Dry Eye Disease is Complex and Complicated to Diagnose and Treat
Multifactorial issues contribute to the onset and progression of Dry Eye Disease.
Depending on the level of severity, most patients present with some, many or most of these factors. For providers, it is important to understand the complex environmental, physiological, surgical and lifestyle factors behind Dry Eye Disease and to address them comprehensively if management of Dry Eye Disease is to be effective.
“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.”
– DEWSAlso known as the Dry Eye Workshop, the DEWS II panel created a contemporary evidence-based definition for Dry Eye Disease. II July 21, 2017
Multifactorial components of Dry Eye Disease:
Dysfunction of the Lacrimal Functional Unit
Allergies
Contact Lens Wear
Ocular Surface Inflammation
Reduced Meibomian Gland Function
Hours of Computer, Mobile Phone
and Tablet Use
and Tablet Use
It starts with the cornea and conjunctiva…but doesn’t end there
The cornea and conjunctiva are the focal areas where instruments may uncover initial signs of Dry Eye Disease. But Dry Eye Disease doesn’t manifest on the cornea and conjunctivaThe thin, highly vascularized tissue layer lining the inside of the eyelids. alone. Less common symptoms can indicate disease progressionA disease or condition that continues to grow or spread. and the possible need for additional levels of care.
Many different findings are possible during a Dry Eye Disease evaluation:
Collarettes at the Base
of the Lashes (DemodexA family of tiny mites that live in or near hair follicles, including eye lashes.)
of the Lashes (DemodexA family of tiny mites that live in or near hair follicles, including eye lashes.)
Scarring to the
Eyelid Margin (hyperkeratinization)
Eyelid Margin (hyperkeratinization)
Corneal Staining / Surface Changes
Conjuctival Staining
Tear Break Up
Reduced Tear Lake
Scurf and Debris on the Lashes
TrichiasisAn eyelash-related irritation that results from ocular surface inflammation., PoliosisThe decrease or absence of color in eyebrows, eyelashes or any other hairy area., DistichiasisA rare disorder where there is abnormal growth of eye lashes from the Meibomian glands., MadarosisA condition that results in the loss of eyelashes and, at times, eyebrows.
Scalloped Lid Margin (Notching)
Chalazion
Vascularization to the Eyelid Margin
Lid Wiper EpitheliopathyA disease of the epithelium.
Redundant Bulbar ConjunctivaAlso known as Conjunctivochalasis, this is a common eye surface condition characterized by the presence of excess folds of the conjunctiva located between the globe of the eye and the eyelid margin. T...
PingueculaA deposit of protein, fat, or calcium on the conjunctiva. / PterygiumAn elevated, wedged-shaped bump on the eyeball that starts on the white of the eye (sclera) and can invade the cornea.
Salzman’s Nodule
Corneal VascularizationThe excessive formation of blood vessels within the cornea. Often attributed to long-term contact lens wear./Pannus
Corneal Scarring
Poor Lid AppositionThe accurate side-by-side placement of the upper and lower eyelids. or Changes
Blinking Pattern
