Journal: Musings about why we don't "get" dry eye

While trying to chase bugs and a mini-abrasion off my brain this morning I was pondering once again some of the reasons why I think good dry eye care is such a scarce commodity.

Western medicine has this annoying way of looking at things in nice neat boxes for ease of use.

Are we looking at a person, or a pair of eyes? Ophthalmology seems to want to box up the eye and isolate it from the rest of the body. Yet most of dry eye is attributable to side effects of medications and surgeries; auto-immune disease; hormones; skin disease; eyelid mechanics; unfriendly home and office environments full of dried out air and allergens; and lousy diet.

Eye surfaces and a sophisticated lubricating system, or a tear film? Similarly, the cornea folks want to box up the tear film ("Three layers... not enough oil... add oil...") and/or the ocular surface ("Inflammation Is The Enemy...Must Fight Inflammation...")

What's missing?

Well, the rest of the body, for one. We pay lip service to it by pushing fish oil supplements, or going on allergy hunts, and under certain circumstances we test for Sjogrens, and we think we've done our duty and can return to the much more comfortable business of suppressing surface inflammation medically.

Then there's the complex interworkings of the tear system. This is increasingly evident in scientific findings - the ones that bother to look for the connections. (Mess with my MGs? Guess what - my mucus will suffer too. Mess with my nerve endings? You'll screw up my aqueous production. Mess with my aqueous? You'll screw up my MGs. And on and on.)

And then there's the question of what's happening on the infamous ocular surfaces themselves. You see what you look for, which raises many interesting questions of emphasis. For example, is the problem an inadequate or imbalanced tear film - or the surface state that occurs as a result, such as the "de-wetting" or whatever it is that's causing excessive pain? But again, that idea would take us out of the medical box into another area of science altogether. Sorry, no can do!

Ponder ponder ponder. Off to start the day now.