Nov. 2, 2016
You have the opportunity to let patients know the symptoms that may indicate dry eye. Most adults with dry eye symptoms (57 percent) responded that they wished they had spoken to an eyecare professional sooner, according to The National Eye C.A.R.E. Survey conducted by Harris Poll on behalf of Shire. The survey found that people typically wait two years between when symptoms first occur and when they seek medical advice to address them – even though their symptoms may affect their daily activities.
The tears are the first refractive surface of the eye. Anything that interferes with the tears will negatively impact the refractive ability of the eyes, as well as negatively impact the health of the eyes. For these reasons, we need to put increased attention on the quality and quantity of the tears when examining patients. But before we get to the examination, we need to make sure we have a pre-examination questionnaire history that will help us identify at-risk patients for dry eye.
Dry eye syndrome (and ocular surface disease) is going to increase with the aging of the second largest demographic (the Baby Boomers) in our population. Dry eye can occur at any age, but its incidence increases as people age. NIH reports that approximately 5 million Americans age 50 and older are estimated to have dry eye. Of this number, approximately 3 million are women (the incidence increases after menopause) and one half million are men. NIH states that “Tens of millions more have less severe symptoms.” This is a problem that deserves our attention.
NIH lists 16 causes of dry eye on its web site:
1) A side effect of some medications (e.g: antihistamines, nasal decongestants, tranquilizers, certain blood pressure medicines, Parkinson’s medications, birth control pills and anti-depressants)
2) Skin disease on or around the eyelids
3) Diseases of the glands in the eyelids (eg: meibomian gland dysfunction)
5) Hormone replacement therapy (eg: women taking only estrogen are 70 percent more likely to experience dry eye, whereas those taking estrogen and progesterone have a 30 percent increased risk of developing dry eye)
6) Can develop after LASIK (symptoms generally last 3-6 months, but may last longer in some cases)
7) Dry eye can result from chemical and thermal burns that scar the membrane lining the eyelids and covering the eye
9) Infrequent blinking, associated with staring at computer or video screens
10) Both excessive and insufficient dosages of vitamins
11) Homeopathic remedies
12) Loss of sensation in the cornea from long-term contact lens wear
13) Immune system disorders (e.g: Sjögren’s syndrome, lupus and rheumatoid arthritis)
14) Chronic inflammation of the conjunctiva or the lacrimal gland (chronic conjunctivitis can be caused by certain eye diseases, infection, exposure to irritants such as chemical fumes and tobacco smoke, or drafts from air conditioning or heating)
15) Increase in the surface area of the eye as in thyroid disease or after cosmetic surgery
16) Exposure keratitis during sleep
Does your pre-examination history questionnaire ask about the 16 causes of dry eye?
Also, look at your pre-examination history questionnaire and compare your symptoms section to the NIH web site list of dry eye symptoms. Does your history ask about…
• Stinging or burning of the eyes
• A sandy or gritty feeling as if something is in the eye
• Episodes of excess tears following very dry eye periods
• A stringy discharge from the eye
• Pain and redness of the eye
• Episodes of blurred vision
• Heavy eyelids
• Inability to cry when emotionally stressed
• Uncomfortable contact lenses
• Decreased tolerance of reading, working on the computer, or any activity that requires sustained visual attention
• Eye fatigue
Here are some dry eye history tools that are available on the internet that can help you:
• McMonnies Questionnaire
Here are a few videos that you might find helpful:
Don’t wait for patients to bring up the topic of dry eye. Take this week to review and update your pre-examination history resulting in at-risk patients getting care sooner rather than later.