Dry eye triggers versus causes

I frequently hear people saying, or posting on DryEyeTalk, "XXX caused my dry eye."

Often, a review of their history gives even a layperson like me good reason to question whether what they are so sure of is actually correct. And even in some apparently black-and-white situations where dry eye symptoms are sudden and severe - commencing immediately after or during some identifiable event - reliably establishing cause and effect is not always that simple.

My personal belief (theory, I guess) is that in many cases, there are one or more underlying conditions - perhaps mild blepharitis/MGD, perhaps ocular allergies or rosacea, perhaps something else - but with no symptoms. Then, along comes a single traumatic event of some kind and punts you right over the edge into a fullflown severe dry eye episode. So as reasonable as it seems to blame the event that "started" it all... I think we're looking at the difference between a trigger and a cause.

Not that there's any simple straightforward line to be drawn between triggers and causes, of course. LASIK is both. And so are many of the things you'll see on the classic "Causes of dry eye" lists... surgeries, drugs, environmental factors and so on. But the point is that your "tipping point" is not necessary the beginning and the end of your dry eye story.

I was reminded of this today while speaking with a gentleman who traces his dry eye to paint exposure. From the story, it seemed compelling: No history of dry eye whatsoever, and almost immediately after a brief exposure to paint in the air he began having severe symptoms. And here he is four years later, still with dry eye (and incidentally unusually sensitive to paint). But while we were talking I happened to mention instances I know of where dry eye was attributable to mold attacking the meibomian glands. It turns out that this gentleman had had problems with mold in the house. Was that related? I have no idea. But could it be? Possibly.

Then of course there's all the people who have a drying drug or surgery... BUT did they already have bleph, rosacea, lagophthalmos, etc. beforehand?

So for those of you whose doctors seem skeptical of your claims, please don't forget that there could be a decent reason for their skepticism. Unfortunately, dry eye patients have a rough time because of the lack of validation of the life impact of their symptoms. As a result there is a tendency to take things personally and even to lump a doctor's resistance to one's claims about causation in that same "He/she does not get it!" category. Step back and put yourself in their shoes. Dry eye is a complex, usually multifactorial disease and sorting out causes can take some serious detective work.

On the other hand, if you're doing your best to be a good open-minded compliant patient and your doctor is simply not up to the task - is not willing to be a detective in the cause of helping you get some relief - don't waste your time. Move on.

Another Omega 3 player joins the crowd

Just letting you know there's yet another company trying to cash in on the dry eye omega 3 craze.

Dry Eye Omega Benefits from LifeGuard Health LLC

Fifty bucks for a two-month supply puts it right in the neighborhood of the other proprietary dry eye supplements (most of which run $20 to $30 ish per month). Personally I'll stick with my Barleans oils - I spend $10 or less a month and still get top quality. If I feel like splurging I'll get a couple bottles of the high epa/dha fish oil.

If somebody out there with SEVERE dry eye sees a massive difference from any supplement, please let me know. Oh yes and please make sure you've been taking it for a considerable period, have made no changes whatsoever to your eyecare regimen during that time, and have not experienced any other significant changes such as allergies, new job, etc.

I'm not pooh-poohing Omega 3s. I love them, I think they are vital for general health, and I faithfully stir my cinnamon Barlenas into yoghurt each morning with some berries (yum). But they sure aren't a cureall for dry eye.

Abstract: Antibiotic toxicity

So in test tubes, topical antibiotics showed some toxicity, especially Vigamox. It will be interesting to see what happens when they do some in vivo testing.

Evaluation of toxicity of commercial ophthalmic fluoroquinolone antibiotics as assessed on immortalized corneal and conjunctival epithelial cells.
Cornea. 2008 Sep;27(8):930-4.
Sosa AB, Epstein SP, Asbell PA.

PURPOSE: To evaluate the toxicity of a variety of the fluoroquinolone antibiotics on the ocular surface by using tissue culture models of corneal epithelial cells and conjunctival epithelial cells.

METHODS: Immortalized conjunctival (CCC) and human corneal (HCE) epithelial cells were grown and when confluent the cells allowed to air dry for 1 hour. Medium was then replaced with 100 microL of one of the following: 1) Vigamox [moxifloxacin (0.5%: MX)]; (2) Zymar [gatifloxacin (0.3%: GA)]; 3) Quixin [levofloxacin (0.5%: LE)]; 4) Ocuflox [ofloxacin (0.3%: OF)]; 5) Ciloxan [ciprofloxacin (0.3%: CP)]; 6) medium (viable control); 7) "normal"/physiologic saline; 8) formalin (dead control). After one hour, 150 microL of MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazonium bromide was added and incubated for 4 hours. After decanting, precipitate was dissolved in 150 microL of isopropanol. Absorbance was determined at 572 nm.

RESULTS: The lowest amount of cell death was associated with the viable control. All ophthalmic preparations showed both corneal and conjunctival cell toxicity. Aside from the viable control, normal saline showed the next lowest amount of toxicity. Of the topical ocular antibiotics tested, MX showed the least amount of toxicity. All of the other antibiotics tested were statistically indistinguishable from each other.

CONCLUSIONS: All of the topical ocular antibiotics tested showed evidence of both corneal and conjunctival toxicity (MX < OF < or = LE < or = CP < or = GA), although only MX was statistically significant. Whether this finding reflects on in vivo wound healing remains to be determined. This model provides a rapid and cost-effective method to screen for surface toxicity of topical agents.

Abstract: Preventing dry eye from some cancer treatments

Prevention of radiochemotherapy-induced toxicity with amifostine in patients with malignant orbital tumors involving the lacrimal gland: a pilot study.
Radiat Oncol. 2008 Sep 1;3(1):22.
Goldblum D, Ghadjar P, Curschmann J, Greiner R, Aebersold D.

ABSTRACT: BACKGROUND: To use amifostine concurrently with radiochemotherapy (CT-RT) or radiotherapy (RT) alone in order to prevent dry eye syndrome in patients with malignancies located in the fronto-orbital region.

METHODS: Five patients (2 males, 3 females) with diagnosed malignancies (Non-Hodgkin B-cell Lymphoma, neuroendocrine carcinoma) involving the lacrimal gland, in which either combined CT-RT or local RT were indicated, were prophylactically treated with amifostine (500mg sc). Single RT fraction dose, total dose and treatment duration were individually adjusted to the patient's need. Acute and late adverse effects were recorded using the RTOG score. Subjective and objective dry eye assessment was performed for the post-treatment control of lacrimal gland function.

RESULTS: All patients have completed CT-RT or RT as indicated. The median total duration of RT was 29 days (range, 23 - 39 days) and the median total RT dose was 40 Gy (range, 36 - 60 Gy). Median lacrimal gland exposure was 35.9 Gy (range, 16.8 - 42.6 Gy). Very good partial or complete tumor remission was achieved in all patients. The treatment was well tolerated without major toxic reactions. Post-treatment control did not reveal in any patient either subjective or objective signs of a dry eye syndrome. CONCLUSIONS: The addition of Amifostine to RT/CT-RT of patients with tumors localized in orbital region was found to be associated with absence of dry eye syndrome.

Abstract: Chlamydia infection and dry eye

Discussing possible link between conjunctival chlamydia infection and dry eye.

Vestn Oftalmol. 2008 Jul-Aug;124(4):16-9.
[To the role of Chlamydia infection in the development of dry eye]
[Article in Russian / No authors listed]

The study deals with the possible etiological role of Chlamydia, Mycoplasma, Ureaplasma, and bacteroid infections in the development of chronic conjunctivitis and dry eye (DE). A hundred and fifty patients with DE and chronic conjunctivitis were examined. Conjunctival scrapes were examined by direct immunofluorescence for evidence of Chlamydia, Mycoplasma, Ureaplasma, and bacteroid infections. DE was verified by the Schirmer test and the Norn test. Ninety-five (63.3%) persons were found to be infected. GE was diagnosed in 84 (56%) of the 150 patients. Analysis of infection rates revealed Chlamydia, Mycoplasma, Ureaplasma as mono- and mixed infection in 63.3, 50.6, and 35.3, respectively, and bacteroids as mixed infection in 32.6%. Chlamydia was detected in the conjunctiva in the vast majority of patients with DE (90.5%). Chlamydia infection of the conjunctiva is one of the causes of artificial DE. Conjunctival Chlamydia affliction is manifested by the clinical picture of chronic slowly progressive inflammation with the progression of DE after a latent period of about 2-3 years.

Abstract: Silicone plug aftermath

Only 17 eyes so I'm not personally inclined to take the stenosis bits as gospel truth. But the overall message seems to be that "silicone punctal plugs are good", i.e. reliably improving symptoms and not causing complications (other than spontaneously falling out sometimes). I sure won't argue with that. Probably everyone here knows how I feel about intracanalicular plug risks.

Long-term Follow-up of Punctal and Proximal Canalicular Stenoses After Silicone Punctal Plug Treatment in Dry Eye Patients.
Am J Ophthalmol. 2008 Aug 22.
Boldin I, Klein A, Haller-Schober EM, Horwath-Winter J.

PURPOSE: To determine the clinical value and relevance of punctal and proximal canalicular stenoses after punctal plug therapy in moderate to severe dry eye syndrome. DESIGN: Retrospective, observational case series.

METHODS: Seventeen eyes were determined to have punctum or proximal canalicular stenoses after spontaneous loss of a collared silicone punctal plug. After initial diagnosis all patients had 12 months or more of follow-up (mean, 39; range, 12 to 87 months). The clinical data collected included gender and age of patients, localization of the stenosis, plug size, duration of punctal occlusion, subjective symptoms, objective ocular surface disease parameters, and occurrence of complications.

RESULTS: A statistically significant correlation between localization of the stenosis and plug size, and localization of the stenosis and duration of punctal occlusion could not be found. At follow-up, subjective symptoms (P < .01) and frequency of artificial tear application (P < .001) were significantly reduced compared to data before plug insertion. Schirmer I test results (P < .001), corneal fluorescein staining (P < .01), and rose bengal staining (P < .001) improved significantly, whereas tear break-up time (P < .2) and impression cytology scores of the conjunctival surface (P = .2) remained almost unchanged. Complications could not be found.

CONCLUSION: Within the observation period of up to seven years, all stenoses remained asymptomatic. Additionally, subjective symptoms and most dry eye parameters in our study population improved.

Abstract: Dry eye among Japanese high school students

THESE ARE ABSOLUTELY MIND-BOGGLING NUMBERS.

Very worrying. I sure would like to see a study like this done on high school students the US! I have worried for quite some time about the twenty-somethings and even teenagers on DryEyeTalk who have no obvious disease or dry eye cause. We really need better education of youngsters on eyecare so that at least they can be forewarned about things that could make this worse, such as abusing contact lenses or using vasoconstrictors frequently.

Japan Ministry of Health Study on Prevalence of Dry Eye Disease Among Japanese High School Students.
Am J Ophthalmol. 2008 Aug 22.
Uchino M, Dogru M, Uchino Y, Fukagawa K, Shimmura S, Takebayashi T, Schaumberg DA, Tsubota K.

PURPOSE: To determine the prevalence of dry eye disease and contact lens (CL) use among Japanese private high school students.

DESIGN: Cross-sectional prevalence survey. METHODS: We carried out a cross-sectional survey in 3,433 Japanese high school students who completed questionnaires designed to ascertain a prior diagnosis of dry eye disease and current symptoms of dry eye disease, as well as information on CL use and type of CL. We used logistic regression analysis to examine the associations between dry eye disease and CL use.

RESULTS: Of the 3,443 high school students, 3,433 (100%) completed the questionnaires. A total of 2,848 boys and 585 girls joined and the age range was from 15 to 18 years. Clinically diagnosed dry eye disease was present in 123 boys (4.3%) and 47 girls (8.0%). Severe symptoms of dry eye disease were observed in 599 subjects in boys (21.0%) and 143 in girls (24.4%). Soft contact lens (SCL) and hard contact lens (HCL) use was 36.1% and 1.7%, respectively.

CONCLUSION: Dry eye disease leading to a clinical diagnosis or severe symptoms is prevalent in the studied Japanese private high school students. The condition is more prevalent among female subjects and CL wearers. Relevant measures directed against these risks could provide a positive impact on public health and quality of life of high school students.

Abstract: New diagnostic for examining the lipid layer

Doesn't sound like the quickest & easiest clinical test I've ever heard of, but it does sound interesting. Anything to add to TBUT results could be a good thing.

New test to quantify lipid layer behavior in healthy subjects and patients with keratoconjunctivitis sicca.
Cornea. 2008 Sep;27(8):866-70. Links
Rolando M, Valente C, Barabino S.

PURPOSE: Diagnostic procedures currently available to evaluate tear film lipid layer alterations are of limited application and do not provide quantitative results. The purpose of this prospective, case-control study was to develop a noninvasive test to measure tear lipid behavior in healthy subjects and patients with dry eye.

METHODS: The dynamic lipid layer interference patterns (DLIP) test was performed on 21 patients with dry eye and 21 age-matched controls. Subjects in the study and control groups were asked to perform 5 forced blinks and 10 consecutive nonforced blinks every 2 seconds to load lipids from the palpebral reservoir into the tear film. After recording the lipid layer interference patterns obtained with the Tearscope, a masked investigator counted the number of blinks to observe significant changes of shape, position, and number of waves of the interference patterns. Patients with dry eye were identified on the basis of the typical symptoms measured by a validated questionnaire (Ocular Surface Disease Index questionnaire score >10), Schirmer I test scores <10 mm/5 min, tear breakup time (TBUT) <7 seconds, and lissamine green conjunctival staining >4.

RESULTS: Significant differences in Schirmer test, TBUT, and lissamine green were recorded between groups. The DLIP test in the dry eye group (2.4 +/- 3.1 blinks) was statistically decreased compared with the control group (18.1 +/- 5.9 blinks; P < 0.0001, t test). A significant Pearson correlation (r = 0.788) was found between the DLIP test and TBUT. The receiver operating characteristic curve defined a cutoff value of 6.5 blinks to separate healthy from dry eyes (sensitivity of 100%, specificity of 95%).

CONCLUSIONS: The DLIP is a new test that can be used in clinical practice to quantify tear film lipid layer behavior and to diagnose dry eye.

Abstract: Doxy drops and epithelial cell loss

For those of you following developments of doxycycline drops, here's a new study examining the effects of dessicating stress in mice and the ability of doxy drops to mitigate the damage.

Desiccating stress decreases apical corneal epithelial cell size--modulation by the metalloproteinase inhibitor doxycycline.
Cornea. 2008 Sep;27(8):935-40.
Beardsley RM, De Paiva CS, Power DF, Pflugfelder SC.

PURPOSE: We investigated the effects of desiccating stress on murine corneal apical epithelial cell area and desquamation by using 4 defined parameters and evaluated the effects of the metalloproteinase inhibitor doxycycline on this process.

METHODS: C57BL/6 mice were subjected to experimental dry eye (EDE) for 5 days without or with topical therapy with doxycycline 0.025% or 0.0025% or vehicle 4 times a day. C57BL/6 mice that were not exposed to desiccating stress served as controls. Whole mount corneas from each group were immunostained for occludin and visualized by laser scanning confocal microscopy. The images were analyzed in a masked fashion, and mean individual cell area, apical cell density, average cell number loss, and average percent loss were recorded.

RESULTS: EDE caused a significant decrease in apical corneal cell area (1073 +/- 135.9 microm2), an increase in apical cell density (895.8 +/- 115.4 cells per mm2) and a greater percent of epithelial loss (21.29% +/- 13.40%) than controls (1341 +/- 95.28 microm2, 714.4 +/- 55.60 cells per mm2, 2.897% +/- 3.452%, P < 0.001 for all, respectively). Treatment with 0.025% doxycycline preserved cell area (1337 +/- 144.6 microm2) and the apical cell density (721.0 +/- 91.62 cells per mm2) and decreased percentage loss (5.117% +/- 6.757%) compared with the vehicle control group (1154 +/- 88.10 microm2, 830.2 +/- 49.76 cells per mm2, 22.14 +/- 9.616%, P < 0.001 for all, respectively).

CONCLUSIONS: Desiccating stress decreases apical corneal epithelial cell area, increases apical cell density, and promotes epithelial cell loss. Treatment with the metalloproteinase inhibitor doxycycline during desiccating stress preserves cell area and apical cell density and prevents EDE-induced corneal epithelial cell loss. These findings suggest that metalloproteinases mediate apical corneal epithelial loss during desiccating stress.

Dry Eye Shop news

Seems like the blog has slimmed down into simply Medline searches and summaries... boring for you and me both! I'll see what I can do to spice things up a bit.

First, a shameless plug for my business. If you get my weekly bulletins you probably are aware of all these things but for those of you who don't like email spam, here's some of the most recent updates to the Shop:

Tranquileyes Economy Buster Prepack ($35)
This is a limited-time offer from Eye Eco... for $35, a moisture goggle and 6 pairs of replacement foam. The catch? The foam is less fancy and less durable than the standard foam, but it still works fine and is comfortable, and it makes this pack the best Tranquileyes deal going, for those who want to try out this night protection system at a lower price than the usual $49 or $65 kits.

New 7Eye BALI
Excellent new frame from 7Eye... very nice fit and styling.

New Wiley-X Products
Wiley-X has two new sunglasses frames in their Climate-Control foam-lined series, the Airborne and the Jake. I like the Airborne especially, in the rootbeer color... very nice. Like the others, the baseline lens is $80, light-adjusting is $135 and polarized is $130.
Also, we now have the spare eyecups available for all 7 Wiley-X models, for $15.

Scleral contact lens cases ($12.50)
Specially designed for Boston Foundation for Sight. Suitable for all scleral lenses.

Scleral contact lens case/kit ($19.34)
A scleral lens case, an inserter, a remover, and a padded soft carrying case that fits all these plus your lubricating drops. 15% discount off the price of these items purchased separately.

7Eye SPF100 Brochure
Wiley-X Climate Control Brochure
If you want to learn more about foam-lined eyewear, with some great pix, add brochures to your next DryEyeShop order.

Live chat!

If you are browsing the shop and have a question... check the livechat window (bottom right, under the shopping cart) in case we're online. If not use that same screen to send an email - you never know, we may respond even if it's after hours.

Public comments to the FDA re: LASIK redacted

According to Dickenson's FDA Review (this is subscription only but you can get a free trial subscription at fdaweb.com if you want to read the entire article - it's dated 8/26/2008):

Once labeled one of the most secretive government agencies for consumers, FDA seems to continue to shoot itself in the foot on the “transparency” front. Notwithstanding a regulation at a regulation at 21 CFR 20.103 that says all public comments received by the agency are available for public disclosure, the agency has taken the unprecedented action of redacting the names, affiliations/locations and apparently random slabs of text from all but two of the 246 public comments it received after the 4/25 meeting of its Ophthalmic Devices Panel on LASIK safety.

Why? In an effort to find out, FDA Webview asked panel executive secretary Karen Warburton. She did not respond to two emails. We next asked acting Office of Public Affairs head Judy Leon, who replied: “Since your question deals with FOI process your best bet is to redirect your question to the Freedom of Information office.” So we asked FOI Division director Frederick J. Sadler, who also did not respond.

In addition to redacting all but two commenters’ names, affiliations and addresses, FDA also redacted device names and LASIK surgeons’ names and affiliations from the text of comments, as well as seemingly arbitrary other words and phrases....

For those of you who sent comments to the FDA for that meeting: If you wished and expected that your comments would be published in full, I recommend you contact the FDA and perhaps your congressperson about this.

Abstract: Systane

Varying the pace, a Romanian infomercial :)

[Assessment of systane in severe dry eye]
Oftalmologia. 2008;52(1):105-10.
[Article in Romanian]

Mocanu C, Bărăscu D, Bîrjovanu F, Mănescu R, Iliuşi F.
Clinica de Oftalmologie Craiova.

The study proposes the evaluation of the Systane effect on people that have severe dry eye sensation, with cornea or conjunctive complications. In order to do this, a study protocol has been adopted which meant comparing the values of lacrimal film break-up time, before and after Systane treatment, comparing cornea and conjunctive staining, comparing the crystalization test before and after treatment, comparing the conjunctival impression before and after treatment, and the general acceptability of Systane. The study results have shown that in severe dry eye cases, Systane increases lacrimal film break-up time by 2-3 seconds than the initial value, as well as considerable reduction in corneanl/conjunctival staining and in conjunctival hyperemia in Sicca keratoconjunctivitis. After treatment, conjunctival impression have shown the proliferation of conjunctival and goblet cells, with normal morphologic aspect of the new-formed cells. In every case, the regenerating effect on epithelia of Systane was obvious, which is determined by the direct action of the HP-guar, forming a protective layer with lubricative effect, helpful to the initiation of tisular repairing processes.

Abstract: Dry eye as an occupational hazard

Doesn't look too sophisticated but it would be very interesting to see a more in depth study of this type - not just for airline personnel, either.

[Is dry eye syndrome a profesional disease for aeronautical personnel?]
Oftalmologia. 2008;52(1):100-4.
[Article in Romanian]
Nicodin A, Macri M.

The purpose of this study is to analyze the eye comfort of the aeronautical personnel. This study has been conducted in ophthalmologic office of the National Institute of Aeronautical and Space Medicine, for 68 patients (group 1), men and women, active aeronautical personnel, between 35-55 years old, apparently ophthalmologically normal subjects. First the patients were subjected to a questionnaire that was meant to provide the subjective evaluation as such included: biomicroscopy, fluorescein stain, tear break up time (BUT), Schirmer tear test. There have been found subclinical, mild and moderate dry eye; tear substitutes have been prescribed. The patients were checked up each 3 months, for a period of 9 months. Results were compared with those obtained from a control group--20 people (group 2), women and men, with ages in the same range, people not involved in the aviation field who requested ophthalmological examination for optical correction. The results raise the question: can the "Dry eye syndrome" be considered a work-related disease? The answer will be "probably no" indulging oneself conditions required by International Aeronautical Authority (ex. periodically hydration and enough in volume), even if categorically environment element--conditions inside the aircraft can produce this disorder. During the flight the aeronautical personnel should use tear substitutes, because of the low humidity of the air inside the craft.

Abstract: More on indoor environment and dry eye

Atopy, symptoms and indoor environmental perceptions, tear film stability, nasal patency and lavage biomarkers in university staff.Int Arch Occup Environ Health. 2008 Jul;81(7):861-72. Epub 2007 Dec 8.
Bakke JV, Wieslander G, Norbäck D, Moen BE.

OBJECTIVE: Study associations between airway symptoms, complaints on environmental perceptions, atopy definitions and biomarkers including tear film stability (BUT), nasal patency and nasal lavage (NAL). Personal predictors (gender, age, smoking, infections) for the biomarkers as well as associations between the biomarkers were also assessed.

METHODS: A cross-sectional study of 173 employees in four university buildings, response rate 86%. Tear film break up time (BUT) was measured by a non-invasive method (NIBUT) and self-reported (SBUT). NAL-analysis included eosinophilic cationic protein (ECP), myeloperoxidase (MPO), lysozyme and albumin. Total serum IgE, and specific IgE using Phadiatop was measured. Data on subjective symptoms, environmental perceptions and background data were collected by use of a questionnaire. Multiple regression analyses were applied.

RESULTS: Mean age was 43 years, 21% had weekly ocular, 21% nasal, and 17% laryngeal symptoms. Women had more complaints on environmental perceptions, shorter BUT and less nasal patency. Neither atopy (Phadiatop) nor Total IgE or allergy in the family, but asthma and hay fever was associated with mucosal symptoms or perceptions. Subjects with positive Phadiatop had higher levels of all NAL-biomarkers. Those with ocular symptoms had shorter BUT. Nasal symptoms were related to respiratory infections and laryngeal symptoms to NAL-lysozyme. Perceiving dry air was associated with lower BUT and reduced nasal volume difference before and after decongestion. Older subjects had greater nasal patency, and less atopy. All NAL-biomarkers were positively correlated. Higher lysozyme level was associated with less nasal patency and greater nasal decongestion.

CONCLUSIONS: BUT and NAL-lysozyme was associated with ocular, nasal, laryngeal symptoms and indoor environmental perceptions. Ever having had asthma and ever having had hay fever were predictors for symptoms and perceived air quality, respectively. Phadiatop, Total IgE, familiar allergy and ever eczema were not associated to symptoms or perceived environments. Age, gender and Phadiatop were main predictors for ocular and nasal biomarkers.

Abstract: Computer use & dry eye

Don't think I need to bother commenting on this... it's nothing we don't all already know, sigh, but human resources departments need to see things like this so they will be more willing to accommodate special requirements and work on making a more eye friendly office environment.

Prevalence of Dry Eye Disease among Japanese Visual Display Terminal Users.
Ophthalmology. 2008 Aug 15. [Epub ahead of print]Uchino M, Schaumberg DA, Dogru M, Uchino Y, Fukagawa K, Shimmura S, Satoh T, Takebayashi T, Tsubota K.

OBJECTIVE: To determine the prevalence of dry eye disease (DED) and risk factors among young and middle-aged Japanese office workers using visual display terminals (VDTs).

DESIGN: Cross-sectional prevalence survey.

PARTICIPANTS: Four thousand three hundred ninety-three Japanese young and middle-aged office workers using VDTs.

INTERVENTION: Office workers completed questionnaires sent by e-mail designed to detect dry eye diagnosis and risk factors.

MAIN OUTCOME MEASURES: Clinically diagnosed DED was defined as the presence of a previous clinical diagnosis of DED by dry eye specialists or severe symptoms of DED (both dryness and irritation constantly or often). Current symptoms of DED and possible risk factors such as age, duration of VDT use, type of VDT work, environmental factors, presence of systemic diseases, systemic medicine use, smoking history, and contact lens (CL) use were the main outcome measures. We used logistic regression to examine associations between DED and other demographic factors.

RESULTS: Of the 4393 office workers, 3549 (80.1%) completed the questionnaire. Clinically diagnosed DED was present in 266 (10.1%) of 2640 male subjects and in 195 (21.5%) of 909 female subjects. Severe symptoms of DED were observed in 711 male and in 436 female participants. More than 4 hours of VDT use was associated with an increased risk of DED (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.40-2.02). In addition, CL use (OR, 3.91; 95% CI, 3.37-4.53) increased the risk of severe dry eye symptoms.

CONCLUSIONS: Dry eye disease leading to a clinical diagnosis or severe symptoms is prevalent among young and middle-aged Japanese office workers. The condition is more prevalent among females, CL wearers, and prolonged VDT users. Relevant measures directed against the modifiable risks could provide a positive impact on public health and quality of life of office workers. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.