CAUSES OF DRY EYE DISEASE
Despite the multifactorial nature of dry eye disease (DED), evidence has clearly shown tear evaporation is a leading cause of the disease1,2
have excessive tear evaporation due to MGD as the root cause.1
When a patient reports they don’t have any symptoms, I tell them that I also care about their anatomy, and their meibomian glands are essential to maintaining their visual quality.3
—Preeya K. Gupta, MD
Reduced blink rate, increased screen time, and lid laxity can lead to tear evaporation, but the main contributor is MGD4,5
MGD is characterized by:
Changes in meibum
composition5
Reduced meibum secretion6
Breakdown of the tear
film lipid layer2,5
Evaporation drives the persistent cycle of DED2
Tear evaporation triggers a cycle of ocular surface damage, inflammation, and worsening of DED symptoms.2,7
The continuation of this cycle can contribute to the loss of ocular surface homeostasis.8
*Desiccation is the drying of the ocular surface due to tear evaporation exceeding tear production.5
Treating the underlying source of DED signs and symptoms could help break the cycle and restore ocular surface homeostasis
The Missing Piece of the Therapeutic Equation: Excessive Tear Evaporation in DED
Review an expert perspective written by ophthalmologist Darrell E. White, MD, the founder of SkyVision Centers.
NEW
Evaporation in Dry Eye Disease: Delving Into the Core Mechanism
Review an expert perspective on the mechanisms of DED written by optometrist Paul Karpecki, OD, FAAO, chief clinical editor for Review of Optometry.
If evaporation is not addressed, signs and symptoms of DED may chronically persist.9
Review select literature expanding on the mechanism of DED
Revisiting the vicious circle of dry eye disease: a focus on the pathophysiology of meibomian gland dysfunction
Baudouin C, et al. Br J Ophthalmol. 2016
The International Workshop on Meibomian Gland Dysfunction: executive summary
Nichols KK, et al. Invest Ophthalmol
Vis Sci. 2011
New
The interventional MGD consensus statement: detecting, diagnosing, and dealing with MGD
Devries D, et al. Cataract & Refractive Surgery Today. 2022
New
Meibomian gland disease: the role of gland dysfunction in dry eye disease
Chhadva P, et al. Ophthalmology. 2017
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References: 1. Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012;31(5):472-478. doi:10.1097/ICO.0b013e318225415a 2. Craig JP, Nelson JD, Azar DT, et al. TFOS DEWS II report executive summary. Ocul Surf. 2017;15(4):802-812. doi:10.1016/j.jtos.2017.08.003 3. McDonald M, Gupta P, Devries D. Perspectives on prevalence, gaps, and management of MGD. Modern Optometry. 2022;(suppl):2. Accessed October 4, 2022. https://modernod.com/articles/2022-jan-feb-supplement/perspectives-on-prevalence-gaps-and-management-of-mgd 4. Al-Mohtaseb Z, Schachter S, Shen Lee B, Garlich J, Trattler W. The relationship between dry eye disease and digital screen use. Clin Ophthalmol. 2021;15:3811-3820. doi:10.2147/OPTH.S321591 5. Bron AJ, de Paiva CS, Chauhan SK, et al. TFOS DEWS II pathophysiology report. Ocul Surf. 2017;15(3):438-510. doi:10.1016/j.jtos.2017.05.011 6. Yeotikar NS, Zhu H, Markoulli M, Nichols KK, Naduvilath T, Papas EB. Functional and morphologic changes of meibomian glands in an asymptomatic adult population. Invest Ophthalmol Vis Sci. 2016;57(10):3996-4007. doi:10.1167/iovs.15-18467 7. Pflugfelder SC, de Paiva CS. The pathophysiology of dry eye disease: what we know and future directions for research. Ophthalmology. 2017;124(11S):S4-S13. doi:10.1016/j.ophtha.2017.07.010 8. Zhang R, Pandzic E, Park M, Wakefield D, Di Girolamo N. Inducing dry eye disease using a custom engineered desiccation system: impact on the ocular surface including keratin-14-positive limbal epithelial stem cells. Ocul Surf. 2021;21:145-159. doi:10.1016/j.jtos.2021.04.006 9. Lienert JP, Tarko L, Uchino M, Christen WG, Schaumberg DA. Long-term natural history of dry eye disease from the patient's perspective. Ophthalmology. 2016;123(2):425-433. doi:10.1016/j.ophtha.2015.10.011
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