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Dry eye syndrome more widespread than predicted
With dry eye on the rise, surgeons are looking to common systemic medications as a possible cause.
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DANA POINT, Calif. — Dry eye syndrome could be on the rise, and it may be correlated with the use of common systemic medications, according to a physician speaking at the Ocular Drug and Surgical Therapy Update meeting here.
“Conservatively, one to two patients in your office out of every 10 will statistically and epidemiologically carry a diagnosis of dry eye. This will make up a large percentage of your patient population,” Michael S. Conners, MD, PhD, said “[A high percentage] of patients are on medications. These medications are going to impact dry eye considerably.”
Women have a greater prevalence of dry eye than men, and that prevalence tends to go up with increasing age, Dr. Conners said.
Dry eye prevalence
“There does exist a pharmacologic explanation for many dry eye patients who take systemic medicines,” he said. “I want you to see what a tremendous impact these medications are having on tear production in our patients.
“Dry eye is more prevalent with age, and medication use is more prevalent with age. Many systemic medications exacerbate dry eye. Of the most-prescribed medications prescribed in 2005, 43% were associated with worsening dry eye syndrome. We are going to see these medications on a daily basis,” Dr. Conners said.
It is important to consider the patients’ perception of their dry eye problems, Dr. Conners said.
“In patients’ minds, moderate and severe dry eye equate to severe angina. I found this to be interesting because we perhaps do not take our patients’ concerns as seriously as they do. Patients, for those of you who treat dry eye, take their condition very seriously,” he said.
Dr. Conners referred to a recent survey that showed of the 60% of dry eye patients seen in offices in the last year, 64% used tears regularly and 40% have had punctal occlusion.
“Three-quarters of the patients feel their symptoms are the same if not worse than the previous year,” he said. “This has a significant impact on productivity.”
Drug categories
Some drug categories that can be associated with reduced tear production include antispasmodics, antiemetics, antihistamines, tricyclic antidepressants, selective serotonin reuptake inhibitors and antipsychotics.
He said the systemic medications have an effect on the parasympathetic and sympathetic nervous system, which control the lacrimal acini and their pump functions.
“If you block with anticholinergic [antimuscarinic] agents, you decrease tear production,” he said.
“The goal would be, as eye care providers, if we could educate the primary care physicians and subspecialists regarding better choices when available, we could maybe impact the effects on dry eye,” Dr. Conners said.
“If we can modify these comorbidities, we can lessen their impact on dry eye and improve the quality of life of our patients,” he said.
For more information:
- Michael S. Conners, MD, PhD, can be reached at Washington University Refractive Surgery Center, 4921 Parkview Place, Suite 12C, St. Louis, MO 63110; 314-747-8036; fax: 314-362-3725; e-mail: conners@vision.wustl.edu. He is a consultant for Allergan.
- Daniele Cruz is an OSN Staff Writer who covers all aspects of ophthalmology, focusing on optics, refraction and contact lenses.