Dry Eye ISN’T an Eye Disease and Here’s Why!

Ok hold on, this is NOT clickbait and I DO know what I’m talking about, I promise. I’m an Optometrist that specializes in Interventional Dry Eye and in today's video I’ll go over why Dry Eye is not an eye disease. Rather, It’s often a manifestation of systemic disease, it’s a skin disease, but an eye disease? Nah, that doesn't quite cover it.

This is the eye school blog where I teach you about products and treatments related to dry eye syndrome and eye beauty.


I’m an eye doctor that treats patients with dry eye and I pay special attention to makeup and skincare, I even have an esthetician that I work closely with in my practice. I’m obsessed with helping you achieve beautiful, comfortable healthy eyes.


So What Exactly Is Dry Eye Syndrome, If Not An Eye Disease?


Dry Eye is defined as “Dry eye is a multi­factorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface in­flammation and damage, and neurosen­sory abnormalities play etiological roles.” Dry eye syndrome (DES) is a common condition that occurs as a result of insufficient tear quantity, or inadequate tear quality.


We know that 5-15% of people have Dry Eye, so it's an incredibly common disease. Women are affected disproportionately as compared to men. This means that women are twice as likely to suffer with dry eyes than men. It’s more common with lots of screen time and more common with comorbidities like diabetes, hypertension etc. It increases with age and can be caused by systemic medications.


Autoimmune disease increases the risk and allergies exacerbate the symptoms. Potential triggers for dry eyes from allergies or irritants include pet dander, pollen from trees, grasses, or weeds, exhaust fumes, dust mites, cigarette smoke, mold and perfume. Allergy sufferer's know that their most dreaded pollen can make dry eye symptoms worse because pollen is one of the most common allergens. So if you have dry eye syndrome, it's not a surprise that your symptoms feel exacerbated by the spring!


A Little About Systemic Disease and Its Relation to The Eye


Of all the things I just listed, isn’t it interesting that almost all of them have to do with SYSTEMIC issues? Think about it menopause affects our entire body when our hormones change, diabetes is a systemic disease, as is hypertension. Autoimmune diseases are systemic diseases as well that cause low-grade inflammation. Sjögren's syndrome is a chronic autoimmune disease in which the body's immune system inappropriately attacks self-tissues, particularly the glands that produce moisture in the eyes, the mouth, and elsewhere in the body; this causes the most common symptoms of Sjögren's syndrome, which are dry eyes and dry mouth.


Dry eye happens as a result of all of these systemic diseases as well as skin diseases like rosacea or blepharitis and therefore it’s my position that dry eye isn’t really a primary eye disease at all and is more accurately described as the secondary effect of systemic and skin diseases.


Now that I’ve got your attention. Let’s talk about some common systemic diseases that cause a secondary dry eye:


Diabetes

Most eye care professionals speak extensively on the connection between diabetes and the development of retinopathy or macular edema. However, one of the most common––and often overlooked––ocular manifestations of diabetes is dry eye disease.


The Beaver Dam Eye Study showed that nearly 20% of participants between ages 43 and 86 with type 2 diabetes had dry eye.


Another study by Milton Hom, O.D., indicated that 53% of patients with either diabetes or borderline diabetes reported clinically significant dry eye.


One other study showed that 55% of patients with diabetes had at least mild dry eye signs and symptoms throughout the day.


Sjogren’s Syndrome

An autoimmune disease that causes dry eyes and dry mouth, this disease can be tested for with the use of a Sjo test.


Rheumatoid arthritis (RA)

Patients with RA often suffer from the signs and symptoms of dry eye disease. Research on RA patients in the United Kingdom revealed that more than 70% of the subjects tested positive for dry eye disease.12 And, similar to diabetes, it appears that the more severe the patient’s RA, the more significant his or her dry eye symptoms.


Systemic lupus erythematosus (SLE)

Many SLE patients also have been diagnosed with dry eye. In a study of 36 patients with SLE, 57% had pathological dry eye.


Thyroid eye disease

Because of hormonal changes and exophthalmos-related corneal exposure, thyroid eye disease is a common systemic disease associated with dry eye.


Inflammatory conditions

Several inflammatory conditions, including irritable bowel syndrome and Crohn’s disease, have a high incidence of dry eye. One prospective study on patients with inflammatory bowel syndrome showed a 22% prevalence of dry eye disease compared to an 11% incidence in age- and gender-matched controls.


About Skin and Dermatological Diseases That Cause Dry Eye


Dermatological conditions

  • Several dermatological conditions, such as rosacea, have a high incidence of OSD. Additionally, patients with psoriasis have an increased likelihood to develop dry eye.

  • In one study of psoriasis patients, 50% showed significant conjunctival impression cytology differentiation that was indicative of OSD compared to just 5% of patients in the control group.


Furthermore, we don’t completely understand what causes seborrheic blepharitis, a common condition that exacerbates dry eye syndrome. A skin condition called seborrheic dermatitis or seborrhea.


This problem involves the scalp, eyebrows, eyelids, skin behind the ears, and the creases of the nose. Seborrheic blepharitis patients have greasy flakes or scales around the base of eyelashes and a mild redness of the eyelids. Could it be that blepharitis is a skin disease that causes dry eye syndrome as well?


Tell me, did your dry eye disease occur as a result of a systemic or dermatological disease? What do you think about my pronouncement that Dry Eye Disease is really a secondary side effect of systemic or skin diseases?

Reference Article:

https://www.reviewofoptometry.com/article/systemic-disease-and-dry-eye