What is Dry Eye Disease?
From A Slight Irritation to a Life-Changing Condition
Until just a few years ago, a complaint of dry eyes was without much understanding. The treatment was almost universally to send the patient to the local pharmacy for over the counter eye drops. There were many from which to choose. Most provided some artificially derived tears that may have provided some episodic relief but the need to use progressed from one or two times per day to many times per day.
As more and more patients presented to the ophthalmologist or optometrist, those patients were of both genders and were younger and younger. Now we know, the complaints of dry eyes is a pervasive problem in the United States. By some accounts, as many as 25 million Americans may have the formal diagnosis of Dry Eye Disease and perhaps another 20 million have undiagnosed symptoms.
What then is chronic dry eye, what causes the condition, and how is it treated?
Dry eyes is a common condition that occurs when your own tears aren’t able to provide adequate lubrication for your eyes. That lack of the production of tears may be either as a result of low tear volume or of poor quality of tears. Tears are necessary both for the lubrication and moisture of the front surface of the eye and for providing clear vision.
To find a successful treatment for a medical condition or complaint, such as chronic dry eye, is better met when a cause is identified. Chronic dry eye has no single cause. We expand the term “syndrome” to not only include multiple symptoms but also multiple causes. A recognized definition of dry is that “Dry eye is a disorder of the tear film due to tear deficiency or excessive evaporation, which causes damage to the interpalpebral ocular surface and is associated with symptoms of ocular discomfort”. This was further advanced to say that “it is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface”. (cite: 1995 National Eye Institute (NEI)/Industry Dry Eye Workshop and April 2008 paper presenting guidelines for the 2007 International Dry Eye workshop).
The most common causes of dry eye:
- Aging- Tear duct production declines after age 50
- Medication- Since tears are composed of oil, water, and mucus, certain medications can decrease mucous production. When someone first has symptoms of dry, it may be thought to be an allergy. So, antihistamines are taken. Antihistamines reduce production. Also, antidepressants, diuretics and medication for the treatment of high blood pressure also have a negative effect on tear production.
- Screen time- both computer, tablet, and cell phone.
- Some eye surgeries may cause dry eye problems
- Hormone changes in females
- Vitamin A deficiency
- Dry climates, low humidity, and wind exposure
- Autoimmune conditions, diabetes, herpes zoster
- Inflammation of eyelids
- Contact lenses
As wide-ranging as the causes, so too are the signs and symptoms:
- A burning or scratchy sensation
- Sensitivity to light
- Redness of the eyes and even red definition of the blood vessels of the eyes
- Blurred vision
- Difficulty wearing contacts
- Excessive watering of the eyes as an overreaction to irritation of the eyes
- Difficulty in opening eyelids
- Mucus secretion from the eye in string-like texture
There are two predominant types of dry eye- aqueous and evaporative. Aqueous dry eye occurs when the tear gland does not produce enough of the watery component of tears to keep the eyes moist. Evaporative dry eye is the most common form of dry eye and is due to a deficient tear film lipid layer which increases tear evaporation. As much as 85% of evaporative dry eye disease is due to meibomian gland dysfunction caused by severe inflammation.
While medical science continues to research to find a preemptive cure, today we have several treatment options:
- For the mild cases, non-prescription OTC eye drops
- More advanced/severe cases prescription medications acting as anti-inflammatories, steroids, and antibiotics
- Eye inserts- small clear tubes of medication
- Special procedures- partial or complete plugging of tear ducts, special contacts known as scleral or bandage contact lenses, LipiFlow thermal pulsation to clear blocked oil glands
- Human biologics to include ePRP (using the patient’s own biologic proteins for potential cell repair and regeneration) and instillation of eye drops derived from other human biologic sources to potentially promote repair and regeneration of cells.
M2 Biologics now offers the prescribing doctor the treatment option of the derived human biologic in an eye drop formulation - StimulEyes. The composition of StimulEyes is hyaluronic acid for lubrication and soothing, and proteins for anti-inflammation (cytokines) and the essential growth factors which may provide restoration of cells.