Review

Authors: Ruojing Huang, Caiying Su, Lvjie Fang...

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

Meta-Analysis

Authors: Lijun Qian, Wei Wei

A meta-analytic approach was used to identify potential risk factors for dry eye syndrome. PubMed, Embase, and the Cochrane library were systematically searched for studies investigated the risk factors for dry eye syndrome from their inception until September 2021. The odds ratio (OR) with 95% confidence interval (CI) was calculated using the random-effects model. Forty-eight studies comprising 493,630 individuals were included. Older age (OR: 1.82; P<0.001), female sex (OR: 1.56; P<0.001), other race (OR: 1.27; P<0.001), visual display terminal use (OR: 1.32; P<0.001), cataract surgery (OR: 1.80; P<0.001), contact lens wear (OR: 1.74; P<0.001), pterygium (OR: 1.85; P = 0.014), glaucoma (OR: 1.77; P = 0.007), eye surgery (OR: 1.65; P<0.001), depression (OR: 1.83; P<0.001), post-traumatic stress disorder (OR: 1.65; P<0.001), sleep apnea (OR: 1.57; P = 0.003), asthma (OR: 1.43; P<0.001), allergy (OR: 1.38; P<0.001), hypertension (OR: 1.12; P = 0.004), diabetes mellitus (OR: 1.15; P = 0.019), cardiovascular disease (OR: 1.20; P<0.001), stroke (OR: 1.32; P<0.001), rosacea (OR: 1.99; P = 0.001), thyroid disease (OR: 1.60; P<0.001), gout (OR: 1.40; P<0.001), migraines (OR: 1.53; P<0.001), arthritis (OR: 1.76; P<0.001), osteoporosis (OR: 1.36; P = 0.030), tumor (OR: 1.46; P<0.001), eczema (OR: 1.30; P<0.001), and systemic disease (OR: 1.45; P = 0.007) were associated with an increased risk of dry eye syndrome. This study reported risk factors for dry eye syndrome, and identified patients at high risk for dry eye syndrome.

Topics: Contact Lenses; Dry Eye Syndromes; Female; Humans; Odds Ratio; Risk Factors; Stress Disorders, Post-Traumatic

PubMed: 35984830
DOI: 10.1371/journal.pone.0271267

Review

Authors: Oddbjørn Bjordal, Katrine Brække Norheim, Eyvind Rødahl...

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

Review

Authors: Bhavya Gorimanipalli, Pooja Khamar, Swaminathan Sethu...

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

Review

Authors: Simmy Chaudhary, Deepak Ghimire, Sayan Basu...

Dry eye disease (DED) is prevalent in all age groups and is known to cause chronic ocular discomfort and pain, and greatly affects the quality of life. Patients with ocular surface disease (OSD) may also have reduced tear secretion due to lacrimal gland damage, thus leading to aqueous deficient DED. Even with conventional management modalities such as lubricating eyedrops, topical corticosteroids, autologous serum eyedrops, or punctal plugs, many patients continue to suffer from debilitating symptoms. Contact lenses are increasingly being used in OSD providing surface hydration, protection from environmental insults, mechanical damage from abnormal lids, and as a modality for constant drug delivery to the ocular surface. This review describes the role of soft lenses and rigid gas-permeable scleral lenses in the management of DED associated with OSD. The efficacy of contact lenses, lens selection, and optimal lens fit are reviewed for specific indications.

Topics: Humans; Quality of Life; Dry Eye Syndromes; Contact Lenses; Lacrimal Apparatus; Ophthalmic Solutions

PubMed: 37026246
DOI: 10.4103/IJO.IJO_2778_22

Review

Authors: Hebatallah B Mohamed, Basma N Abd El-Hamid, Dina Fathalla...

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

Review

Authors: Bjørnar Kamøy, Morten Magno, Sara T Nøland...

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

Review

Authors: Maurizio Rolando, Stefano Barabino

Dry eye disease (DED) is a multifactorial condition resulting from reduced tear secretion from the lacrimal glands, increased tear water evaporation or the production of poor-quality tears. Such tear instability can lead to inflammation and damage of the ocular surface, as well as to abnormal nociception. Historically, tear substitutes and corticosteroids have been the bastion of DED therapy, but a substantial number of patients still suffer from residual symptoms even after being treated with traditional treatments. Aiming to find safe and effective alternative therapies, recent efforts have been focused on the role of vitamin D in the cellular physiology of the eye. Possibly because of its positive effect in modulating the immune and inflammatory responses, the systemic supplementation of vitamin D seems, indeed, to be an effective therapeutic strategy, especially, but not only, for patients affected by DED that does not respond to conventional treatments. In this context, this review focuses on the literature reporting on the pathogenesis and treatment of DED, with a special emphasis on the recent investigations reporting on the potential role of the systemic administration of vitamin D as a therapeutic approach in the management of such condition.

Topics: Humans; Vitamin D; Dry Eye Syndromes; Vitamins; Tears; Lacrimal Apparatus

PubMed: 36674972
DOI: 10.3390/ijms24021458

Review

Authors: Sukanya Jaiswal, Lisa Asper, Jennifer Long...

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

Review

Authors: Alan N Baer, Brian Walitt

Dry eye and dry mouth symptoms are each reported by up to 30% of persons more than 65 years of age, particularly in women. Medication side effects are the most common contributing factors. The evaluation of these symptoms requires measures of ocular and oral dryness. Sjögren syndrome is the prototypical disease associated with dryness of the eyes and mouth and predominantly affects women in their perimenopausal and postmenopausal years. In addition to topical treatment of the mucosal dryness, patients with Sjögren syndrome may require treatment with systemic immunomodulatory and immunosuppressive agents to manage a variety of extraglandular manifestations.

Topics: Aged; Diagnosis, Differential; Disease Management; Dry Eye Syndromes; Humans; Sjogren's Syndrome; Xerostomia

PubMed: 30001784
DOI: 10.1016/j.rdc.2018.03.002