Dry Eye Disease: Early Recognition with Guidance on Management and Treatment for Primary Care Family Physicians

Abstract

Primary care presentations of dry eye disease (DED) are common and pose a diagnostic challenge due to the variety of symptoms and the absence of certainty for family practitioners. While there are many published articles on the topic, the 2017 Tear Film and Ocular Surface Society Dry Eye Workshop was a landmark report in distinguishing multifactorial differences. Redefined terms clarified the DED disorder. The ocular surface—the tear/air interface—is the primary refractive component of the eye, which is why DED is so significant and impacts vision. There is a high prevalence of DED in the community, ranging from 5% to 30% of people across multiple studies. Elderly patients have up to 75% increased risk of DED and receive more intensive treatment than younger age groups. DED is also more common in women than men, occurring in 9.8% of postmenopausal women. The causes of DED span defective lacrimal apparatus and systemic disorders. Despite its prevalence, up to one-half of patients with confirmed DED do not receive proper alleviating treatment. Risk factors on functional and environmental bases follow. Tools to elicit a diagnosis more confidently are outlined using the Ocular Surface Disease Index (OSDI) and the Symptom Assessment in Dry Eye questionnaires (SANDE). Lacritin, lutein, vitamin A, and balanced nutrition are essential contributors to maintaining healthy eyes with appropriate management and treatment. The authors hope that this paper will prompt a more accurate and expedient diagnosis of DED in primary care practice and an earlier recognition of specialist referrals. Electronic supplementary material The online version of this article (10.1007/s40123-020-00308-z) contains supplementary material, which is available to authorized users.

A Narrative Review of Current Understanding and Classification of Dry Eye Disease with New Insights on the Impact of Dry Eye during the COVID-19 Pandemic

“…Clinical assessments should examine the production and quality of tears and identify damage at the ocular surface. Standard tests include tear film break-up time (TBUT), Schirmer’s test (with/without anaesthesia) and ocular surface staining/corneal fluorescein staining (CFS; Oxford scale grade) [ 5 , 7 , 18 , 19 ]. Slit lamp examination of the eyelashes, eyelid margins and meibomian gland orifices (with expression of meibomian secretion) is also helpful in identifying MGD [ 5 , 7 , 18 , 19 ].…”

Efficacy of hyaluronic acid 0.3%, cyanocobalamin, electrolytes, and P-Plus in menopause patients with moderate dry eye disease

“…Currently, there are several strategies for the treatment of dry eyes, whereby autologous serum [10], surgical interventions [11] or combinations of lubrication and anti-inflammatory agents [12] have been used. In many cases, nutritional supplementation [13], such as that with omega-3 and omega-6 fatty acids, and temporary occlusion of the dry eye [14] are considered reasonable recommendations. The current understanding of the ocular surface changes in patients with dry eye syndrome results from hyperosmolarity of the tear film, inflammatory processes, and oxidative stress.…”

An Overview on Dry Eye Disease Evaluation and Management Approach in Primary Health Care Centre

“…Primary health care practitioners are well-positioned for this task as such disease can be encountered frequently in primary health care centers. Nevertheless, long periods of reading, being hooked to a computer screen for prolonged hours, using the contact lens long-term, rapid air-current flow, decreased dampness like on passenger flights, and first contact to compounds as in respired cigarette smoke are all moderate risk factors that may be controlled or avoided [29]. Long-term usage of a digital gadget like a computer screen reduces the rate of blinking and causes eye stress.…”

“…Ophthalmic gels used overnight, as well as twice-daily artificial tear replacement, help to maintain moisture levels. Warm eye compresses help to increase Meibomian gland production and smooth the surface of the eyes, and extra lid cleanliness is recommended [29].…”

“…Topical omega-3 alpha-linoleic acid demonstrated a substantial reduction in the symptoms of dry eye and swelling alterations at both the molecular and cellular levels in recent research. It has been suggested that high parenteral dosages of vitamin D therapy reduced DED by lowering the swelling of the optical surface, increasing tear production, and lowering tear instability, however, this is no longer advised as a first-line treatment [4,29].…”