Why Is Dry Eye So Difficult to Treat?
By Reena Mukamal
Reviewed By Christopher E Starr MD
Sep. 15, 2021
Many people living with dry eye feel misunderstood and unsatisfied with their treatment, according to a new survey.
Health Union interviewed 415 Americans with chronic dry eye about their experience managing the condition. Here’s what the survey found, and what ophthalmologists say could help.
The most frustrating thing about dry eye is:
Difficulty finding relief from dry eye symptoms
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Almost half (48%) of patients with dry eye said they followed their treatment plan carefully, but only 13% experienced lasting relief
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Most people say that over-the-counter eye drops alone do not provide sufficient relief, and seek out additional treatments
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Home remedies include drinking additional water throughout the day (reported by 76% of survey respondents), using a warm compress (56%), blinking often (52%), avoiding cigarettes and secondhand smoke (45%) and thoroughly removing eye makeup (34%)
Frustration with how dry eye is diagnosed or perceived
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Between a quarter and a third of people say that their condition has been written off as an “old person’s disease” or attributed to something less severe such as allergies
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Nearly half of people feel others don’t understand what they’re going through or appreciate the reality of their discomfort
Struggling with the debilitating symptoms of dry eye
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Many people struggle with multiple symptoms such as dryness (76%), foreign body sensation (64%), eye fatigue (62%), light sensitivity (62%) and blurred vision (60%), as well as burning, scratchiness and itchiness
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Dry eye interferes with many aspects of everyday life, including driving at night (56%), reading (42%), using a computer (34%) and watching television (24%)
Dry Eye is often mistaken for other conditions
Dry eye is one type of ocular surface disease, a group of disorders that causes the eyes to not produce enough tears or the right quality of tears. Tears are essential for keeping your eyes healthy and comfortable.
“Ocular surface disease is very complex with many subtypes and overlapping symptoms. Getting to a correct diagnosis requires expertise and can take time,” says dry eye expert Christopher Starr, MD, an associate professor of ophthalmology at Weill Cornell Medical Center.
“A lot of symptoms are labeled and treated as dry eye, but patients may not be getting better because there are other things going on,” he says.
Allergic conjunctivitis, blepharitis, meibomian gland dysfunction, floppy eyelid syndrome, corneal dystrophies and toxicity to medications or cosmetics are just a handful of the many conditions that can be incorrectly referred to as dry eye disease, Starr says. While artificial tears can provide temporary relief in many of these cases, they don’t treat the underlying causes.
The best tools and tests for diagnosing dry eye
“People who are feeling frustrated should not give up. There are a growing number of diagnostic tools to pinpoint the root problems and an expanding number of treatments to address them,” Starr says.
Diagnostic tests used by dry eye experts include:
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Tearlab Osmolarity System: This tool can determine if someone has dry eye disease and how severe it is.
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InflammaDry: This test detects an inflammatory molecule that is almost always elevated in the tears of patients with ocular surface disease.
Eye doctors may also use other tests that measure the quality of tears. They may also perform imaging tests to look for problems with the meibomian glands, which produce an oil found in healthy tears.
Treating dry eye is tricky, but not impossible
There are many treatment options today and finding a solution may involve some trial and error. Many people find it necessary to combine therapies and make a few lifestyle changes. The right treatment regimen can involve a lot of daily maintenance.
Your eye doctor may suggest:
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Lifestyle, environmental and dietary changes
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Punctual plugs
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Topical medications or pills that prevent inflammation and infection
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FDA-approved drugs such as Restasis, Xiidra, Cequa or Eyesuvis
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Devices such as LipiFlow, TearCare, Blephex and/or specialty contact lenses
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Turn to your ophthalmologist for education and support throughout the treatment process.