DRY EYE DISEASE (DED) has become an epidemic. Dry Eye Disease is due to many factors, which include:
1. chronic dry eyes,
2. chronic inflammation (from genetic risks, diet, constant staring at electronic devices and other environmental risks: smoking, dry workplace/home, etc)
3. underlying inflammatory conditions, such as Rheumatoid Arthritis, Irritable Bowel Syndrome, Sjogren’s Syndrome, Ulcerative Colitis, Chron’s Disease, Rosacea.
4. Poor blinking quality & rates
5. Computer Vision Syndrome
DED which leads causes significant morbidity, with symptoms of chronic pain, irritation, and interference with normal daily activities requiring vision.
We now have evidence that Dry Eyes Disease and Dry Eye Pain is not just from a poorly constructed tear film (ie, poor oil production from meibomian gland function, poor aqueous production from the lacrimal gland, poor mucin production from the Goblet cells), but ALSO from abnormal nerve function of the cornea and ocular surface.
There is a strong association with patients who have Dry Eye Disease and ALSO other chronic pain syndromes. Often these patients do not look “too bad” under the microscope but complain of severe pain.
In clinical practice, more awareness of chronic pain syndromes might help in understanding the discrepancy between signs and symptoms in DED.
Some studies are now showing that dry eye symptoms are, in part, a consequence of neuropathic ocular pain, instead of thinking of dry eye as a tear dysfunction syndrome only.
DED is a heterogeneous group of different disease subtypes with various levels of dysfunction in the corneal pain system.
DED appears to be a chronic pain syndrome in a subgroup of patients.
Dry eye patients with a chronic pain syndrome, both in the general population and in the dry eye clinic, might have dysfunctional pain perception (we are not sure if this is at the level of the cornea, the ocular surface or the brain), and this should be considered, particularly when symptoms appear more severe than the ocular signs suggest.
These severe DED represent a challenge to health care providers, as they may be more likely to be resistant to standard therapies of dry eye aimed at the ocular surface