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Dry Eye Pathophysiology

Friday, November 12, 2010

Dry eye disease is a common multfactorial ocular disorder of the tear film among middle-aged and older adults. The incidence of dry eye is higher in females than males and new science suggests the systemic disease link may differ between ethnic groups.

The quality of life for those who suffer from dry eye disease is significantly compromised owing to constant or intermittent symptoms of dryness, foreign body or burning sensation, photophobia, pain, ocular fatigue and visual disturbances.

A better understanding of the pathophysiological development of dry eye is vital. The body of evidence is growing that suggests dry eye disease may be associated with many systemic diseases including autoimmune disorders, infectious disease, neuropathic dysfunction and endocrine problems.  Unfortunately, not all systemic disease linked to dry eye has been identified. 

A study published in the August 2010 Acta  Ophthalmologica looked at co-morbidity risks in 12,007 adult (ages  44-65 - 1/3 male, 2/3 female), non- Sjogren's  patients with a principal diagnosis of dry eye disease vs. 36, 021 same age and same gender-mix subjects without dry eye disease.

The data collected on these subjects were analyzed with 20 standard measurements of cormobidity. The results suggested that the prevalence of many medical co-morbidities in patients with dry eye disease, compared to the controls, was significantly higher. The related medical co-rmorbidities included cardiovascular disease, neurological problems, pulmonary disease, endocrine disease, gastrointestinal diseases, hepatitis B and mental illness.

This study found that the prevalence of hypertension, ischemic heart disease, hyperlipidemia, cardiac arrythmias, peripheral vascular disorders, and stroke was significantly higher in patients with dry eye disease.  Conversely, the Beaver Dam Eye Study found that blood pressure, hypertension, and cardiovascular disease were not significant risk factors for dry eye disease. 

The nationwide population-based study published in Acta Ophthalmologica study demonstrated significantly higher prevalence of medical co-morbidities in Asian patients with dry eye disease inTaiwan. 

These findings suggest that the systemic conditions in patients with dry eye disease need to be evaluated in detail to determine whether this data can be replicated.

Ellen Troyer, MT MA
Biosyntrx CEO / Chief Research Officer


It is interesting that data gathered from the Beaver Dam Eye Study before the year 2000 suggested smoking, caffeine, thyroid disease, gout, and total to high-density lipoporotein cholesterol ratio increased the risk of dry eye disease. The Beaver Dam cohort data also found the  nonsignificant variables for the risk of dry eye disease included body mass; blood pressure; white blood cell count; hematocrit; osteoporosis, stroke, cardiovascular disease, allergies; antihistamines, antidepressants, diuretics, alcohol consumption, time spent outdoors, maculopathy, central cataract; and lens surgery. 

The Beaver Dam nonsignificant variables leave some questions, given more recent findings. Or does Beaver Dam Wisconsin cohort data vs. Taiwanese cohort data suggest possible ethnic difference in systemic disease link to dry eye disease?

For those of you attending the Academy of Optometry annual in meeting in San Francisco next week, stop by the Biosyntx booth to introduce yourself to Ellen Troyer, Sharee Parker and Jennifer Pace.

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Comorbidities of dry eye disease: a nationwide population-based study. Want TJ, Want IJ, et al. Acta Ophthalmol 2010 Aug 31 [abstract]

Incidence of dry eye in an older population. Moss SE, Klein R. Klein BE. Arch Ophthalmol 2004 Mar; 122(3): 369-73 [abstract]

Prevalence of and risk factors for dry eye syndrome.  Moss SE, Klein R. Klein BE. Arch Ophthalmol. 2000 Sep; 118(9): 1264-8 [abstract]