Dry eye symptoms can affect patients' quality of life

Dry eye is an important ophthalmic disorder because of its high prevalence and significant effect on quality of life, said Esen K. Akpek, MD, associate professor of ophthalmology and director, ocular surface diseases and dry eye clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore.

Dr. Akpek said that about 1 in 4 people who come to a general ophthalmology clinic have dry-eye symptoms.

"Not only do they complain about dryness, redness, and discomfort, but they suffer with vision problems and may have quality-of-life impairment similar to that seen in patients with moderate-to-severe angina," Dr. Akpek said.

She also discussed diagnosis and treatment. In evaluating patients with dry eye, it is important to conduct a thorough ophthalmic exam along with a review of medical history to look for underlying ocular and systemic conditions. While there is no single accepted method to diagnose dry eye, Dr. Akpek noted she will conduct fluorescein and lissamine green staining, evaluate patients for meibomian gland dysfunction, and perform a Schirmer test-which is helpful for identifying patients who may have underlying rheumatoid arthritis or Sjogren's syndrome.

"If an autoimmune disease is suspected, a blood workup should also be undertaken," she said.

Treatment requires replenishment of tears and control of ocular surface inflammation. Artificial tears are the first step in managing dry eye syndrome. A preservative-free formulation is recommended if patients need to instill the drops more than four times a day. Ointments also can be used for lubrication, but should be reserved for bedtime because of their potential to cause blurring. Topical cyclosporine 0.05% ophthalmic emulsion (Restasis, Allergan) is recommended for patients whose dry eye does not respond sufficiently to artificial tears.

"It is important to recognize that the pathology of dry eye is much more complicated than mere dryness of the ocular surface," Dr. Akpek said. "Patients need to understand the course of this condition is chronic and there is no cure."