Prof. Petra Lišková: Prevention of Dry Eye Syndrome is Difficult but Not Impossible
Dry eye syndrome is one of the most common ophthalmological problems, and its incidence is rising. Ophthalmologist Prof. MUDr. Petra Lišková, Ph.D., from the Clinic of Pediatrics and Hereditary Metabolic Disorders of the First Faculty of Medicine, Charles University, and University Hospital in Prague, explains how these difficulties arise and why patients should visit an eye doctor rather than relying solely on self-treatment.
What is dry eye syndrome, and why is its incidence increasing?
It is a condition that occurs when tears are not able to provide adequate moisture to the surface of the eye. Tears are either insufficient or of poor quality. Tears consist of three components: oil, water, and mucus. The oil layer helps prevent the evaporation of the water layer, while the mucus layer spreads tears evenly over the surface of the eye. If tears evaporate too quickly or do not spread evenly, symptoms of dry eye syndrome may occur.
Age is the biggest risk factor, as tear production decreases. The primary disease causing reduced tear production must be sought, especially in younger people. It is a question of how much the incidence really increases and to what extent greater awareness of possible manifestations plays a role.
Are the symptoms of dry eye syndrome specific to this problem, or do we see them in other diseases as well?
The symptoms are non-specific and the same regardless of the cause — redness, burning, and cutting sensations in the eyes, eye fatigue, photophobia, blurred vision, and sometimes even headaches. Symptoms can worsen in the wind, in winter, or in hot weather.
In which individuals does the syndrome appear most frequently?
Women over the age of 50 are at the greatest risk. In younger people, dry eye syndrome often has another detectable cause. Studies report the prevalence of this condition ranging from 5% in individuals under 50 to 19% in older age categories. However, precise epidemiological data do not exist, which is due to various diagnostic approaches and inconsistent definitions of this syndrome.
What are the main causes?
In addition to insufficient tear production related to age, many patients also have chronic inflammation of the eyelid margins. Here are glands that produce the fatty component of the tear film, which prevents rapid evaporation. About 10% of patients have an underlying systemic disease, most commonly primary Sjögren's syndrome, which is an inflammatory cellular infiltration of exocrine glands leading to a deficiency in saliva and tear production. Among local causes, one can mention inadequate eyelid closure. In summary, dry eye syndrome is a multifactorial problem that can be associated with a number of local or systemic issues.
What can further worsen the existing dry eye syndrome?
The intensity of dry eye syndrome can be exacerbated by the toxic effects of preservatives in topical treatments, for example, in glaucoma patients. Worsening of symptoms is also known in women taking hormonal contraception. Currently, staring at computer screens, televisions, or mobile phones is often mentioned, which can lead to reduced blinking frequency. Symptoms can also be worsened by decreased air humidity, allergens, dust in the air, or staying in air-conditioned rooms.
Is it typically a chronic disease? And can it cause vision disturbances or even vision loss?
Yes, the disease is chronic. In patients with severe manifestations, especially in cases where dry eye syndrome arises from a systemic autoimmune disease, it can even lead to permanent vision loss if keratitis or corneal scarring occurs.
How much is this syndrome related to wearing contact lenses?
Patients may experience the same unpleasant non-specific sensations while wearing contact lenses as with dry eye syndrome, even if their tear film is normal. However, soft contact lenses are used as a therapeutic agent in selected cases, as they can provide symptomatic relief, especially in filamentary keratitis.
How is dry eye syndrome diagnosed? Are symptoms enough to know?
Symptoms alone are not enough, and knowing the severity of the disease is necessary for setting up treatment. The most commonly performed clinical tests are the Schirmer test and corneal staining with special dye — fluorescein.
What are the current treatment options?
Pharmacotherapy primarily involves the application of artificial tears, with a preference for preparations without preservatives. If necessary, an ointment or gel may be added at night. If these measures are insufficient, temporary or permanent closure of the tear ducts should be considered. It is also important to consider the possibility of an underlying disease, diagnose and treat it timely. Despite treatment, many patients complain of persistent symptoms, while the objective clinical finding may not always correspond to the extent of subjective discomfort.
A recent innovation is the possibility of electrostimulation based on the application of high-frequency pulses, which stimulate metabolism and regeneration at the cellular level.
Do patients always need to be referred to an ophthalmologist, or is self-treatment sufficient?
In primary care, treatment is challenging due to the non-specificity of symptoms and the inability to perform a detailed biomicroscopic assessment of the eye's surface. Many people, however, when feeling dry eyes, likely consult a pharmacist and try artificial tears. If the syndrome is of mild intensity and the symptoms disappear with occasional application of tears or barely bother the patient, the problem is usually not pursued further. Those with persistent unpleasant symptoms may seek their eye doctor. The visit can also be combined with a preventive examination, which is regularly recommended after the age of 40 to catch other eye diseases whose incidence increases with age, such as glaucoma.
How to choose from the wide range of over-the-counter products?
There are various types of artificial tears and gels available over the counter. Currently, we prefer artificial tears without preservatives, which are widely available on the market. We recommend that the patient gradually try different tears and stick with those that suit them.
What is the position of hyaluronic acid in the therapy of dry eye syndrome?
Most artificial tears are based on it.
Is there an effective prevention for dry eye syndrome?
Prevention is difficult. For patients with signs of eyelid inflammation, eyelid hygiene can be recommended, but if the person does not currently feel any discomfort, this process is rarely adhered to. It is also possible to focus on improving comfort, for example, reducing screen time, not smoking, and avoiding smoky environments, but this takes us to an overall healthy lifestyle. Ultimately, everything can be interconnected.
MUDr. Andrea Skálová
editor, proLékaře.cz
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