Dry Eye Affects Multiple Parts of Eye, Eyelid in Patients With Condition

Mina Massaro-Giordano, MD, co-director of Penn Dry Eye & Ocular Surface Center, spoke with The American Journal of Managed Care® (AJMC®) about how dry eye can introduce complications to a patient's eyelid and the surface of the eye. She also discussed how symptoms of the condition can vary greatly from patient to patient.

This transcript has been lightly edited for clarity.

Transcript

How can dry eye affect patients with the condition?

So, dry eye disease is a very complex condition. It's a multifactorial condition of the ocular surface. By the ocular surface, I mean not just the eyeball itself, it actually affects the eyelids. You have to have a wonderful marriage between the eyelids and the eyeballs on the surface of the eye. And people who have an imbalance or have this disease, which affects the lids or the ocular surface, can develop dry eye. And it's about the structures being damaged. It's about an abnormal tear film, a tear film that becomes very concentrated. There's inflammatory changes that can occur on the surface of the eye. And with the newest definition from our DEWS classification system, we also understand that the nerves in the cornea and the eye can also become affected with chronic dry eye. So it's a very common process. Many, many Americans are affected by it and unfortunately, some people don't know they have it and don't even know how to diagnose themselves and are erroneously treating themselves with medications that really don't hit the root cause of the disease. So very, very complex, very, very common, and affects quality of life in a big way. Patients can really suffer with surface disease and dry eye.

What are common symptoms of dry eye?

The symptoms can really run the gamut. They can be a feeling of dryness, there can be a feeling of irritation, burning, itchy eyelids, which sometimes can cause some confusion with patients. Sometimes patients have light sensitivity, sometimes patients have pain, some patients have absolutely no symptoms. So that's why it makes it very difficult to diagnose. And a lot of times, patients will kind of deal with these symptoms, thinking that it's just a nuisance and it will go away. But the problem with this is that if this becomes a condition that if they have these symptoms for a longer period of time, these chronic symptoms can lead to surface inflammation and damage on the ocular surface, and you get caught really in this very vicious cycle.

Oddly enough, 1 symptom that many patients almost don't believe that their eyes are dry is they can have increased tearing in the early stages of the disease. And the increased tearing is sort of a mechanism to try to lubricate the eye from patches of dryness or irritation. And many times patients will come to my office with a complaint of tearing and after I do a full eye exam and I tell them they have dry eye they kind of look at me like I have 4 heads and say, "How can I have dry when I'm telling you I'm tearing all the time?" But that can be also a symptom. And the problem with the term dry eye is that some of these patients might not have dry eyes, they may have very moist or mucousy eyes or wet eyes that also are categorized. So we're trying to kind of step away from the term dry eye and maybe tear film insufficiency or ocular surface disease or tear film dysfunction syndrome. Probably, dry is not an appropriate term but so many patients and physicians have adopted that term. And there are many symptoms and many disease processes of the ocular surface that go under the dry eye umbrella.