DRY EYE

Dry eye disease is one of the most prevalent conditions encountered in eye care, affecting millions of individuals worldwide and significantly impacting daily comfort, vision and quality of life (1, 2). Despite its name, dry eye disease is not simply a deficiency of tears. Rather, it is a complex disorder of the ocular surface characterised by instability of the tear film, inflammation, neurosensory abnormalities and disruption of the delicate balance required to maintain a healthy ocular environment (3).

The tear film is a highly sophisticated structure that coats the surface of the eye and plays an essential role in maintaining optical clarity, protecting against infection, nourishing the cornea and ensuring comfortable vision. When the quality, quantity or stability of the tear film becomes compromised, patients may experience a wide variety of symptoms including dryness, burning, irritation, fluctuating vision, excessive tearing, sensitivity to light, contact lens intolerance and ocular fatigue. These symptoms frequently worsen during prolonged screen use, reading, driving, air-conditioned environments or exposure to wind and low humidity conditions(1-6).

  • Dry eye disease is increasingly recognised as a multifactorial condition with numerous contributing factors. Dysfunction of the meibomian glands, which produce the oily layer of the tear film, is one of the most common causes of tear film instability (7,8). Other contributing factors may include ageing, hormonal changes, autoimmune disease, certain medications, contact lens wear, ocular surgery, environmental conditions and prolonged visual tasks that reduce blink frequency (3-7). In many patients, several of these factors coexist, compounding symptoms and contributing to a cycle of tear film instability, inflammation and ocular surface damage that can have significant impacts on ocular health and vision if left untreated (9).


    At Onèj Optometry, we follow contemporary evidence-based principles for the diagnosis and management of dry eye disease, consistent with ongoing international research into dry eye, especially the recommendations of the Tear Film and Ocular Surface Society Dry Eye Workshop (DEWS III). Comprehensive evaluation extends beyond the identification of symptoms alone and seeks to determine the underlying mechanisms contributing to disease. Assessment may include evaluation of tear film stability, meibomian gland function, ocular surface integrity, blink dynamics and inflammatory risk factors.


    Advanced ocular surface imaging allows detailed assessment of the tear film and meibomian glands, providing valuable insight into the structure and function of the ocular surface. These investigations enable a more precise understanding of disease severity and assist in developing targeted treatment strategies tailored to the individual patient. Importantly, objective measurements also allow disease progression and treatment response to be monitored over time.


    Management of dry eye disease should be directed toward the underlying causes of disease rather than simply alleviating symptoms. Depending upon the clinical findings, treatment may include ocular lubricants, eyelid hygiene therapies, thermal treatment of meibomian gland dysfunction, dietary modification, environmental optimisation, co- management of contributing systemic conditions, anti-inflammatory therapies or other evidence-based interventions. Because the causes and manifestations of dry eye disease vary considerably between individuals, successful treatment often requires a personalised and staged approach.


    At Onèj Optometry, we understand that persistent ocular discomfort can have a profound impact upon productivity, concentration, visual performance and overall wellbeing. Our commitment is to identify the factors contributing to your symptoms, explain findings clearly, and develop a management plan based upon the best available evidence. Through detailed ocular surface assessment and personalised care, it is often possible to significantly improve both comfort and visual quality whilst supporting the long-term health of the ocular surface.


References

  1. Britten-Jones, A. C., Wang, M. T., Samuels, I., Jennings, C., Stapleton, F., & Craig, J. P. (2024). Epidemiology and risk factors of dry eye disease: considerations for clinical management. Medicina, 60(9), 1458. 

  2. Cutrupi, F., De Luca, A., Di Zazzo, A., Micera, A., Coassin, M., & Bonini, S. (2023, November). Real life impact of dry eye disease. In Seminars in Ophthalmology (Vol. 38, No. 8, pp. 690-702). Taylor & Francis. 

  3. Jones, L., Craig, J. P., Markoulli, M., Karpecki, P., Akpek, E. K., Basu, S., ... & Yoon, K. C. (2025). TFOS DEWS III: management and therapy. American journal of ophthalmology, 279, 289-386. 

  4. Huang, A., Janecki, J., Galor, A., Rock, S., Menendez, D., Hackam, A. S., ... & Kumar, N. (2020). Association of the indoor environment with dry eye metrics. JAMA ophthalmology, 138(8), 867-874. 

  5. Patel, S., Mittal, R., Kumar, N., & Galor, A. (2023). The environment and dry eye—manifestations, mechanisms, and more. Frontiers in toxicology, 5, 1173683. 

  6. Mandell, J. T., Idarraga, M., Kumar, N., & Galor, A. (2020). Impact of air pollution and weather on dry eye. Journal of clinical medicine, 9(11), 3740. 

  7.  Korb, D. R., & Blackie, C. A. (2008). Meibomian gland diagnostic expressibility: correlation with dry eye symptoms and gland location. Cornea, 27(10), 1142-1147. 

  8. Baudouin, C., Messmer, E. M., Aragona, P., Geerling, G., Akova, Y. A., Benítez-del-Castillo, J., ... & Labetoulle, M. (2016). Revisiting the vicious circle of dry eye disease: a focus on the pathophysiology of meibomian gland dysfunction. British Journal of Ophthalmology, 100(3), 300-306.

  9. Morthen, M. K., Magno, M. S., Utheim, T. P., Snieder, H., Jansonius, N., Hammond, C. J., & Vehof, J. (2022). The vision-related burden of dry eye. The ocular surface, 23, 207-215.