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Dry Eye Disease: Risk Factors, Diagnosis, Treatment and Prevention Measures

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: 25 December 2024 | Viewed by 13335

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Prof. Dr. James J. Wolffsohn

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Guest Editor

1. Optometry and Vision Sciences Research Group, Aston University, Birmingham, UK
2. Ocular Surface Laboratory, Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
Interests: dry eye disease; contact lenses; intraocular lenses; presbyopia; ophthalmic instrumentation; accommodation

Prof. Dr. Jennifer P. Craig

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Guest Editor

1. Ocular Surface Laboratory, Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
2. Optometry and Vision Sciences Research Group, Aston University, Birmingham, UK
3. Centre for Ocular Research and Education, University of Waterloo, Waterloo, ON, Canada
Interests: dry eye disease; ocular surface disease; meibomian gland dysfunction; tear film; contact lenses; microbial keratitis; refractive surgery
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Special Issue Information

Dear Colleagues,

Dry eyes are a common and debilitating chronic disease, with around one-third of the adult population affected and a growing incidence among children. The Tear Film and Ocular Surface Society Dry Eye Workshops (TFOS DEWS I and TFOS DEWS II) summarized the latest evidence to inform practice, but a lot of research is still needed to inform clinical practice to optimally enhance patients’ quality of life.

This Special Issue aims to showcase some of the latest research on epidemiology (including risk factors) and the diagnosis (including instrumentation/techniques) and management (including predictive markers) of dry eyes. Therefore, we invite original research and state-of-the-art review submissions. In particular, we would like to encourage the submission of manuscripts that will assist clinicians to develop better treatment decision trees to improve the long-term outcome of patients with dry eye disease.

We look forward to your submissions!

Prof. Dr. James J. Wolffsohn
Prof. Dr. Jennifer P. Craig
Guest Editors

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Keywords

dry eye disease
meibomian gland dysfunction
epidemiology
diagnosis
management
risk factors

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Published Papers (9 papers)

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Research

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11 pages, 1091 KiB

Open AccessFeature PaperArticle

Safety and Efficacy of Photocatalytic Micro-Mist Desktop Humidifier for Dry Eye Caused by Digital Environment: A Randomized Controlled Trial

by Reiko Arita and Shima Fukuoka

J. Clin. Med. 2024, 13(13), 3720; https://doi.org/10.3390/jcm13133720 - 26 Jun 2024

Viewed by 1493

Abstract

Background/Objectives: Modern life is inconceivable without visual display terminal (VDT) work, including smartphones, computers, and games for both children and adults. VDT work under air conditioning and low humidity poses a high risk of dry eye and digital eye strain. Methods: Thirty-one participants were randomly divided into two groups using a desktop humidifier with photocatalytic technology, namely the “with mist” (humidifier) group and “without mist” (control) group. Participants performed VDT tasks using the humidifier with or without mist for 1 h. Ocular subjective symptoms and objective tear film parameters were assessed before, immediately after, and 1.5 h after the VDT task with or without mist. (Registry ID: UMIN000054379) Results: Ocular symptom scores improved significantly in the humidifier group immediately after the VDT task and up to 1.5 h later compared to before the task (p < 0.001, =0.006, respectively). Immediately after the VDT task, tear meniscus height was significantly higher and non-invasive breakup time was significantly longer in the humidifier group than in the control group (p < 0.001, =0.040, respectively). Plugging of the meibomian gland orifices was significantly reduced only in the humidifier group immediately after the VDT task compared to before the VDT task and remained significantly reduced up to 1.5 h later (p = 0.004, 0.016, respectively). Conclusions: The use of the photocatalytic desktop humidifier during VDT task resulted in significant improvements in the tear film parameters and subjective symptoms. The photocatalytic desktop humidifier could be effective in alleviating dry eye and eye strain in computer users in a modern office environment. Full article

(This article belongs to the Special Issue Dry Eye Disease: Risk Factors, Diagnosis, Treatment and Prevention Measures)

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9 pages, 739 KiB

Open AccessArticle

Appropriateness of Questionnaires for the Diagnosis and Monitoring Treatment of Dry Eye Disease

by James S. Wolffsohn, Sònia Travé-Huarte, Jennifer P. Craig, Alex Muntz and Fiona J. Stapleton

J. Clin. Med. 2024, 13(11), 3146; https://doi.org/10.3390/jcm13113146 - 27 May 2024

Cited by 1 | Viewed by 1038

Abstract

Objectives: If questionnaires contributing to the diagnosis of dry eye disease are to be recommended as alternatives to existing questionnaires, they must be comparable, with similar repeatability and treatment sensitivity. Comparability was thus examined for three common dry eye questionnaires along with identifying the individual questions that most strongly predicted overall scores. Methods: Anonymised data (n = 329) collected via the Ocular Surface Disease Index (OSDI), 5-item Dry Eye Questionnaire (DEQ-5) and Symptom Assessment in Dry Eye (SANDE) questionnaires (including responses to individual questions) from consenting patients were drawn from real-world dry eye clinics/registries in the United Kingdom, Australia and New Zealand; at follow-up, normalised changes were evaluated in 54 of these patients. Treatment data were also analysed from a 6-month, randomised controlled trial assessing artificial tear supplement treatments with 43 responders and 13 non-responders to treatment identified. The questions extracted from the OSDI which form the abbreviated 6-item OSDI were also analysed. Results: The agreement between the questionnaires ranged from r = 0.577 to 0.754 (all p < 0.001). For the OSDI, three questions accounted for 89.1% of the variability in the total score. The correlation between the OSDI and OSDI-6 was r = 0.939, p < 0.001. For the DEQ-5, two questions accounted for 88.5% of the variance in the total score. Normalised treatment changes were also only moderately correlated between the questionnaires (r = 0.441 to 0.595, p < 0.01). For non-responders, variability was 7.4% with both OSDI and OSDI-6, 9.7% with DEQ-5, 12.1% with SANDE-frequency and 11.9% with SANDE-severity scale. For responders, improvement with drops was detected with a 19.1% change in OSDI, 20.2% in OSDI-6, 20.9% in DEQ-5, and 27.5%/23.6% in SANDE-frequency/severity scales. Conclusions: Existing commonly used dry eye questionnaire scores do not show high levels of correlation. The OSDI was the least variable of the questionnaires and while displaying a slightly lower treatment effect than either the DEQ or SANDE, it was more sensitive to detection of a treatment effect. The quicker-to-complete OSDI-6 exhibited essentially the same outcome as the OSDI, with similar variability and treatment sensitivity. Full article

(This article belongs to the Special Issue Dry Eye Disease: Risk Factors, Diagnosis, Treatment and Prevention Measures)

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9 pages, 1544 KiB

Open AccessArticle

Beauty versus Health—How Eyelash Extensions May Affect Dry Eye Disease?

by Christina N. Grupcheva, Dimitar I. Grupchev, Natalya Usheva and Lora O. Grupcheva

J. Clin. Med. 2024, 13(11), 3101; https://doi.org/10.3390/jcm13113101 - 25 May 2024

Viewed by 1256

Abstract

Background: Eyelash extensions (EEs) are among the most popular cosmetic procedures today. There is no prospective study demonstrating how this procedure affects the ocular surface and eye dryness in particular. The goal of this study is to evaluate the effect of EEs removal on dry eye symptoms and signs. Materials and Methods: The subjects were prospectively recruited from routine clinical examinations for dry eye complaints. Only subjects with an OSDI score above 31 were included in the study. The subjects also planned to have the EEs removed and agreed to abstain from makeup use and new cosmetic procedures for 4 weeks. The presence of dry eye was evaluated by an OSDI questionnaire, and objectively by tear breakup time (TBUT), staining (Oxford scale) and blinking intervals. All tests for dry eye were performed at baseline and 4 weeks after EEs removal. Results: The mean age of our patients, all female, was 28 years. The size and type of EEs was diverse. The decision process was mainly based on appearance and models. None of the subjects had any health conditions. The mean result from the score from the OSDI questionnaire at the baseline was 33.4 and improved to 26.7 points 4 weeks after EEs removal. Objectively, the mean TBUT increased from 11.25 to 13.96 s. For the same period, the blinks increased by two per minute, and the staining was reduced by 1.0 grade. Conclusions: Removal of EEs improves the symptoms and the objective signs of dry eye. The most popular beauty procedure regarding eyelashes might not be innocuous to eye health. Full article

(This article belongs to the Special Issue Dry Eye Disease: Risk Factors, Diagnosis, Treatment and Prevention Measures)

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11 pages, 1078 KiB

Open AccessArticle

Associations between Corneal Nerve Structure and Function in a Veteran Population

by Mohammad Ayoubi, Kimberly Cabrera, Elyana VT Locatelli, Elizabeth R. Felix and Anat Galor

J. Clin. Med. 2024, 13(9), 2513; https://doi.org/10.3390/jcm13092513 - 25 Apr 2024

Viewed by 1164

Abstract

Background: We evaluate the relationship between corneal nerve structure and function in a veteran population. Methods: 83 veterans (mean age: 55 ± 5 years) seen at the Miami Veterans Affairs (VA) eye clinic were included in this study. Each individual filled out questionnaires to evaluate ocular symptoms (5-Item Dry Eye Questionnaire, DEQ5; Ocular Surface Disease Index, OSDI) and ocular pain (Numerical Rating Scale, NRS; Neuropathic Pain Symptom Inventory modified for the Eye, NPSI-Eye). The individuals also underwent an ocular surface examination that captured functional nerve tests including corneal sensation, corneal staining, and the Schirmer test for tear production. Corneal sub-basal nerve analysis was conducted using in vivo confocal microscopy (IVCM) images with corneal nerve density, length, area, width, and fractal dimension captured. IVCM and functional corneal metrics from the right eye were examined using correlational and linear regression analysis. Results: Most corneal structural metrics were not related to functional metrics, except for weak correlations between various IVCM metrics and tear production. In addition, corneal nerve fiber area was positively related to corneal sensation (r = 0.3, p = 0.01). On linear regression analyses, only the corneal fractal dimension remained significantly related to tear production (β = −0.26, p = 0.02) and only the corneal nerve fiber area remained significantly related to corneal sensation (β = 0.3, p = 0.01). Conclusions: Most corneal nerve structural metrics did not relate to functional metrics in our veteran population, apart from a few weak correlations between structural metrics and tear production. This suggests that using corneal nerve anatomy alone may be insufficient for predicting corneal function. Full article

(This article belongs to the Special Issue Dry Eye Disease: Risk Factors, Diagnosis, Treatment and Prevention Measures)

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11 pages, 233 KiB

Open AccessArticle

Post-Blink Blur Time—A Simple Test to Detect Dry Eye-Related Visual Disturbances

by Igor Petriček, Dina Lešin Gaćina, Martina Tomić, Tomislav Bulum, Iva Bešlić and Sania Vidas Pauk

J. Clin. Med. 2024, 13(9), 2473; https://doi.org/10.3390/jcm13092473 - 24 Apr 2024

Viewed by 1120

Abstract

Background: Dry eye disease (DED) stands out as one of the most common eye conditions encountered in clinical settings. This study aimed to determine the diagnostic ability and feasibility of post-blink blur time (PBBT) in detecting patients with DED symptoms. Methods: The study included 200 subjects, 100 with and 100 without DED symptoms defined by the Schein questionnaire, who underwent assessment of DED signs [visual acuity, PBBT, conjunctival hyperemia, lid-parallel conjunctival folds—LIPCOF, tear film break-up time—TBUT, fluorescein corneal staining, and meibum score]. Results: DED subjects had a lower PBBT than controls (p < 0.001), with subjective (6 (1–45) s vs. 8 (1–70) s) and objective (6 (2–33) s vs. 8 (2–50) s) PBBT measurements being similar between repeats. The correlations between subjective and objective PBBT measurements were significantly positive (R = 0.873, p < 0.001). Subjective PBBT was negatively related to the Schein questionnaire (R = −0.217, p = 0.002), conjunctival hyperemia (R = −0.105, p = 0.035), and corneal staining (R = −0.153, p = 0.031), while positively related to the TBUT (R = 0.382, p < 0.001) and meibum score (R = 0.106, p = 0.033). Logistic regression analysis showed DED symptoms were significantly associated with subjective PBBT (AOR 0.91, p = 0.001), TBUT (AOR 0.79, p < 0.001), meibum score (AOR 0.65, p = 0.008), LIPCOF (AOR 1.18, p = 0.002) and corneal staining (AOR 1.14, p = 0.028). Conclusions: Subjective self-reported PBBT is a reliable and non-invasive screening test for evaluating time-wise changes in visual acuity and detecting a tear film dysfunction. Full article

(This article belongs to the Special Issue Dry Eye Disease: Risk Factors, Diagnosis, Treatment and Prevention Measures)

12 pages, 472 KiB

Open AccessArticle

A Comprehensive Study on Tear Meniscus Height Inter-Eye Differences in Aqueous Deficient Dry Eye Diagnosis

by Hugo Pena-Verdeal, Jacobo Garcia-Queiruga, Belen Sabucedo-Villamarin, Carlos Garcia-Resua, Maria J. Giraldez and Eva Yebra-Pimentel

J. Clin. Med. 2024, 13(3), 659; https://doi.org/10.3390/jcm13030659 - 23 Jan 2024

Cited by 3 | Viewed by 1800

Abstract

(1) Background: Dry eye disease (DED) is a chronic ocular surface condition that requires precise diagnostic tools. The present study aimed to investigate the diagnostic potential of the absolute inter-eye difference (|OD-OS|) in tear meniscus height (TMH) for the detection of the presence of aqueous deficient dry eye (ADDE). (2) Methods: A sample of 260 participants with dry eye complaints underwent ocular surface examinations thorough diagnostic assessments based on the Tear Film and Ocular Surface Society guidelines (TFOS DEWS II). Participants were subsequently categorized as No ADDE and ADDE based on TMH. Statistical analyses to determine the optimal TMH|OD-OS| cut-off value in a randomly selected study group (200 participants) were performed, while a separate validation analysis of the cut-off value obtained in a random cross-validation group (60 participants) was also performed. (3) Results: The significant diagnostic capability of TMH|OD-OS| (area under the curve = 0.719 ± 0.036, p < 0.001) was found. The identified cut-off value of 0.033 mm demonstrated reliable specificity (77.6%) and moderate sensitivity (59.1%). Cross-validation confirmed the cut-off value’s association with the TFOS DEWS II diagnostic criterion (Cramer’s V = 0.354, p = 0.006). (4) Conclusions: The present study provides evidence for the diagnostic potential of TMH|OD-OS| in identifying ADDE. The identified cut-off value enhances the specificity and offers moderate sensitivity, providing an objective tool for clinical decision making. Full article

(This article belongs to the Special Issue Dry Eye Disease: Risk Factors, Diagnosis, Treatment and Prevention Measures)

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20 pages, 1580 KiB

Open AccessArticle

The Association of Dry Eye Disease with Functional Visual Acuity and Quality of Life

by Lydia Hui-Peng Tan and Louis Tong

J. Clin. Med. 2023, 12(23), 7484; https://doi.org/10.3390/jcm12237484 - 4 Dec 2023

Cited by 7 | Viewed by 1669

Abstract

Background: Dry eye disease (DED) is a common chronic condition with increasing prevalence. Standard discriminative visual acuity is not reflective of real-world visual function, as patients can achieve normal acuities by blinking. Methods: Participants recruited from a tertiary referral eye centre were divided into two groups—Severe DED (with significant, central staining) and Mild DED (absence of such staining). Functional Visual Acuity (FVA) in both groups was assessed using the DryeyeKT mobile application and Impact of Vision Impairment (IVI) questionnaire to assess quality of life (QOL). Results: Among the 78 participants (74.4% women), 30 (38.5%) had Severe DED and 48 (61.5%) Mild DED. In women, Severe DED produced a significantly worse FVA of 0.53 ± 0.20 vs. 0.73 ± 0.30 in the Mild DED group (p = 0.006). FVA decreased with increasing age, showing a significant inverse correlation (r = −0.55). A poorer FVA ≤ 0.6 was seen in older patients (68.2 years ± 7.68) vs. an FVA > 0.6 in younger patients (58.9 years ± 10.7), p < 0.001. When adjusting for age, FVA was still 0.107 lower in the Severe DED group, p = 0.003. There was significant difficulty in performing specific daily activities in the Severe DED group, after adjusting for age, gender and FVA. Conclusions: FVA is reduced in severe DED and older people. Severe DED significantly impacts certain aspects of QOL. However, no significant relationship was found between FVA and QOL. FVA is not the only reason for the compromise of health-related QOL in severe dry eye. Full article

(This article belongs to the Special Issue Dry Eye Disease: Risk Factors, Diagnosis, Treatment and Prevention Measures)

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Review

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15 pages, 1776 KiB

Open AccessReview

Scleral Lenses for Managing Dry Eye Disease in the Absence of Corneal Irregularities: What Is the Current Evidence?

by Sharon X. Qiu, Daddi Fadel and Alex Hui

J. Clin. Med. 2024, 13(13), 3838; https://doi.org/10.3390/jcm13133838 - 29 Jun 2024

Viewed by 1780

Abstract

Scleral lenses (SLs) are large-diameter rigid contact lenses that are a mainstay treatment for eyes with corneal irregularities. In recent years, there has been increased interest in the role of managing dry eye disease (DED) with SLs, as many patients with DED have reported symptomatic relief with SL wear. The role of SLs for DED management when there are associated corneal irregularities is supported by individual case reports and studies. This has prompted practitioners to begin advocating using SLs in DED cases, even in the absence of associated corneal irregularities and other ocular surface diseases (OSDs). There have also been discussions on potentially placing SLs earlier in the treatment hierarchy of DED, where it currently sits at a more advanced level of intervention (Step 3) in the TFOS DEWS II Report. This review will present the currently available, albeit sparse, evidence that supports and suggests this practice, as well as ancillary evidence supporting the purported benefits of SL wear in DED. The advantages of SL wear, such as corneal healing, absence of tear evaporation and contact lens dehydration, and improved visual acuity with associated increased wear comfort, and how this will benefit DED patients will be explored. Conversely, the challenges associated with fitting SLs in DED patients, including increased midday fogging, poor wettability, and subjective patient satisfaction, will also be presented, as well as a discussion on the key considerations for SL fitting in this population. Overall, while more research is needed to support the use of SLs in DED patients without associated corneal irregularities and other forms of OSD, the use of these lenses may prove to have a potentially wider role given their reported ancillary benefits in these populations. Full article

(This article belongs to the Special Issue Dry Eye Disease: Risk Factors, Diagnosis, Treatment and Prevention Measures)

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Other

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16 pages, 3566 KiB

Open AccessSystematic Review

Understanding the Dry Eye Disease-Related Symptoms in South America: Prevalence and Associated Factors—A Systematic Review

by Valentina Loaiza-Guevara, Camila Salazar-Santoliva, Alvaro J. Villota-Arevalo, Marjorie E. Acosta-Villas, Betty-Liliana Coral-Gaón, Jesús E. Afanador, Natalia Restrepo, Laurens L. Hernandez-Benitez, Wendy Rincón Hernández, Laura C. Caceres-Delgado and Juan S. Izquierdo-Condoy

J. Clin. Med. 2024, 13(20), 6060; https://doi.org/10.3390/jcm13206060 - 11 Oct 2024

Viewed by 1076

Abstract

Background/Objectives: Dry eye disease is a leading cause of ophthalmologic consultations worldwide and can significantly impact quality of life. While global prevalence rates vary widely, data specific to South America are limited. This systematic review aims to describe and analyze the prevalence and associated factors of dry eye disease-related symptoms in South American populations. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was conducted using databases such as PubMed, Web of Science, Scopus, and LILACS. Primary studies in English and Spanish that examined the prevalence of dry eye disease-related symptoms in South American populations and its associated factors were included without date restrictions. Studies were screened and selected based on predefined inclusion and exclusion criteria, resulting in the final inclusion of 16 studies from six South American countries. Results: This review identified significant variability in the prevalence of dry eye disease-related symptoms in South American populations in the region, ranging from 4% to 77.5%, with a mean prevalence of 39.3%. Higher prevalence rates were observed among specific groups, such as university students (58.6%) and administrative workers (57.9%). Factors associated with dry eye disease-related symptoms in South American populations included female sex, older age, prolonged screen time, insufficient sleep, and medical conditions such as hypertension, connective tissue disorders, and the use of medications like antihypertensives and antidepressants. Conclusions: The prevalence of dry eye disease-related symptoms in South American populations is notably higher than global averages, highlighting regional challenges. This study emphasizes the need for standardized diagnostic tools and comprehensive epidemiological research across South America, particularly in underrepresented countries, to inform public health strategies tailored to the specific needs of these populations. Full article

(This article belongs to the Special Issue Dry Eye Disease: Risk Factors, Diagnosis, Treatment and Prevention Measures)

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