Why Is Dry Eye So Difficult to Treat?

Experts say 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 conjunctivitisblepharitis, meibomian gland dysfunction, floppy eyelid syndromecorneal 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.

Here are 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:

  • Tearlab Osmolarity System: This tool can determine if someone has dry eye disease and how severe it is.
  • 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 devices and medications available today, and even more effective treatments are on the horizon. 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:

Turn to your ophthalmologist for education and support throughout the treatment process.

Many exciting therapies for ocular surface disease are expected to become available in the next 1 to 3 years. Ask your doctor if you are eligible to participate in clinical trials for new treatments.

Resource: Aao.org