II. Epidemiology
- As many as 30% of over age 50 years old complain of dry, irritated eyes
III. Causes
- Sjogren's Syndrome
- Allergic Conjunctivitis
- Blepharitis
- Decreased blinking with prolonged reading or driving
- Chronic exposure to dry, dusty conditions
- Rosacea
- See Medication Causes of Dry Eyes (e.g. Anticholinergic Medications, Diuretics, Estrogen Replacement)
IV. Management
-
General measures
- Sunglasses
- Room humidifiers
- Tobacco Cessation
- Take computer breaks
- Protect eyes from fan
- Avoid drying, Anticholinergic Agents (Antihistamines, Tricyclic Antidepressants, Diuretics)
- Use 20-20-20 rule
- Shift eye focus every 20 min to something 20 feet away for 20 seconds
- Artificial tears or ointments
- Preservative-free solutions are preferred (e.g. Refresh Plus), esp. if used more than 4x/day
- Contact Lens users may try rewetting drops (e.g. Renu rewetting, Blink Contacts)
- Consider eye lubricants (e.g. lacrilube) for moderate symptoms (esp. at night), but may blur Vision
- Avoid agents with Decongestant (e.g. Visine original)
- Consider Muscarinic Agonists and other agents in Sjogren's Syndrome refractory to other measures
- Cyclosporine twice daily (expensive, at $500/month)
- Remove contacts before instilling drops (and wait 15 min before reinserting)
- Restasis 0.05% emulsion (preferred over Ceqo)
- Cequa 0.09% solution
- Pilocarpine (Salagen)
- Cevimeline (Evoxac)
- Cyclosporine twice daily (expensive, at $500/month)
- Other options in refractory cases
- Lifitegrast (Xiidra)
- Lymphocyte function-associated Antigen-1 (LFA-1) Antagonist ophthalmic solution
- One drop instilled every 12 hours
- Expensive (>$400/month), with risk of eye irritation, altered Taste Sensation
- Contact Lenses must be out of eye for installation for at least 15 minutes after administration
- Ophthalmic Corticosteroid
- Short-term use only (<2 weeks) for severe Dry Eye flare
- Consider consult with ophthalmology
- Risk of Glaucoma, Cataracts and infection
- Eysuvis (loteprednol) 0.25% suspension is FDA approved for Dry Eyes (but costs nearly $500 per course)
- Dexamethasone 0.1% ophthalmic solution is <10% of Eysuvis cost and is used off-label for Dry Eyes
- Intranasal Varenicline (Tyrvaya)
- Varenicline 0.03 mg used intranasally ($600/month in 2021)
- Results in Cholinergic effects to increase tear production (may have a modest effect)
- Minimal systemic absorption (8%)
- Varenicline used systemically is Chantix
- References
- (2021) Presc Lett 28(12): 70
- Lifitegrast (Xiidra)
- Avoid measures that are unlikely to be helpful
- HydroEye (Omega-3 Fatty Acid) has no quality studies demonstrating efficacy
V. Diagnosis
- See Schirmer's Test
VI. References
- (2021) Presc Lett 28(1): 6
- (2019) Presc Lett 26(5)
- (2016) Presc Lett 23(9)
- (2015) Presc Lett 22(1): 5
- Ono (2004) Am J Ophthalmol 138(1): 6-17 [PubMed]
- Whitcher (2004) Br J Ophthalmol 88(5): 603-4 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSHCZE) | Vysychání spojivky a rohovky oka, které může vést k jejich těžkému poškození. Srov. xerostomie, Sjögrenův syndrom, sicca syndrom, vitamin A. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
| Definition (NCI) | A syndrome characterized by dryness of the cornea and conjunctiva. It is usually caused by a deficiency in tear production. Symptoms include a feeling of burning eyes and a possible foreign body presence in the eye. |
| Definition (NCI_CTCAE) | A disorder characterized by dryness of the cornea and conjunctiva. |
| Definition (MSH) | Corneal and conjunctival dryness due to deficient tear production, predominantly in menopausal and post-menopausal women. Filamentary keratitis or erosion of the conjunctival and corneal epithelium may be caused by these disorders. Sensation of the presence of a foreign body in the eye and burning of the eyes may occur. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D015352 , D014985 |
| ICD10 | H04.12 |
| SnomedCT | 193980001, 155182003, 1249004, 46152009 |
| English | Syndrome, Dry Eye, Syndromes, Dry Eye, dry eye, Dry Eye Syndromes, dry eye syndrome (diagnosis), dry eye syndrome, Keratoconjunctivitis Sicca, Dry Eye Syndromes [Disease/Finding], syndrome dry eye, dry eyes syndrome, dry eye syndromes, Dry eye syndrome (disorder), Dry eye (finding), Dry eye, Dry eye syndromes, EYE(S), DRY, DRY EYE(S), Dry eye syndrome, dry eye; syndrome, syndrome; dry eye, Dry Eye Syndrome |
| Swedish | Torrögdhetssyndrom |
| Czech | xeroftalmie, syndromy suchého oka, Syndrom suchého oka, keratitis sicca, KCS, keratoconjunctivitis sicca |
| Finnish | Kseroftalmia, Kuivasilmäisyysoireyhtymät |
| Russian | KSEROFTAL'MIIA, SUKHOGO GLAZA SINDROMY, GLAZA SUKHOGO SINDROMY, ГЛАЗА СУХОГО СИНДРОМЫ, СУХОГО ГЛАЗА СИНДРОМЫ |
| Croatian | KSEROFTALMIJA, Ceratoconjunctivitis sicca, SUHI KERATOKONJUNKTIVITIS, Sindrom suhog oka |
| Polish | Zespoły suchego oka, Zeschnięcie spojówki i rogówki, Zeschnięcie gałki ocznej |
| Spanish | Síndrome de ojo seco, Síndromes de Ojo Seco |
| Portuguese | Síndrome de olho seco, Síndromes do Olho Seco, Xeroftalmia |
| Dutch | droog oogsyndroom, droge ogen; syndroom, syndroom; droge ogen, Droogoogsyndromen, Droogoogsyndroom, Syndromen, droogoog-, Syndroom, droogoog- |
| French | Syndrome des yeux secs, Xérophtalmie, Syndromes de l'oeil sec |
| German | Trockene Augen-Syndrom, Syndrome des trockenen Auges, Xerophthalmie |
| Hungarian | Száraz szem syndroma |
| Italian | Sindrome dell'occhio secco, Sindromi dell'occhio secco, Xeroftalmia |
| Japanese | ｶﾞﾝｶﾝｿｳｼｮｳｺｳｸﾞﾝ, 眼乾燥症候群 |
| Norwegian | Tørre øyne, Xeroftalmi, Tørt øye-syndrom, A-vitaminmangel med konjunktival tørrhet |
Ontology: Xerophthalmia (C0043349)
| Definition (NCI) | Dryness of the eye due to inadequate production of tears. Causes include vitamin A deficiency, Sjogren syndrome, rheumatoid arthritis, systemic lupus erythematosus, and scleroderma. |
| Definition (MSH) | Dryness of the eye surfaces caused by deficiency of tears or conjunctival secretions. It may be associated with vitamin A deficiency, trauma, or any condition in which the eyelids do not close completely. |
| Definition (CSP) | dryness of the eye surfaces caused by deficiency of tears or conjunctival secretions; may be associated with vitamin A deficiency, trauma, or any condition in which the eyelids do not close completely. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D014985 |
| ICD9 | 375.15 |
| ICD10 | H04.12 , E50.7 |
| SnomedCT | 193887002, 155167008, 193980001, 46152009, 363677007, 69316005 |
| English | Xerophthalmias, DRY EYES, XEROPHTHALMIA, ophthalmoxerosis, xeroma, xerophthalmus, Tear film insuffic NOS, Tear film insufficiency, NOS, Xerophthalmia NOS, Xerophthalmia [Disease/Finding], xerophthalmia, Conjunctival xerosis (& [xerophthalmia]), Conjunctival xerosis (& [xerophthalmia]) (disorder), Tear film insufficiency, Tear film insufficiency (disorder), Xerophthalmia (disorder), xerophthalmia (etiology), xerophthalmia (manifestation), Conjunctival Xerosis, Xerophthalmia, Tear film insufficiency, unspecified |
| French | XEROPHTALMIE, YEUX SECS, Xérophtalmie |
| Portuguese | XEROFTALMIA, SECURA DOS OLHOS, Xeroftalmia |
| Spanish | XEROFTALMIA, OJOS SECOS, xeroftalmia (trastorno), xeroftalmia, xeroftalmía, xeroftalmía (trastorno), insuficiencia de la película lagrimal (trastorno), Xeroftalmia |
| German | XEROPHTHALMIE, AUGENTROCKENHEIT, Xerophthalmia |
| Italian | Xeroftalmia |
| Swedish | Ögontorrhet |
| Czech | Xeroftalmie |
| Polish | Kseroftalmia |
| Hungarian | Xerophthalmia |
| Japanese | ｶﾞﾝｷｭｳｶﾝｿｳｼｮｳ, 眼球乾燥症 |
| Dutch | xeroftalmie, Xeroftalmie |
| Russian | КСЕРОФТАЛЬМИЯ |
