-
Ceska a Slovenska Oftalmologie :... 2021This article provides a comprehensive view of the issue of dry eye. It emphasizes provisions of the Tear Film and Ocular Surface Society, discusses the new... (Review)
Review
This article provides a comprehensive view of the issue of dry eye. It emphasizes provisions of the Tear Film and Ocular Surface Society, discusses the new classification and definition of dry eye based on its pathophysiology, and emphasizes the correct diagnostic and therapeutic approaches, which appears in the form of algorithms. Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles. Dry eye disease is a dynamic and complex disease of the ocular surface and ocular adnexa with known risk factors. It is a disease with a cyclical character, in which the most important step is to find the etiological trigger, to restore homeostasis and break the vicious circle. The key elements in the diagnosis are increased osmolarity of the tear film and inflammation of the ocular surface, which are accompanied by ocular symptoms (discomfort, visual disturbance). Inflammation is not always associated with hyperemia and can be confirmed by several techniques and methods. However, in current clinical practice, there is still no "gold standard" and sufficient tests to diagnose inflammation of the ocular surface. The treatment of dry eye disease must be individualized, dynamic and optimized for each stage of the disease.
Topics: Dry Eye Syndromes; Eye; Humans; Osmolar Concentration; Tears; Vision, Ocular
PubMed: 34107689
DOI: 10.31348/2020/29 -
Survey of Ophthalmology 2020Primary Sjögren syndrome is an autoimmune disease that mainly affects exocrine glands such as the salivary and lacrimal glands. In addition, systemic involvement is... (Review)
Review
Primary Sjögren syndrome is an autoimmune disease that mainly affects exocrine glands such as the salivary and lacrimal glands. In addition, systemic involvement is common. Primary Sjögren syndrome is of particular interest to ophthalmologists as it constitutes an important differential diagnosis in conditions with dry eye disease. In addition, ocular tests for more precisely diagnosing and monitoring primary Sjögren syndrome have become increasingly important, and new therapeutics for local and systemic treatment evolve as a result of increased understanding of immunological mechanisms and molecular pathways in the pathogenesis of primary Sjögren syndrome. We provide an update of interest to ophthalmologists regarding pathogenesis, diagnosis, investigative procedures, and treatment options.
Topics: Animals; Autoimmune Diseases; Autoimmunity; Biopsy; Dry Eye Syndromes; Humans; Lacrimal Apparatus; Sjogren's Syndrome
PubMed: 31634487
DOI: 10.1016/j.survophthal.2019.10.004 -
Deutsches Arzteblatt International Jan 2015Dry eye disease (DED) is common; its prevalence around the world varies from 5% to 34%. Its putative pathogenetic mechanisms include hyperosmolarity of the tear film and... (Review)
Review
BACKGROUND
Dry eye disease (DED) is common; its prevalence around the world varies from 5% to 34%. Its putative pathogenetic mechanisms include hyperosmolarity of the tear film and inflammation of the ocular surface and lacrimal gland. Dry eye is clinically subdivided into two subtypes: one with decreased tear secretion (aqueous-deficient DED), and one with increased tear evaporation (hyperevaporative DED).
METHODS
This review is based on pertinent publications retrieved by a selective PubMed search and on the authors' own clinical and scientific experience.
RESULTS
The diagnostic evaluation of dry eye disease should include a detailed patient history, thorough split-lamp examination, and additional tests as indicated. Few randomized controlled therapeutic trials for dry eye have been published to date. Artificial tears of various kinds are recommended if the symptoms are mild. Lid hygiene is helpful in the treatment of hyperevaporative dry eye, while collagen or silicon plugs can be used for partial occlusion of the efferent lacrimal ducts to treat severe hyposecretory dry eye. The benefit of long-term topical anti-inflammatory treatment of moderate or severe dry eye disease with corticosteroids or cyclosporine A eye drops has been documented in clinical trials on a high evidence level. Orally administered tetraycycline derivatives and omega-3 or omega-6 fatty acids are also used.
CONCLUSION
The treatment of dry eye has evolved from tear substitution alone to a rationally based therapeutic algorithm. Current research focuses on pathophysiology, new diagnostic techniques, and novel therapies including secretagogues, topical androgens, and new anti- inflammatory drugs.
Topics: Anti-Inflammatory Agents; Dry Eye Syndromes; Humans; Lubricant Eye Drops; Medical History Taking; Slit Lamp
PubMed: 25686388
DOI: 10.3238/arztebl.2015.0071 -
International Ophthalmology Oct 2022Dry eye syndrome (DES) is multifactorial and likely to be a cause of concern more so than ever given the rapid pace of modernization, which is directly associated with... (Review)
Review
Dry eye syndrome (DES) is multifactorial and likely to be a cause of concern more so than ever given the rapid pace of modernization, which is directly associated with many of the extrinsic causative factors. Additionally, recent studies have also postulated novel etiologies that may provide the basis for alternative treatment methods clinically. Such insights are especially important given that current approaches to tackle DES remains suboptimal. This review will primarily cover a comprehensive list of causes that lead to DES, summarize all the upcoming and ongoing clinical trials that focuses on treating this disease as well as discuss future potential treatments that can improve inclusivity.
Topics: Dry Eye Syndromes; Humans; Lacrimal Apparatus
PubMed: 35678897
DOI: 10.1007/s10792-022-02320-7 -
European Journal of Pharmaceutical... Aug 2022Dry eye disease (DED), keratoconjunctivitis sicca or dysfunctional tear syndrome, is the most prevalent ophthalmic disease which affects a substantial segment of people... (Review)
Review
Dry eye disease (DED), keratoconjunctivitis sicca or dysfunctional tear syndrome, is the most prevalent ophthalmic disease which affects a substantial segment of people worldwide with increasing frequency. It is considered a multifactorial disease of the ocular surface and tear film, characterized by a variation of signs and symptoms. The symptoms range from mild to severe itching, burning, irritation, eye fatigue, and ocular inflammation that may lead to potential damage to the cornea, conjunctiva and even vision loss. Correspondingly, depending on the different manifestations and pathophysiology, the treatment must be tailored specifically to each patient by targeting the specific mechanisms implicated in their disease. Currently, there are several medical products and techniques available or under investigation for the treatment of DED. The present article focused on the pathophysiology of DED, the new diagnostic approach and the recently developed drug delivery systems or devices reducing the progress of the disease and treating the causes.
Topics: Conjunctiva; Cornea; Dry Eye Syndromes; Humans; Inflammation; Pharmaceutical Preparations; Tears
PubMed: 35568107
DOI: 10.1016/j.ejps.2022.106206 -
Indian Journal of Ophthalmology Apr 2023The endocrine system influences all tissues and cells in the human body. The ocular surface is constantly exposed to circulating hormones and expresses their specific... (Review)
Review
The endocrine system influences all tissues and cells in the human body. The ocular surface is constantly exposed to circulating hormones and expresses their specific receptors. Dry eye disease (DED) is a disorder with multifactorial etiology, and endocrine anomalies are one of the inciting factors. The endocrine anomalies that cause DED include physiological conditions such as menopause, menstrual cycle variations, pathologies such as polycystic ovarian syndrome, androgen resistance, iatrogenic conditions such as contraceptive use, and antiandrogen treatment. This review highlights the status of these hormones in DED along with the mechanism of action of different hormones on the ocular surface structures and the clinical implications of these effects. The influence of androgens, estrogens, and progesterone on the ocular surface tissues, and the implications of androgen-deficient states in DED are also discussed. The physiological and pathological effects of menopause and sex hormone replacement therapy are discussed. The effects of insulin and insulin resistance on the ocular surface and DED, and the growing potential of topical insulin therapeutics for DED are mentioned. Thyroid-associated ophthalmopathy, its impact on the ocular surface, and the tissue effects of thyroid hormone in the context of DED are reviewed. Finally, the potential role of hormonal therapeutics in the management of DED has also been discussed. The compelling evidence suggests that it would be clinically beneficial to consider the possibility of hormonal imbalances and their impact while treating patients with DED.
Topics: Female; Humans; Androgens; Tears; Dry Eye Syndromes; Eye; Insulins
PubMed: 37026259
DOI: 10.4103/IJO.IJO_2887_22 -
Annals of Medicine Dec 2023Dry eye disease (DED) is a multifactorial disorder characterized by loss of tear film homeostasis with an estimated worldwide prevalence of 5% to 50%. In DED,... (Review)
Review
Dry eye disease (DED) is a multifactorial disorder characterized by loss of tear film homeostasis with an estimated worldwide prevalence of 5% to 50%. In DED, dysfunction of the ocular structures that create and regulate the tear film components-including the lacrimal glands, meibomian glands, cornea, and conjunctiva-causes a qualitative and/or quantitative tear deficiency with resultant tear film instability and hyperosmolarity. This initiates a vicious cycle of ocular surface inflammation and damage that may ultimately impair the quality of life and vision of affected patients. Many factors can contribute to the development of DED, including ocular and systemic diseases, topical and systemic medications, and environmental conditions. Because DED is a chronic disorder, treatment is most often long term and may utilize both pharmacologic and nonpharmacologic interventions to address all etiologic components. The long-term management of DED can be challenging and most often should involve eye care specialist referral. However, primary care clinicians (PCCs) are often the first points of contact for patients with DED and importantly provide initial diagnosis and preliminary patient education about the disease process. Consideration of DED is also vital for the practice of various specialties due to the large number of comorbidities and medications that can contribute to DED pathogenesis and progression. Therefore, it is important that PCCs and clinical specialists be aware of the etiology of DED and its available therapeutic options. This manuscript provides an overview of DED pathophysiology and treatment and discusses specific considerations regarding DED management for PCCs and clinical specialists.Key messagesSuccessful management of dry eye disease often requires the use of various pharmacologic and/or nonpharmacologic therapies, as well as environmental and lifestyle modifications, to mitigate the underlying etiologies and restore tear film homeostasis.Primary care clinicians play an essential role in dry eye disease management by establishing a diagnosis, educating patients about the disorder, and providing referrals to eye care specialists for initiation of specialized treatment and long-term follow-up.Primary care clinicians and clinical specialists should consider prescribing medications with fewer ocular surface effects whenever possible in patients at risk for or with existing dry eye disease.
Topics: Humans; Quality of Life; Dry Eye Syndromes; Conjunctiva; Tears; Primary Health Care
PubMed: 36576348
DOI: 10.1080/07853890.2022.2157477 -
Cornea May 2019Sjögren's syndrome (SS) is a common autoimmune disease affecting about four million Americans. Although approximately 1 in 10 patients with clinically-significant... (Review)
Review
PURPOSE
Sjögren's syndrome (SS) is a common autoimmune disease affecting about four million Americans. Although approximately 1 in 10 patients with clinically-significant aqueous deficient dry eye has underlying SS, widespread underappreciation of SS leads to significant underdiagnosis, delays in diagnosis, and consequent morbidity and mortality. The purpose of this article is to illustrate that in addition to dry eye, SS can cause serious, vision-threatening extraglandular ocular manifestations.
METHODS
We conducted a narrative review of studies that have examined the dry eye and extraglandular ocular complications of SS.
RESULTS
SS-related dry eye is a progressive condition with major negative impact on the quality-of-life of afflicted patients, not only due to symptoms of ocular discomfort but also visual dysfunction. In addition, SS can lead to corneal melt/perforation, uveitis, scleritis, retinal vasculitis, and optic neuritis. A major problem with currently-available SS disease activity measurement instruments is the lack of domains evaluating dry eye-related visual dysfunction. For example, one of the most commonly-used instruments for assessing patient symptoms in SS (the EULAR Sjögren's Syndrome Patient Reported Index [ESSPRI]) only includes one item (out of three) that addresses the severity of overall dryness, without mention of dry eye symptoms or vision-related quality-of-life. Similarly, no extraglandular ocular complications are included in currently-available SS disease activity instruments (e.g., the EULAR Sjögren's Syndrome Disease Activity Index [ESSDAI]).
CONCLUSIONS
There needs to be a paradigm shift in which eye care providers and rheumatologists become more familiar with various SS-related extraglandular ocular manifestations. Existing disease activity measurement instruments must incorporate dry eye symptoms, particularly those related to visual dysfunction. An evidence-based screening algorithm for determining which patients with dry eye should be tested for underlying SS may be particularly helpful in preventing delays in diagnosis.
Topics: Dry Eye Syndromes; Eye Diseases; Humans; Quality of Life; Sjogren's Syndrome; Vision Disorders
PubMed: 30681523
DOI: 10.1097/ICO.0000000000001865 -
Acta Ophthalmologica Nov 2022Dry eye disease (DED) is a common cause of ocular pain and discomfort. Dry eye disease (DED) stems from a loss-of-tear film homeostasis and is frequently seen in video... (Review)
Review
BACKGROUND
Dry eye disease (DED) is a common cause of ocular pain and discomfort. Dry eye disease (DED) stems from a loss-of-tear film homeostasis and is frequently seen in video display terminal (VDT) users. Video display terminal (VDT) use reduces blink rates and increases incomplete blinks, leading to tear film instability and ocular inflammation, promoting DED.
PURPOSE
To assess and evaluate the methods for preventing VDT-associated DED and ocular discomfort.
METHODS
Studies were found using PubMed and Embase with the search terms: (digital visual terminal* OR computer use OR screen use OR smartphone OR display OR visual display terminal* OR computer vision syndrome OR tablet OR phone OR screen time) AND (dry eye OR DED).
RESULTS
Thirty-one relevant articles were found. Ten described single-visit studies, whereas 21 had a prolonged follow-up. Most preventive measures of VDT-associated DED aimed to increase blink rate or directly prevent tear film instability, ocular inflammation, mucin loss or ocular surface damage. Using an adjustable chair and ergonomic training, blink animations and omega-3 supplementation improved signs and symptoms of VDT-associated DED. Taking frequent breaks was associated with fewer symptoms, but no study assessed the commonly suggested 20-20-20 rule.
CONCLUSION
Preventive measures, such as blink animation programmes, oral intake of omega-3 fatty acids and improved ergonomics act on different parts of the vicious cycle of dry eye and could supplement each other. A comparison of the efficacy of the different interventions as well as more evidence of the effect of increased humidity, VDT filters and ergonomic practices, are required.
Topics: Computer Terminals; Dry Eye Syndromes; Fatty Acids, Omega-3; Humans; Inflammation; Mucins; Tears
PubMed: 35122403
DOI: 10.1111/aos.15105 -
Clinical & Experimental Optometry Sep 2019Smartphone and tablet use in Australia and worldwide is reaching saturation levels and associated visual and ocular discomfort such as headaches, eyestrain, dry eyes and... (Review)
Review
Smartphone and tablet use in Australia and worldwide is reaching saturation levels and associated visual and ocular discomfort such as headaches, eyestrain, dry eyes and sore eyes are widespread. This review synthesises the available literature and considers these symptoms in the context of a binocular vision and/or ocular surface aetiology. Eye discomfort with smartphones and tablets is discussed alongside similar symptoms reported with desktop computer use. Handheld devices differ from computers in viewing position and distance, screen size and luminance, and patterns of use. Accommodation is altered with handheld device use, with increased lag and decreased amplitude. Smartphone and tablet use results in reduced fusional convergence and possibly a receded near point of convergence. This is similar to what happens with computer use. Findings related to blink rate with smartphone and tablet use are contradictory, perhaps due to the influence of task difficulty, and there is limited evidence related to blink amplitude. Reduced blink rate and amplitude are consistently reported with computer use. Use of handheld digital devices, like computers, may adversely impact tear stability. There is insufficient evidence to support the impact of handheld devices on tear volume, although this is reduced with computer use. The available literature does not conclusively link eye and visual discomfort symptoms reported with handheld digital devices, with changes in binocular vision, blinking or ocular surface. However, there is a gap in our understanding of symptoms which occur with smartphone and tablet use in the context of how these devices are used. In addition, studies are required in high users such as teenagers, and in patients with dry eye or accommodative/binocular vision anomalies, all of whom may have a higher risk of symptoms. A better understanding of symptom aetiology can guide clinical advice to minimise adverse impacts on visual and ocular surface health and discomfort.
Topics: Asthenopia; Computers; Computers, Handheld; Dry Eye Syndromes; Humans; Smartphone; Vision Disorders; Vision, Binocular
PubMed: 30663136
DOI: 10.1111/cxo.12851