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Dry eye disease management

BMJ 2024; 384 doi: https://doi.org/10.1136/bmj-2023-077344 (Published 25 March 2024) Cite this as: BMJ 2024;384:e077344
  1. Margarita Safir, ophthalmologist12,
  2. Gilad Twig, professor of epidemiology, internal medicine, and endocrinology35,
  3. Michael Mimouni, professor of ophthalmology6
  1. 1Ophthalmology Department, Yitzhak Shamir Medical Center, Zerifin, Israel
  2. 2Faculty of Medicine, Tel Aviv University, Israel
  3. 3Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University, Israel
  4. 4Institute of Endocrinology, Diabetes and Metabolism (G.T.), Sheba Medical Center, Ramat Gan, Israel
  5. 5The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
  6. 6Ophthalmology Department, Rambam Health Care Campus, Haifa, Israel
  7. Correspondence to: M Mimouni michael@intername.co.il

What you need to know

  • Dry eye disease is a highly prevalent chronic ocular condition

  • The mainstays of dry eye disease management include lifestyle modification, eyelid hygiene, and lubrication

  • Novel therapeutic methods using intense pulse light or thermal pulsation may offer future benefit to patients with this condition

Dry eye disease is common, with large cross sectional studies estimating a prevalence of 19-31% among the adult population123 and 6-23% among children.4 This condition is often associated with ocular discomfort and visual symptoms, and severity can range from mild occasional discomfort to sight threatening disease.5 This article offers an approach to identifying and managing dry eye disease and discusses novel treatment modalities.

What causes dry eye disease?

Adequate lubrication of the ocular surface requires appropriate coverage of the ocular surface by the eyelids and sufficient production of tear film components, including both the aqueous component (produced by the lacrimal and accessory glands) and the lipid component (produced by the meibomian glands and the conjunctival mucin-producing glands).6 Damage to the ocular surface can induce an inflammatory response causing further ocular surface damage and propagating disease development.6 While meibomian gland dysfunction is the most common cause of dry eye disease, the aetiology of dry eyes is often multifactorial. Additional common causes of dry eye disease include blepharitis, rosacea, commonly prescribed drugs, and environmental factors (box 1).

Box 1

Medical conditions that are associated with or aggravate dry eye disease

Demographic

  • Older age

  • Female

Medications

  • Antihistamines

  • Antidepressants

  • β blockers

  • Retinoic acid

  • Hormone replacement therapy

Environmental factors and lifestyle

  • Smoking

  • Low humidity

  • Air conditioning or heating systems

  • Exposure to dust, allergens, air pollution

  • Prolonged digital device use

  • Reduced sleep duration

Ocular conditions

  • Contact lens use

  • Ocular surgery

  • Trauma to ocular surface

  • Blepharitis

  • Thyroid eye disease

  • Previous herpetic keratitis

Systemic conditions

  • Rosacea

  • Sjogren's syndrome

  • Rheumatoid arthritis

  • Systemic lupus erythematosus

  • Graft versus host disease

  • Stevens-Johnson syndrome

  • Vitamin A deficiency

  • Diabetes

  • Parkinson's disease

  • Multiple sclerosis

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The symptoms of dry eye disease vary. Patients …

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