Research and Solutions for Dry Eye Disease

Dry eye

The Eye & Ear Foundation’s October 1, 2021 webinar, “Dry Eye: The Problems, The Solutions, The Future,” was one of the most well attended. This is no surprise, considering that dry disease is very common.

At least 15-30 million Americans suffer from ocular surface damage due to dry eye, said Dr. Deepinder Dhaliwal, MD, L.Ac, Professor of Ophthalmology at the University of Pittsburgh School of Medicine, Director of Refractive Surgery and the Director of the Cornea Service at the UPMC Eye Center. Dr. Dhaliwal also serves as the Director of the UPMC Laser Vision Center, is Associate Medical Director of the Campbell Ophthalmic Microbiology Laboratory and was recently appointed as Director of the Corneal Stem Cell Task Force.

In fact, Dr. Dhaliwal also has dry eye disease, which is the leading cause of visits to eye care professionals. It’s treatable, but not curable. She described it as a chronic condition like arthritis. “We want to do our best to help you function optimally,” she said.

After explaining the complexity of tears, Dr. Dhaliwal emphasized the importance of blinking. She recommends the 20/20/20 rule: Take a break every 20 minutes, look at something 20 feet away for at least 20 seconds while continuously blinking. This will refresh your eyes and make you feel better.

Symptoms of Dry Eye Disease

Dry eye disease isn’t life-threatening, but it affects your lifestyle. Symptoms include the following:

  • Red, irritated eyes with burning sensation
  • Scratchy or gritty feeling
  • Blurred vision that fluctuates
  • Excessive tearing

If you’re thinking that excessive tearing seems paradoxical, Dr. Dhaliwal explained that there are different types of tears. A reflex tear, which occurs when cutting onions, for example, doesn’t nourish the ocular surface.

Causes of Dry Eye Disease

With our increased electronic device use, we blink less, causing tears to evaporate more. “Think of lids like windshield wipers,” Dr. Dhaliwal said. “Make sure you cover that ocular surface to get the best results.”

Other causes of dry eye disease include:

  • Environmental factors (low humidity, overhead fans, vents from heating or air conditioning)
  • Lifestyle (smoking, secondhand smoke)
  • Increased age
  • Gender (women are affected more than men)
  • Contact lens wear
  • Certain medications (e.g. antihistamines, anti-depressants, diuretics, beta-blockers, estrogen replacement therapy)
  • Medical conditions: Sjogren’s syndrome, thyroid disease, diabetes, rheumatoid arthritis, among others
  • Glaucoma drops

Treating Dry Eye Disease

When it comes to treatment, there’s no “one size fits all.” Rather, treatment takes a customized approach. However, there are basic steps to follow:

  • Modify environment: Increase humidity, decrease airflow (turn off fans, especially overnight, and when driving, make sure vents are not aimed directly at your face)
  • Start artificial tears 1-4x/day (preservative-free are preferred)
  • Warm compresses: Help melt thick oil in glands (beaded or electric mask is preferred), do 15 minutes twice a day
  • Lid wipes if debris on lashes
  • Other treatments:
    • Prescription drops for dry eye (Restasis, Xiidra, Cequa, (mild) steroids
    • Punctual plugs, gels, ointments, serum drops, moisture goggles (especially important if you open your eyes when sleeping)
    • In-office procedures, scleral contact lens, etc.

Research on Dry Eye Disease

Deepinder Dhaliwal, MD, L.Ac and Shivalingappa (Shiva) Swamynathan, PhD

The latest research on dry eye disease was shared by Dr. Shivalingappa (Shiva) Swamynathan, Associate Professor of Ophthalmology and Cell Biology, Ocular Surface Development and Gene Expression Laboratory, McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine. He described five different studies. One is studying the properties and functions of genes (KLF4 and KLF5) that regulate the formation and function of the ocular surface.

Another is studying the protein (SLURP1) that’s part of the tear fluid produced by the corneal cells. It acts as an immunomodulator, which means it can help suppress inflammation in a healthy ocular surface. “I’m proud to say that we are one of the only laboratories in the whole world studying this protein,” Dr. Swamynathan said. “We have a particular advantage in understanding this.”

A third study is looking at the beneficial effects of cyclosporine, which is FDA-approved at 0.05% to treat inflammation of the lacrimal glands. The study is testing whether a slightly higher concentration of cyclosporine is more effective.

One study has to do with goblet cells, which produce and secrete mucins that help retain tear fluid. In most types of dry eye, goblet cells are affected. A peptide called IP10p promotes goblet cell formation, so it’s being tested to see if it’s useful for treating dry eye.

The last study that Dr. Swamynathan shared has to do with ocular surface drug delivery, which is challenging because the tear fluid is quickly replaced, washing the drug away. A biologic anchor that binds the ocular surface cells has been identified, so the study is looking at whether drugs can be attached to the other end of the anchor for conditions like dry eye disease.

Audience Q&A

The last part of the webinar allowed audience members to ask questions. In response to a question about supplements, Dr. Dhaliwal said supplements are generally pretty safe right now, like omega-3 fatty acids and black currant seed oil. “It’s not just one magic bullet,” she cautioned. “Because of different components of the tear film, you really need to do multiple things. We joke with our patients that you have to do your homework to get good grades to get the good results. So part of the homework is a strategy where you may use an oral supplement, but also there would be topical therapy, warm compresses, blinking exercises, and all of those things together form your strategy for success.”

While supplements have a role, things work differently for different people, she added. So as long as it’s something that won’t hurt you, you can try it and see if it makes a difference.

As to whether dry eye can be genetic, the answer is that it’s rare. Someone else asked if there are specific kinds of computer glasses that help with dry eye. Blue light blocking glasses can help decrease glare, but really, any type of glasses help dry eye patients because it decreases the amount of air flow around the eye. Dr. Dhaliwal offered another good environmental modification tip. Sit a little higher at your computer so you’re looking down at the screen. This way your eyelid is protecting your ocular surface. Even looking straight ahead keeps your eyes open a little too much.

A question about eye makeup affecting dry eye had Dr. Dhaliwal calling mascara the worst offender. When patients come in with severe dry eye, they’re asked to stop using all eye makeup. She gave a shout out to Blinc mascara, which is much easier to clean.

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