Dry Eye Types
Aqueous Deficient Dry Eye
Aqueous Deficient Dry Eye (ADDE) is a subtype of dry eye disease characterized by inadequate tear production. The lacrimal glands fail to produce sufficient aqueous fluid, leading to an imbalance in the tear film.
This condition can result in discomfort, visual disturbances, and an increased risk of ocular surface damage. ADDE is often associated with systemic diseases like Sjögren’s Syndrome or age-related changes.
The tear film is a vital component for maintaining ocular health. It comprises three layers: lipid, aqueous, and mucin. The aqueous layer, produced by the lacrimal glands, provides hydration, nutrients, and antimicrobial properties.
In ADDE, a lack of aqueous fluid disrupts the tear film, causing symptoms of dryness, irritation, and inflammation.
Causes of Aqueous Deficient Dry Eye
Primary Causes
- Sjögren’s Syndrome: A chronic autoimmune disorder targeting lacrimal and salivary glands, leading to significant tear production reduction.
- Age-Related Changes: The lacrimal glands’ functionality diminishes with age, especially in individuals over 50.
Secondary Causes
- Medications: Certain drugs, such as antihistamines, beta-blockers, and antidepressants, can reduce tear production.
- Hormonal Changes: Menopause and hormonal imbalances may contribute to lacrimal gland dysfunction.
- Ocular Surgeries: Procedures like LASIK can sometimes impair tear gland function.
- Chronic Inflammation: Conditions like blepharitis or meibomian gland dysfunction can exacerbate ADDE by promoting ocular surface inflammation
Secondary Causes
- Medications: Certain drugs, such as antihistamines, beta-blockers, and antidepressants, can reduce tear production.
- Hormonal Changes: Menopause and hormonal imbalances may contribute to lacrimal gland dysfunction.
- Ocular Surgeries: Procedures like LASIK can sometimes impair tear gland function.
- Chronic Inflammation: Conditions like blepharitis or meibomian gland dysfunction can exacerbate ADDE by promoting ocular surface inflammation
Symptoms of ADDE
Patients with ADDE commonly experience:
- Persistent dryness and a gritty sensation in the eyes.
- Burning or stinging discomfort.
- Light sensitivity (photophobia).
- Blurred vision, especially during prolonged visual tasks.
A paradoxical increase in tearing due to reflex tear production triggered by irritation
Diagnosis of ADDE
Proper diagnosis is crucial for managing ADDE effectively. Diagnostic tools and tests include:
- Patient History
- Identification of systemic conditions like Sjögren’s Syndrome or medication usage.
- Evaluation of symptoms using standardized questionnaires like the Ocular Surface Disease Index (OSDI).
- Clinical Examinations
- Tear Breakup Time (TBUT): Measures the stability of the tear film.
- Schirmer’s Test: Quantifies tear production using a filter paper strip.
- Ocular Surface Staining: Fluorescein, lissamine green, or rose bengal dyes highlight damaged areas.
- Advanced Diagnostics
- Tear Osmolarity Testing: Elevated osmolarity indicates tear film instability.
- Meibography: Assesses meibomian gland function, which may indirectly impact ADDE.
Treatment Options for Aqueous Deficient Dry Eye
Managing ADDE requires a multifaceted approach tailored to the underlying cause.
- Lifestyle and Environmental Adjustments
- Avoid dry, windy environments and direct exposure to air conditioning or fans.
- Use humidifiers indoors to maintain optimal moisture levels.
- Pharmacological Treatments
- Artificial Tears: Non-preserved drops provide symptomatic relief by replenishing the aqueous layer.
- Anti-inflammatory Medications: Corticosteroids or cyclosporine (e.g., Restasis) can reduce ocular inflammation.
- Lifitegrast: A newer option that targets inflammation associated with dry eye disease.
- Surgical Interventions
- Punctal Occlusion: Inserts plugs in tear drainage ducts to retain moisture on the ocular surface.
- Autologous Serum Eye Drops: Derived from the patient’s blood, these drops are rich in growth factors and can improve ocular healing.
- Systemic Treatments for Underlying Conditions
- In cases linked to Sjögren’s Syndrome or other autoimmune diseases, systemic immunosuppressive therapies may be necessary.
Complications of Untreated ADDE
- Neglecting treatment for ADDE can lead to:
- Chronic ocular surface inflammation.
- Corneal damage, including ulcers and infections.
Significant visual impairment that affects daily activities
Prevention
With timely intervention, most patients can manage ADDE effectively and minimize discomfort. Preventive measures include:
- Regular eye examinations, especially for individuals with risk factors like autoimmune diseases.
- Staying hydrated and maintaining a balanced diet rich in omega-3 fatty acids to support tear production.
- Avoiding prolonged screen time and practicing the 20-20-20 rule to reduce digital eye strain