Improving Work Efficiency and Eye Health
– Understanding Dry Eye Disease

Do your eyes often feel dry, fatigued with tight eyelids, appear red and swollen, itchy, have a sensation of foreign objects, experience increased eye discharge, sticky discharge, and sensitivity to light? If you're experiencing these symptoms, then you may have dry eye syndrome. Dry eye disease affects more than 340 million people around the world. It has become increasingly common in people who use electronic devices for extended periods.

The tear film, which covers the surface of the eye, plays a vital role in maintaining eye health, comfort, and optimal vision. It is composed of three key layers – lipid, aqueous, and mucin layers – that work in unison to maintain optimal performance. When one of these layers fails to function properly, such as inadequate lipid or tear secretion, it can eventually lead to the development of dry eye disease.

The Function of Tear Film Layers

Lipid 

Prevents evaporation and facilitates surface tension

Aqueous 

Facilitate hydration to nourish the underlaying cornea and contains antimicrobials to protect the eye

Mucin

Facilitate tear spreading 

 

CEVR Ongoing clinical study: Prevalence and risk factors of Dry Eye Disease in Hong Kong populations

Preliminary data and future plan:

  • 607 eligible subjects recruited; mean age 46
  • 59% diagnosed dry eye disease (DED) according to the definition of dry eye by the Tear Film & Ocular Surface Society (TFOS) Dry Eye Workshop II (DEWS II) report
  • Tears samples collected from the subjects, and biomarkers of DED will be searched by proteomics analysis
Type of Dry Eyes

Aqueous-deficient dry eye

Decreased in tear production due to damage, degeneration, or dysfunction of the lacrimal glands. Age-related gland degeneration, hormonal changes during menopause in women, and autoimmune diseases can all lead to inadequate tear production, resulting in “aqueous deficiency” dry eye syndrome.

Evaporative dry eye

The meibomian glands, located near the base of the upper and lower eyelashes, primarily secrete the lipid layer of the tear film. A healthy lipid layer helps slow down the evaporation of the aqueous layer. When the tear film lacks an adequate lipid layer, the moisture evaporates rapidly, leading to “meibomian gland dysfunction” dry eye syndrome.

Mixed
(Aqueous-deficient & Evaporative dry eye) 

The majority of patients with dry eye syndrome have a combination of both inadequate tear production (aqueous deficiency) and excessive tear evaporation (evaporative dysfunction). This is known as the “mixed type” dry eye syndrome, where symptoms of both water deficiency and oil deficiency coexist.

Individuals at high risk of developing dry eye disease may include:

  1. Spending extended periods in front of digital screens, such as computer or smartphone users.

  2. Individuals who work in environments with low humidity, such as offices or air-conditioned spaces.

  3. Women experiencing hormonal changes, such as during pregnancy or menopause.

  4. Those who wear contact lenses can exacerbate dry eye disease.

  5. Individuals taking medications with dry eye side effects, such as antihistamines, antidepressants, or certain blood pressure medications.

  6. Sjögren’s syndrome is an autoimmune epithelitis that affects the exocrine glands, mainly the lachrymal and salivary ones, with a functional impairment that usually presents as persistent dryness of the eyes and mouth.

Diagnosis Process

 

  1. Patients may conduct dry eye questionnaires in order to quickly assess the symptoms of ocular irritation in dry eye disease and how they affect functioning related to vision.

  2. Detailed Patient History: Conduct a comprehensive interview with the patient to understand their symptoms and eye-related habits in order to assess the main causes of dry eye.

  3. Examination of Eyelids and Cornea: Perform an examination of the eyelids to check for signs of inflammation, meibomian gland disease, or other abnormalities. Additionally, examine the cornea, the clear front surface of the eye, for any irregularities or damage.

  4. Testing to Evaluate Tear Film Stability and Tear Break-Up Time: Conduct tests to quantify the stability of the tear film and measure the time it takes for the tear film to break up. These tests help in determining the quality and stability of the tear film.

  5. Tear Function Tests to Measure Tear Secretion: Perform tests to measure tear production. These tests can provide information about the quantity of tears being produced and help in diagnosing any abnormalities in tear secretion.

  6. Matrix-Metalloproteinase-9 (MMP-9) – Testing: MMP-9-testing in DES is a valuable new diagnostic tool. It correlates well with other dry eye tests. It is especially helpful to identify patients with ocular surface inflammation and autoimmune disease and may facilitate the decision to institute anti-inflammatory treatment in these patients.

  7. Tear osmolarity is an objective measure of the salt concentration in tears, providing valuable insights into tear film stability and ocular surface health. This measurement is obtained using a device called TearLab®, which requires only a small tear sample of approximately 0.2 μL and provides instant results. It serves as one of the diagnostic criteria for dry eye disease, exhibiting a sensitivity of 87%. By assessing tear osmolarity, clinicians can gain valuable information regarding tear film stability and aid in the diagnosis and management of dry eye disease.

 

In addition to using medicated eye drops to alleviate dry eye symptoms, there are several other treatment methods available to improve dry eye disease of varying degrees.

  1. OptiLight by Lumenis is a light-based therapy known as intense pulsed light (IPL) that has been FDA-approved for managing dry eye.It is a non-invasive treatment that targets the area below the eyes to address the underlying causes of dry eye.IPL therapy for dry eye involves using pulses of light to stimulate the meibomian glands, which are responsible for producing the oily component of tears. By improving the function of these glands, IPL treatment aims to enhance the quality and quantity of the tears, thereby reducing dry eye symptoms.

  2. Quantumn Molecular Resonance (QMR) Technology: The treatment is safe, non-invasive, comfortable, and pleasant, providing a relaxing experience. It is suitable for both aqueous deficiency and evaporative dry eye conditions. By utilizing low-power high-frequency electric fields that resonate with tissue molecular bindings, it stimulates the repair and regeneration of cells. The treatment involves 20 minutes of therapy per week for a duration of 4 weeks. It offers a long-lasting treatment effect that can last up to 12 months.

  3. iTEAR is a non-invasive technique to stimulate the nasal nerves which is FDA and TFOS DEWSII endorsed to promote natural tear production. With the unique vibration frequency, iTEAR is applied to the area between nasal cartilage and the bone of each side of the nose to induce tear production. The clinical study showed the level of basal tear production increased by 56% after 30 days of use of iTEAR. The tear film stability has also been improved (tear breakup time increased by 33%). The increase in tear production and reduced rate of tear evaporation may help relieve dry eye symptoms from the route, which is independent of the use of artificial tears. 

  4. Punctal plugs, are tiny soluble plugs made of gel-like material that are placed in the tear ducts. They work by reducing the drainage of tears through the tear ducts, allowing tears to stay in the eye for a longer time, thus maintaining eye moisture. Punctal plugs which can dissolve on their own within approximately two weeks to six months, provide relief for dry eye patients who do not find sufficient relief from artificial tears, lubricating gels, or ointments to moisturize their eyes.

  5. Cyclosporin is an immunomodulator that exhibits anti-inflammatory effects. Restasis® is the only FDA-approved eyedrop containing 0.05% cyclosporin. It relieves dry eye by increasing tear production. The regular dosage is twice a day, but more frequent usage may increase its efficacy. Minimal side effects, such as pain, irritation, and a burning sensation, are associated with its use.

  6. Eye drops are a convenient and easy-to-use method for directly supplementing moisture to the dry surface of the eyes. However, the moisture tends to evaporate quickly, so frequent use may be necessary for severe symptoms. Eye ointments have a higher viscosity, allowing them to stay in the eyes for a longer period, keeping the eyes moisturized. However, due to their thicker consistency, they often cause temporary blurry vision. Therefore, it is generally recommended to use ointment-based artificial tears during periods of eye rest, such as before sleep. 

Prevent Dry Eye Disease

  1. Take regular eye breaks: When reading or using electronic screens, follow the 20-20-20 rule. Every 20 minutes, take a 20-second break and look at something 20 feet (about 6 meters) away to relax your eyes and alleviate dryness.

  2. Use a humidifier to increase the air humidity in the office.

  3. Avoid prolonged use of contact lenses: Dry eye patients are more prone to corneal damage, so it is important to limit the wearing time of contact lenses to prevent the worsening of dry eye symptoms.

  4. Apply warm compresses for symptom relief: Use a warm towel, warm compress bag, or heated eye mask to apply gentle heat to your eyes for 15 minutes in the morning and evening. This helps to keep the eyes moist. Ensure the temperature is around 40°C (104°F) to avoid burning the delicate eye area.

  5.  Seek early eye examinations from an eye care professional to receive a proper diagnosis and treatment plan.

If you have any concerns or discomfort related to dry eye disease or any eye conditions, it is important to seek professional help from an optometrist or ophthalmologist for a detailed examination as soon as possible.

They can assess your symptoms and eye condition, determine if you have dry eye syndrome, and provide appropriate diagnosis and treatment options.

Do not overlook the importance of eye health and make sure to schedule regular eye exams to maintain good vision and eye health.