in vision-related quality of life and interfere with daily activities [6-8]. Furthermore, the limited ability to produce tears may result in an increased risk of ocular infection and ocular surface damage, or even abrasion or corneal ulceration in severe cases [5,9]. …”

“…There is still no gold diagnostic procedure of DED [9,10], and the treatment of DED is only a temporarily symptomatic relief and improvement [3,9]. Common symptom-based questionnaires include the Ocular Surface Disease Index and the Dry Eye Questionnaire [1].…”

Therapeutic Strategies to Treat Dry Eye in an Aging Population

“…Tacrolimus, a calcineurin inhibitor which inhibits the production of IL-2, has also been evaluated in DE, after its successful use in vernal keratoconjunctivitis and graft-versus-host disease (GVHD) [89]. While it's mechanism of action is similar to CsA, it has a significantly greater potency in vitro , with effects at 100 times lower concentrations [90].…”