What could be the cause of chronic dry eye? – 2024-07-20 11:30:03

Intense “burning” or itching in the eyes is a symptom that many of us have experienced, but it is estimated that for 7% of adults dry eyes are not a temporary discomfort. It is a chronic disorder that seriously affects their quality of life and is often difficult to treat.

Existing evidence shows that chronic dry eye (or dry eye syndrome) increases with age: it is estimated that less than 3% of people aged 18-34 years suffer, compared to 18% of people over 75 years of age, and cases are more common in women .

In the US, the Chronic Dry Eye In America Survey showed that although almost half of survey participants (48%) strictly followed the treatment recommended by their eye doctors, only 13% had sustained relief from their symptoms.

Also, most sufferers of dry eye syndrome said that over-the-counter eye drops alone did not improve their condition enough, so they sought additional treatments. Among other things, they drink more water (reported by 76% of participants), use warm patches (hot compresses by 56%) and blink frequently (52%).

45% said that they avoid smoking or being in places with smokers and 34% that they remove their make-up very carefully.

However, most said they have to live with multiple symptoms, with the most common being dry eyes (76%), the feeling that there is something in the eye (64%), eye fatigue (62%), sensitivity to light (62%) and blurred vision (60%). They also reported burning and itching causing them to rub their eyes persistently.

“We know that dry eye syndrome is a type of ocular surface disease, which includes a group of disorders that cause reduced tear production or good quality tears,” says Dr. Anastasios-I. Kanellopoulos, MD, Ophthalmological Surgeon, founder and scientific director of the LaserVision Ophthalmology Institute, Professor of Ophthalmology at New York University and adds:

“Tears are necessary to lubricate the eyes, and their lack or poor quality causes dryness. Ocular surface disease is a complex pathological entity, as it has many subtypes that often have overlapping symptoms, and therefore, making the correct diagnosis is not always easy.

Among others, allergic conjunctivitis, blepharitis, meibomian gland dysfunction, floppy eyelid syndrome, frequent and persistent “wiping” of the eyelids (mucous fishing syndrome), corneal dystrophies and toxic reactions to drugs or cosmetics are some of the disorders that may have symptoms similar to those of dry eye syndrome.

In these cases, however, artificial tears provide only temporary relief, as they do not address the underlying cause.

In our country, it is noted that a large group that is underdiagnosed is the large number of women who have dry eyes due to underlying thyroid disease or another autoimmune disease.

So many symptoms can be considered and treated as dry eye syndrome, but the patients do not see improvement because their true cause is something else”, points out Mr. Kanellopoulos, noting that “chronic dry eye sufferers should not despair, those who are not seeing improvement, because according to the American Academy of Ophthalmology (AAO), there are specialized diagnostic tools that can pinpoint the exact cause of their symptoms, as well as a variety of treatments that may help.”

“Modern diagnostic tests can determine e.g. if someone has dry eye syndrome or if they suffer from any other type of ocular surface disease. The test for example Tearlab Osmolarity System (measurement of the osmolality of the tear layer) can show if someone has dry eye syndrome and how severe it is.

Other tests assess the quality of the tears, and imaging tests look for any problems with the meibomian glands, which produce an oil found in healthy tears.

Special imaging tests, such as optical coherence tomography (OCT), can also be done to check the corneal epithelium. This last, “easy” test for the patient, has been researched and established worldwide by our own scientific team in Athens,” emphasizes Mr. Kanellopoulos.

“Getting a correct diagnosis is key because there are many treatment options and it can take time to find the right one for a patient. In many cases sufferers are not given one treatment, but a combination of treatments, ranging from artificial tears and changes in lifestyle and diet to blocking the tear ducts with silicone plugs and special medications applied topically or taken by mouth.

Most dry eye sufferers find a solution with the prescription of chronic use of topical cyclosporin eye drops. These are options that are adjusted according to the season and the intensity of the symptoms.

However, in any case it is necessary to treat chronic dry eye correctly, because if left for a long time without proper treatment, it can lead to pain, ulcers or scarring of the cornea. In rare cases, it can cause vision loss”, concludes the professor.

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