Dry eyes

Abstract

Dry eye disease (DED), also known as dry eye syndrome (DES) or keratoconjunctivitis sicca (KCS) is one of the most common problems affecting the general population. It is a self-perpetuating cycle of inflammation and damage to the ocular surface. DES affects 15–33% of those aged over 65 years and prevalence increases with age. It is 50% more common in women than in men. There are many other risk factors for dry eyes. It is characterised by ocular irritation and visual disturbance. Dry eye can be classified into two main types. Hypo secretive (aqueous-deficient or tear deficient) causes and evaporative causes. Current treatment is heavily weighted toward supplementation, stimulation, preservation of aqueous tears or treatment of ocular surface inflammation. DED involves multiple deficiency states and can result in treatment failure and frustration. Furthermore, long-term use of some medication can cause harm to the ocular surface. It is estimated that the NHS spends annually over £27,000,000 pounds on over 6,400,000 prescriptions for artificial tears, ocular lubricants and astringents (figures from 2014). Over the last decade, considerable research has been carried out on the pathophysiological mechanisms involved. This article will explore the different ways in which DES presents and how to diagnose it as well as the main management options.