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dry eyes; xerophthalmia; keratitis sicca; keratoconjunctivitis sicca

Etiology: 1) chronic inflammation 2) Sjogren's syndrome (keratoconjunctivitis sicca) 3) meibomian gland dysfuction is a major cause of evaporatic dry eyes [10] 3) aging Epidemiology: - more common in women, especially after menopause [4] Pathology: - dimimished tear production from the lacrimal gland Clinical manifestations: - red eye - foreign body sensation - reflex tearing - eye discomfort or eye pain (even severe eye pain) [5] - light sensitivity - blurry vision - eye pain & blurry vision improve with blinking or rubbing the eyes - these maneuvers spread the remaining tear film over the cornea, temporarily relieving symptoms [5] - ref [11] cited as support that patient may present with watery eyes, but no mention of that found in cited ref Complications: - patients with connective tissue disease, Graves disease, or Bell's palsy may develop corneal damage due to dry eyes & are at higher risk for corneal infection [3] Differential diagnosis: - improvement in vision after blinking or rubbing the eye not a feature of glaucoma, uveitis, or conjunctivitis Management: 1) artificial tears may alleviate symptoms & improve vision [5] 2) lubricating ointment at night if artifical tears alone not sufficient 3) eyelid hygiene if lubricating ointment inadequate [5] 4) restasis 5) lifitegrast (Xiidra) 6) omega-3 fatty acids of no benefit 7) refer to ophthalmologist if conservative measures are unsuccessful [5]

Related

eye lacrimation

General

lacrimal apparatus disease; lacrimal gland disease sign/symptom

References

  1. Greater Los Angeles, GRECC, optometry
  2. Prescriber's Letter 10(4):23 2003
  3. Medical Knowledge Self Assessment Program (MKSAP) 15, 16 American College of Physicians, Philadelphia 2009, 2012
  4. Latkany R. Dry eyes: etiology and management. Curr Opin Ophthalmol. 2008 Jul;19(4):287-91 PMID: 18545008
  5. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  6. Wojtowicz JC, Arciniega JC, McCulley JP, Mootha VV. Effect of systane and optive on aqueous tear evaporation in patients with dry eye disease. Eye Contact Lens. 2010 Nov;36(6):358-60 PMID: 21060260
  7. FDA News Release. July 12, 2016 FDA approves new medication for dry eye disease http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm510720.htm
  8. Clayton JA Dry Eye N Engl J Med 2018; 378:2212-2223. June 7, 2018 PMID: 29874529 https://www.nejm.org/doi/full/10.1056/NEJMra1407936 - Rothaus C Dry Eye. NEJM Resident 360. June 6, 2018 https://resident360.nejm.org/content_items/dry-eye
  9. Christen WG et al. Efficacy of marine omega-3 fatty acid supplementation vs placebo in reducing incidence of dry eye disease in healthy US adults: A randomized clinical trial. JAMA Ophthalmol 2022 Jul; 140:707 PMID: 35679030 PMCID: PMC9185512 (available on 2023-06-09) https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2793162
  10. McCann P, Abraham AG, Mukhopadhyay A et al Prevalence and Incidence of Dry Eye and Meibomian Gland Dysfunction in the United States. A Systematic Review and Meta-analysis. JAMA Ophthalmol. Published online October 27, 2022 PMID: 36301551 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2797832
  11. Sharma RA, Mather R. Five things to know about...dry eye disease. CMAJ. 2014 Oct 7;186(14):1090. PMID: 24821862 PMCID: PMC4188654 Free PMC article. No abstract available.
  12. Dry Eye http://www.nei.nih.gov/health/cornealdisease/index.asp#d