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Red, Stinging, Burning, or Scratchy Eyes? You May Have Dry Eye
Dry eye (Ocular Surface Disease) occurs when the eyes don’t produce enough tears or produce tears without the proper chemical composition.1
What causes dry eye?
Many factors can contribute to dry eye, including aging, hormonal changes, UV exposure, environmental conditions (e.g., exposure to air pollution, wind, low humidity, etc.), or problems with normal blinking. Dry eye can also be symptomatic of problems with general health (e.g. rheumatoid arthritis, thyroid disease, Parkinson’s disease), and medications (e.g. oral contraceptives, antidepressants, antihistamines etc.).1,3,4
How is dry eye diagnosed?
During an eye examination, the optometrist will ask questions about the patient’s general health, medications, and home/work environments to determine whether these are factors that may be causing dry eyes. This information will help an optometrist decide whether to perform additional dry eye testing. An optometrist may use a high-powered microscope known as a slit lamp, in conjunction with specialized dyes, to evaluate the quality, quantity and distribution of tears on the eye to detect signs of dry eyes. Additional assessments, from questionnaires to taking images of the glands in the eye, may also be used to assist the diagnosis of dry eye.5
How is it treated?
In most cases, dry eye is a chronic condition and requires maintenance. However, dry eye symptoms can be alleviated, and the health of the eye can improve through treatment interventions. Depending on the type and severity of the dry eyes, different treatment options are recommended.
Lubricating eye drops and warm compress are a first step, with gels and ointments providing additional lubrication before going to sleep.6 Prescription medications for dry eyes can help reduce inflammation in the eyes and improve the body’s natural ability to produce tears.6 In some cases, small plugs may be inserted in the corner of the eyelids to slow the drainage and loss of tears.6 Lifestyle changes such as avoiding windy conditions, using a humidifier, taking breaks from prolonged screen use, staying hydrated, and getting enough sleep can help to reduce dry eye symptoms.6 Treatment of any underlying systemic disease, change of medication, or addition of omega-3 supplements may alleviate symptoms over time.6 New treatment options using devices that apply heat or light to target the glands in the eye are available to promote a healthy tear film.6
What is the impact of dry eye disease?
If left untreated, dry eyes can affect the individual’s quality of life and can even be harmful to the eye. Dry eye can also make contact lens wear more difficult due to increased irritation and greater chance of eye infection.6
Research has found that dry eye has a significant impact in the workplace and personally if it is not well controlled:
• The economic burden can be high for those with severe disease. The annual direct and indirect cost per patient is estimated at between $6,900 for mild disease and up to $28,000 for severe dry eye disease.8 The indirect cost, mostly due to presenteeism, contributed 90% of the total costs.8
• Dry eye disease is associated with absenteeism, presenteeism, impaired productivity, impaired activity, and difficulty at work.9 It can also negatively impact sleep and driving.10 Patients with Sjögren’s Syndrome (a type of dry eye disease) had significantly lower employment rates, decreased number of hours worked, and increased work disability.9
• Mental health is also affected. The odds of anxiety are 2.8 times, and the odds of depression are 2.92 times more likely than those without dry eye.11
This evidence supports the importance of recognizing and addressing the symptoms of dry eye, seeking a diagnosis, and treating the disease. Dry eye should not be dismissed or ignored by plan sponsors or by plan members.
What needs to happen differently to mitigate the impact of dry eye?
Perhaps, the most important thing for plan members and their dependents is to be aware of their eye health and visit an optometrist for a comprehensive eye exam every 12 to 24 months depending on age and risk factors. They should also visit an optometrist if there are any signs and symptoms of dry eye or other concerns about their optical health, particularly if they have a diagnosis of diabetes.
Some people may be reluctant to visit their optometrist between comprehensive examinations when they develop symptoms. With little to no public vision coverage in most provinces for working adults, group vision care benefits could help bridge the gap by providing coverage for the early detection and treatment of dry eye and other eye diseases. However, most vision care plans today do not reimburse plan members for follow-up examinations for screening, monitoring, and treatment of eye diseases. Simple and relatively inexpensive changes in group vision care coverage can address this gap.
The Canadian Association of Optometrists (CAO) has been spearheading the Don’t Lose Sight initiative. The CAO has proposed that new vision care options be made available to plan sponsors to address the shortfalls in existing group coverage levels. As of today, the CAO is working with insurers and other healthcare stakeholders to design and implement modernized vision care coverage for working Canadians. Those who understand the relatively low cost of providing prevention and management for dry eye and other eye diseases recognize the value in appropriate coverage for their plan members.
Look for more from the CAO on modernizing vision care and providing support to prevent and manage diseases that can lead to vision loss through our blogs, podcasts, and webinars. Want to know more? You can find our handbook and blog posts here on Don’t Lose Sight or contact us directly for a discussion at dontlosesight@opto.ca or 1 888 263 4676 ext. 221.
1. Craig JP et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15(3):276-283.
2. Belmonte C et al. TFOS DEWS II pain and sensation report. Ocul Surf. 2017;15(3):404-437.
3. Stapleton F et al. TFOS DEWS II epidemiology report. Ocul Surf. 2017;15(3):334-365.
4. Bron AJ et al. TFOS DEWS II pathophysiology report. Ocul Surf. 2017;15(3):438-510.
5. Wolffsohn JS et al. TFOS DEWS II diagnostic methodology report. Ocul Surf. 2017;15(3):539-574.
6. Jones et al. TFOS DEWS II Management and therapy report. Ocul Surf. 2017;15(3):575-628.
7. Şimşek C et al. Current Management and Treatment of Dry Eye Disease. Turk J Ophthalmol. 2018;48(6):309-13.
8. Chan, C. C., Ziai, S., Myageri, V., Burns, J. G., & Prokopich, C. L. (2020). Dry eye disease: A Canadian quality of life and productivity loss survey. medRxiv.
9. Sivakumar, G. K., Patel, J., Malvankar-Mehta, M. S., & Mather, R. (2021). Work productivity among Sjögren’s Syndrome and non-Sjögren’s dry eye patients: a systematic review and meta-analysis. Eye, 35(12), 3243-3257.
10. Gomes, J. A., & Santo, R. M. (2019). The impact of dry eye disease treatment on patient satisfaction and quality of life: A review. The Ocular Surface, 17(1), 9-19.
11. Wan, K. H., Chen, L. J., & Young, A. L. (2016). Depression and anxiety in dry eye disease: a systematic review and meta-analysis. Eye, 30(12), 1558-1567.