Managing Dry Eye Disease – A Highly Prevalent Condition

Dry eye disease (DED) is a highly prevalent condition, affecting up to 75% of the population [1]. DED is a chronic condition and may be progressive [2]. In the United States, approximately 30 million adults have reported DED symptoms and that number is expected to increase [3,4]. Common symptoms of DED are dryness, irritation, burning, blurry vision [5], foreign body sensation, itching, light sensitively and tearing. Daily activities such as reading, night driving, watching television, working on the computer and wearing contact lenses can be affected with DED.

There are many risk factors for dry eye. Intrinsic factors include female gender, older age, hormonal changes such as during menopause [6], hormone replacement therapy, autoimmune disorders such as rheumatoid arthritis and Sjögren’s Syndrome [7] and endocrine disorders such as thyroid disease and diabetes. Extrinsic risk factors include contact lens wear [8], medications [9], diets deficient in Omega fatty acids [9], prolonged digital devise or computer use [8], refractive surgery [11], environmental factors such as low humidity, direct air, vents and fans [12] and wearing makeup [13]. Eighty six percent of those with DED have signs of meibomian gland dysfunction [14]. Meibomian glands are oil glands that secrete oils onto the surface of the eye.

Makeup and products around the eyes can potentially disrupt the tear film, be toxic to the ocular surface and exacerbate ocular surface disease. The ingredients and preservatives may be present at much higher levels than are found in a prescription eyedrop. Those who wear waterproof eyeliner or mascara are at risk for ocular surface disease since the makeup remover contains harsh chemicals that can potentially irritate the eyes.

When wearing makeup, it is essential to remove makeup nightly and replace makeup after three months, especially liquid products. Makeup may become a breeding ground for bacteria and fungus if it is used past the “use by” date. For contact lens wearers, it is important to insert contact lenses first, then apply skin creams and makeup. Contact lenses are removed first, then eye makeup is removed.

There are many treatments for OSD such as environment modifications, preservative free eyedrops, prescription dry eye medications, eyelid hygiene, nighttime lubrication or goggles and punctal occlusion. In addition to conventional treatments, Blinc products are an excellent option for my patients. Blinc mascara creates tiny water resistant “tubes" around the lashes for long- lasting hold. Unlike mascaras that are painted on, the tubes bind to the lashes and do not smudge, run, clump or flake. Blinc mascara stays intact with eyedrop use and does not irritate the ocular surface for those with dry, sensitive eyes. For my patients that wear contact lenses, Blinc Dr. Melissa Barnett mascara does not flake into the eye, avoiding eye irritation. My patients love Blinc eyeliner, which is a water resistant, smudge proof liquid eyeliner. To remove the products, harsh chemicals are not needed, just a combination of warm water and gentle pressure are used to cleanse the lashes.

Dry eye is a commonly under diagnosed condition, however it is often the reason why patients visit their eye doctor. A comprehensive eye examination is the best way to see if you have DED. Testing may include evaluation of the ocular structures, temporary staining of the surface of the eye, analysis of the tear film, and symptom questions. Ask your doctor about management recommendations for DED to keep your eyes healthy.

Melissa Barnett, OD, FAAO, FSLS, FBCLA Internationally recognized key opinion leader

References

1. Stapleton F, Alves M, Bunya VY, et al. TFOS DEWS II Epidemiology Report. Ocul Surf. 2017 Jul;15(3):334-365. doi: 10.1016/j.jtos.2017.05.003. Epub 2017 Jul 20.

2. Stern ME, Gao J, Siemasko KF, Beuerman RW, Pflugfelder SC. The Role of the lacrimal functional unit in the pathophysiology of dry eye. Experimental Eye Research. 2004;78:409-416.

3. Paulsen AJ, Cruickshanks KJ, Fischer ME, et al. Dry eye in the Beaver Dam Offspring Study: prevalence, risk factors, and health-related quality of life. Am J Ophthalmol. 2014;157(4):799-806.

4.Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1, 2014. U.S. Census Bureau, Population Division. June 2015. 6. Schaumberg DA, Sullivan DA, Buring JE et al. Prevalence of dry eye syndrome among US women. Am J Ophthalmol.

5. Facts About Dry Eye. The National Eye Institute. https://www.nei.nih.gov/health/dryeye/dryeye. Accessed March 1, 2017.

6. Sullivan DA. Sex and sex steroid influences on the dry eye syndrome, in Pflugfelder SC, Beuerman RW, Stern ME (eds). Dry eye and ocular surface disorders. New York, Marcel Dekker, 2004.

7. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007 Apr;5(2):75-92.

8. Stern ME, Schaumburg CS, Pflugfelder SC. Dry eye as a mucosal autoimmune disease. Int Rev Immunol. 2013 Feb;32(1):19-41.

9. Paulsen AJ, Cruickshanks KJ, Fischer ME, et al. Dry eye in the Beaver Dam Offspring Study: prevalence, risk factors, and health-related quality of life. Am J Ophthalmol. 2014;157(4):799-806.

10. Paulsen AJ, Cruickshanks KJ, Fischer ME, et al. Dry eye in the Beaver Dam Offspring Study: prevalence, risk factors, and health-related quality of life. Am J Ophthalmol. 2014;157(4):799-806.

11. Hovanesian JA, Shah SS, et al. Symptoms of dry eye and recurrent erosion syndrome after refractive surgery. J Cataract Refract Surg. 2001;27:577-84.

12. Wolkoff P, Nøjgaard JK, Troiano P, Piccoli B. Eye complaints in the office environment: precorneal tear film integrity influenced by eye blinking efficiency. Occup Environ Med. 2005 Jan;62(1):4-12.

13. Periman L, O’Dell L. When beauty doesn’t blink. Ophthalmology management. August 2016.

14. Lemp MA, Crews LA, Bron AJ, et al. Distribution of aqueous-deficient and evaporative dry eye in a clinic- based patient cohort: a retrospective study. Cornea.2012 May;31(5):472-8. doi: 10.1097/ICO.0b013e318225415a.