Dry eye syndrome affects hundreds of millions of people worldwide and is one of the most frequent causes of ophthalmological consultation. It is a vicious cycle characterized by tear film instability, increased osmolarity, and ocular surface inflammation. It usually results in eye discomfort, visual disturbances, and potential damage to the ocular surface. The increasing number of cases with this condition is an important testimony that this entity needs immediate attention and understanding of the underlying pathophysiology and identification of the factors that can cause dry eye.
Dry eye affects productivity in the workplace, limiting necessary activities such as reading or using a computer for long periods. In the United States, this problem carries an economic burden of approximately 3.8 billion dollars in health costs per year.3
Dry eye syndrome has many causes, which often overlap and interact. It usually coexists with other conditions or can be exacerbated by different environmental factors.3 The two predominant and mutually non-exclusive categories are water-deficient dry eye and evaporative dry eye. There is increasing evidence that both types of dry eye can coexist and interact with each other.
The approximate prevalence of dry eye syndrome ranges from 5-50%, although based only on clinical signs, it can be as high as 75% in some populations. Women are more affected than men, and signs and symptoms are directly proportional to age.
The diagnosis of dry eye is complicated due to the significant inconsistency between the symptoms reported by the individual and the signs observed. This inconsistency can be explained by the variability of the tests used for this condition, the variability of the disease process, the subjectivity of the symptoms, individual variability of the pain threshold, and the cognitive responses to questions about visual sensitivity.
Risk factors were classified in the TFOS DEWS II as consistent, probable, and inconclusive. Age, gender, ethnicity, meibomian gland dysfunction (MGD), Sjögren’s syndrome, androgen deficiency, computer use, contact lens wear, hormone replacement therapy, hematopoietic stem cell transplantation, some environmental factors (places with low humidity, pollution), and systemic medications (antihistamines, antidepressants, anxiolytics, and isotretinoin) were identified as consistent factors.
In any case, it is necessary to carry out a series of routines and care to treat and prevent dry eye, especially those people with risk factors. The Institute of Ocular Microsurgery offers the following tips:
Eyelid hygiene: apply heat, massage the eyelids, blink frequently and cleanse the eyelashes with specific solutions. Be careful when using contact lenses. Consult the type of lenses that is most advisable and maintain them properly. Avoid environmental factors that can generate this problem, such as heating or air conditioning. Also, environmental pollution. Use humidifiers for dry air indoors. Protect the eyes with approved glasses. Apply artificial tears if you suffer from this condition to hydrate the eyes. Take regular eye breaks, especially when using electronic screens, and avoid rubbing your eyes. Consume omega 3 fatty acids in meals or supplements. Use anti-inflammatory drugs or antibiotics always under medical prescription, if necessary.
To keep the eyes moist, it is necessary to constantly produce and eliminate the tear film, which comprises a thin layer of tears and some other components.
Dry eye syndrome occurs when there is a decrease in tear production or greater evaporation which causes discomfort and, in some cases, damage to the ocular surface.
There are different risk factors for presenting this disease, such as advanced age, hormonal changes, vitamin A deficiency, suffering from hepatitis C or receiving radiotherapy; It is possible that when you are exposed to an environment with little humidity, the sun, chemicals, or tobacco smoke this condition occurs.
The symptoms of this syndrome are blurred vision, the sensation of a foreign body in the eyes, burning, itching, and sensitivity to light.
The treatment for this condition consists of administering artificial tears and, in some cases, glasses that help conserve the ocular humidity, consuming fish oil, and other medications.
It is important to note that the treatment or timely can avoid corneal damage; consult your doctor if you suspect this condition.
In few pathologies, one could say convinced that patients are adherent and more taking into account that half of the chronic patients, in general, are not, a fact from which those affected by dry eye syndrome (SOS) almost ‘escape.’ Being a disease that conditions the quality of life in a very memorable way, patients are adherent to the treatment, although the problem occurs when they are not aware of the symptoms. “We are adherents because of the pain, because the eyes close on their own and because when you open the eyelids, you feel as if you were taking off an unhealed wound. In another section are those who do not feel that they have it dry and do not hydrate, they can live like that for many years until they develop an ulcer, for example,” explains Jenny Inga, president of the Spanish Association of Sjögren’s Syndrome (AESS), an of the diseases with which dry eye is most often associated.
“Dry eye patients do not have to have Sjögren, yet a very small percentage of Sjögren patients have dry eyes, but they hardly notice it. In other words, they generally think they don’t have it, although objective tests show otherwise”, Inga emphasizes.
Dr. Margarita Calonge, professor of Ophthalmology at the University of Valladolid and member of the Ocular Surface Research Group at the University Institute of Applied Ophthalmology (IOBA), agrees with her: “Patients affected by SOS are generally compliant since They have a problem that causes very annoying symptoms that negatively affect their quality of life, practically every day and at all hours. Lack of compliance is usually a major problem in situations where the patient does not ‘notice’ his illness”.
"Lack of compliance is usually a major problem in situations in which the patient does not 'notice' her illness."
In general, the treatment of dry eye syndrome tries to eliminate or correct (if possible) the cause that causes it and includes, according to Dr. Calonge, long-term anti-inflammatory medication and, “of course,” tear substitutes (such as tears). gels) or those derived from the patient’s serum. In this sense, administering said treatment is so important that the AESS always recommends putting tears on, even if they feel unnecessary. “We suggest that you do an AM and PM routine, for example, to get used to it; that they fill the house with plants, humidifiers…”, details the president of the association.
“The type of artificial tear changes over time,” adds Inga, “and as the lesions appear (itching, pain, burning, photophobia, keratitis, or ulcers), it goes through the simple ones and continues with others of a more complex component. Aqueous, other active ingredients. The best ones are those of sodium hyaluronate. Still, they are not covered by social security, and they have a very high cost in the family economy because the application is on-demand. Sometimes you feel so bad that none of them work”.
Improve the doctor-patient relationship
In addition to all this, for Dr. Calonge, the key to therapeutic success lies in the doctor-patient relationship, in which there is reciprocity, and both understand the disease. “They have to be patient enough to accept that it will improve slowly and not after a miracle drug/procedure that, of course, does not exist. Therefore, improving this is the basis for the patient to understand better her disease, why it is chronic, and the reasons why it has to be compliant,” she points out.
This specialist also considers that another of the strategies that could improve compliance when it comes to dry eye syndrome would be to have drugs that could be applied as little as possible: “once a day instead of 3 or 4, without certainly, it would increase compliance”.